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188436 08/03/2010 CITY OF CARMEL, INDIANA VENDOR: 204038 Page 1 of 1 ONE CIVIC SQUARE MIDWEST TOXICOLOGY SVS,INC CHECK AMOUNT: $1,322.00 CARMEL, INDIANA 46032 603 E WASHINGTON ST SUITE 200 INDIANAPOLIS IN 46204 CHECK NUMBER: 188436 CHECK DATE: 8/3/2010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1201 4358800 210104 220.00 TESTING FEES 1201 4358800 210108 717.00 TESTING FEES 1201 4358800 210172 55.00 TESTING FEES 4358800 210245 165.00 TESTING FEES 1201 4358800 210479 110.00 TESTING FEES 1201 4358800 211027 55.00 TESTING FEES Midwest TwCicofogy Invoi o DATE INVOICE 603 East Washington Street, Suite 200, Indianapolis, IN 46204 7/15/2010 210108 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.O. NUMBER JOB SITE TERMS FACILITY 5528 Due on receipt 142376 ITEM CODE QTY DESCRIPTION PRICE EACH AMOUNT DOT Test OS 7 DOT Drug Test 55.00 385.00 Collected Onsite 7/8/10 Michael Williamson Street James Bentley Street Shaun Privet Street Lee Higginbotham Street Scott Townsend Street Richard Walden Street Fred Martz Street DOT Alcohol OS 4 DOT Breath Alcohol Test 28.00 112.00 Collected Onsite 7/8/10 Michael Williamson Street Richard Walden Street Randall Johnson Street Fred Martz Street ND Drug Test OS 4 Non -DOT Drug Test 55.00 220.00 Collected Onsite 7/8/10 Anthony Baskerviile Fire Joseph Love Fire D L//ZX Christopher Walker Fire Brent Liggett Docs AUG 0 2 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 $717.00 Make Checks Payable To: MIDWEST TOXICOLOGY SERVICES, INC. For questions regarding this invoice, contact us at 3.17- 262 -2200 or fax us at 317- 262 -2222. Be sure to visit our website at rvww.midrvestto.vicologv.com. Midwest Toxicology In voi ce o a w� DATE INVOICE 603 East. Washington Street, Suite 200, Indianapolis, IN 46104 7/16/2010 210245 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 CLz CONTROL P.O. NUMBER JOB SITE TERMS FACILITY 5528 Due on receipt 142376 ITEM CODE QTY DESCRIPTION PRICE EACH AMOUNT DOT Test 1 DOT Drug Test 55.00 55.00 Collected at Med Check Carmel 07/14/10 Stephen Jones Igo. ND Drug Test CS 'yk Non -DOT Drug Test 55.00 Z Collected at Community Occupational Health Carmel 07/14/10 Kurtis Baumgartner Michael Turner David Heinzman D Q AUG 0 2 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 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 7oxicofogy Invoi DATE INVOICE 603 East Washington Street, Suite 200, Indianapolis, IN 46204 1 7/15/2010 210104 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 CLz CONTROL P.O. NUMBER JOB SITE TERMS FACILITY 5528 Due on receipt 142376 ITEM CODE QTY DESCRIPTION PRICE EACH AMOUNT DOT Test 2 DOT Drug Test 55.00 110.00 Collected at Community Occupational Health Center Carmel 07/12/10 Kevin Smith Terry Killen ND Drug Test CS 2 Non -DOT Drug Test 55.00 110.00 Collected at Community Occupational Health Center Carmel 07/12/10 Brian Schmidt Lavernezetta Moore D M i 0 2 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 $220.00 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 wwm midwesttoxicology. coin. Midwest 7o ricology Invo ,Services, .Inc. Q DATE INVOICE 7/16/2010 210172 603 East Washington Street, Suite 200, Indianapolis, IN 46204 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 461032 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 07/14/10 Mark Bailey D AU6022010 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 $55.00 Make Checks Payable To: MIDWEST TOXICOLOGY SERVICES, INC. For questions regarding this invoice, contact us at 377 -262 -2200 or fax us at 377 -262 -2222. Be sure to visit our website at rvwtv.ntidwesttoxicology.com. Midwest 7oXicofogy Invo Inc. O��D�' Services, DATE INVOICE 603 East Washington Street, Suite 200, Indianapolis, IN 46204 7/21/2010 210479 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 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 2 Non -DOT Drug Test 55.00 110.00 Collected at Community Occupational Health Carmel 07/19/10 Wendell Howard Jace Platt AUG 02 �iJ By A finance charge will be assessed on at] invoices not paid in 30 days. Thank you for your business. Thank you for your business! Total $110.00 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.niidwesttoxicologp.cow. 914zdwesr: Toxicolo In voice ,Serr�xces, Inc. QOA DATE INVOICE 7/27/2010 211027 603 East Washington Street, Suite 200, Indianapolis, IN 46204 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 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 07/22/10 Christopher Ellison IJ F AUK 0 2 2010 By A finance charge will be assessed on ail invoices not paid in 30 days. Thank you for your business. Thank you for your business! Total $55.00 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 websile at wwN ntidwesttoxicologj,-.cont. VOUCHER NO, WARRANT NO. ALLOWED 20 Midwest Toxicology IN SUM OF 603 East Washington Street, Suite 200 Indianapolis, IN 46204 $1,322.00 ON ACCOUNT