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187952 07/21/2010 CITY OF CARMEL, INDIANA VENDOR: 204038 Page 1 of 1 ONE CIVIC SQUARE MIDWEST TOXICOLOGY SVS,INC CARMEL, INDIANA 46032 603 E WASHINGTON ST SUITE 200 CHECK AMOUNT: $1,458.00 INDIANAPOLIS IN 46204 CHECK NUMBER: 187952 CHECK DATE: 7/21/2010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1201 4358800 209035 55.00 TESTING FEES 1201 4358800 209685 1,018.00 TESTING FEES 1201 4358800 209811 275.00 TESTING FEES 1201 4358800 210019 55.00 TESTING FEES 1201 4358800 210077 55.00 TESTING FEES Midwest 7oxicotogy I n voice DATE INVOICE 603 East Washington Street, Suite 200, Indianapolis, IN 46204 6/30/2010 209035 ,BILL TO: SHIP TO: City of Carmel dames location of collection Attn: Jim Spelbring on invoices no ss 1 Civic Square Email results to Barb Lamb cc Jim Carmel, IN 46032 Still Mail results to Jim CLZ CONTROL P.O. NUMBER JOB SITE TERMS FACILITY 5528 Due on receipt 142376 ITEM CODE QTY DESCRIPTION PRICE EACH AMOUNT ND Drug Test CS 1 Non -DOT Drug Test 55.00 55.00 Collected at Community Occupational Health Center Carmel 06/28/10 Richard Alvarez 7025 D Q JJL 19 2010 By A finance charge will be assessed on all invoices not paid in 30 days. thank you for your business. For the purpose of client confidentiality we are no longer showing the full SSN on invoices. Total $55.00 Make Checks Payable To: MIDWEST TOXICOLOGY SERVICES, INC. For questions regarding this in voice, contact us at 317- 262 -2200 or fax- us at 317 -262 -2222. Be sure to visit our website at www.in dwesttoxicology.com. Midwest 7oXicofogy Invo Services, .Inc. OvQ DATE INVOICE 603 East Washington Street, Suite 200, Indianapolis, IN 46204 7/14/2010 210019 BILL TO: SHIP TO: City of Carmel Names location of collection Attn: Jim Spelbring on invoices no ss #!1 1 Civic Square Email results to Barb Lamb cc Jinn Carmel, IN 46032 Still Mail results to Jim CLz CONTROL P.O. NUMBER JOB SITE TERMS FACILITY 5528 Due on receipt 142376 ITEM CODE QTY DESCRIPTION PRICE EACH AMOUNT ND Drug Test CS 1 Non -DOT Drug Test 55.00 55.00 Collected at Community Occupational Health Center Carmel 07/12/10 Orbie Bowles D Q JUL 19 2010 By A finance charge will be assessed on ali invoices not paid in 30 days. Thank you for your business. Thank you for your business! I Tota $55.00 Make Checks Payable To: MIDWEST TOXICOLOGY SERVICES, INC. For questions regarding this in voice, contact us at 317- 262 -2200 or fax us at 317- 262 -2222. Be sure to visit our wehsite at www.ntidwesttoxicology.cottt. 3fidwest Ta#cofogy Invoi Services, Inc. DATE INVOICE 603 East Washington Street, Suite 200, Indianapolis, IN 46204 7/15/2010 210077 .BILL TO: SHIP TO: City of Carmel Names location of collection Attn: Jim Spelbring on invoices no ss 1 Civic Square Email results to Barb Lamb cc Jim Carmel, IN 46032 Still Mail results to Jim Ctz CONTROL P.O. NUMBER JOB SITE TERMS FACILITY 5528 Due on receipt 142376 ITEM CODE QTY DESCRIPTION PRICE EACH AMOUNT ND Drug Test CS 1 Non -DOT Drug Test 55.00 55.00 Collected at Community Occupational Health Center Carmel 07/12/10 Mark Paris D JUL 1.9 2010 By A finance charge will be assessed on all invoices notpaid in 30 days. Thank you for your business. Thank you for your business! Total $55.00 Make Checks Payable To: MIDWEST TOXICOLOCV SERVICES, INC. For questions regarding this invoice, contact us at 317 -262 -2200 or fax us at 317 -262 -2222. Be sure to visit our website at wiviv. nudwesttoxicologp.coin. Midwest To.#cotogy In vo i c e o i� DATE INVOICE 603 East Washington Street, Suite 200, Indianapolis, IN 46204 7/12/2010 209811 BILL TO: SHIP TO: City of Carmel Names location of collection Attn: Jim Spelbring on invoices no ss#!! Email results to Barb Lamb cc Jim 1 Civic Square Carmel, IN 46032 Still Mail results to Jim AA CONTROL P.O. NUMBER JOB SITE TERMS FACILITY 5528 Due on receipt 142376 ITEM CODE QTY DESCRIPTION PRICE EACH AMOUNT DOT Test CS NC 1 DOT Drug Test 55.00 55.00 Collected at Community Occ. Health Center Carmel 7/08110 Randall Johnson ND Drug Test CS 4 Non -DOT Drug Test 55.00 220.00 Collected at Community Occ. Health Center Carmel 7108110 Sarah E. Harris 7109110 Jeffrey W. Laker Rebecca S.Lannan Troy Smith L r---" LJ JUL 19 2010 By A finance charge will be assessed on all invoices not paid in 30 days. Thank you for your business. Thank you for your business! Total $275.00 Make Checks Payable To: MIDWEST TOXICOLOGY SERVICES, INC. For questions regarding this invoice, contact us at 317- 262 -2200 or fax us at 317 262 -2222. Be sure to visit our website at www.midwesttoxicology.com. Midwest Taricofogy Invoic offi DATE INVOICE 603 East Washington Street, Suite 200, Indianapolis, IN 46204 7/9/2010 209685 .BILL TO: SHIP TO: City of Carmel Names location of collection Attn: Jim Spelbring on invoices no ss 1 Civic Square Email results to Barb Lamb cc Jim Carmel, IN 46032 Still Mail results to Jim KK CONTROL P.Q. NUMBER JOB SITE TERMS FACILITY 5528 Due on receipt 142376 ITEM CODE QTY DESCRIPTION PRICE EACH AMOUNT DOT Test OS 1 DOT Drug Test 55.00 55.00 Collected Onsite 717/10 Harold Oliver Utilities DOT Alcohol OS 1 DOT Breath Alcohol Test 28.00 28.00 Collected Onsite 7/7/10 Harold Oliver Utilities ND Drug Test OS 17 Non -DOT Drug Test 55.00 935.00 Collected Onsite 7/6/10 John Jokantas CCCC James Buttler Fire Jared Kinney Fire Tony Keaton Fire R. Dean Paddock Fire Steven Edwards Fire 7171 Brian Tolan Utilities Mark Bailey Fire Shawn Reynolds Fire William Wolfe Utilities z Frank Vallone Fire Jeffrey Capshaw Fire JUL 1. 9 2010 Steven Frye Fire Teresa Anderson Police Jonathan Foster Police B Tara Washington Random William Akers CCCC A finance charge will be assessed on all invoices not paid in 30 days. Thank you for your business. Thank you for your business! Total $1,018.00 Make Checks Payable To: MIDWEST TOXACOLOCY SERVICES, INC. For questions regarding this invoice, contact us at 317 -262 -2200 or fax us at 317 -262 -2222. Be sure to visit our wehsite at ivwrv.midwestioxicologj,.com. VO NO. WARRANT NO. ALLOWED 20 Midwrest Toxicology IN SUM OF 603 East Washington Street, Suite 200 Indianapolis, IN 46204 -1 1 4-5 ON ACCOUNT OF APPROPRIATION FOR Carmel HR Department PO# Dept. INVOICE NO, ACCT /TITLE AMOUNT Board Members 1201 209035 43- 588.00 $55.00 1 hereby certify that the attached invoice(s), or 1201 209685 43- 588.00 $1,018.00 bill(s) is (are) true and correct and that the 1201 I 209811 43- 588.00 $275.00 I materials or services itemized thereon for which charge is made were ordered and received except Friday, July 16, 2010 r Director, HR Title Cost distribution ledger classification if claim paid motor vehicle highway fund Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc. Payee Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 06/30/10 209035 $55.00 07/09/10 209685 $1,018.00 07/12/10 I 209811 I I $275.00 1 hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance with IC 5- 11- 10 -1.6 20 Clerk- Treasurer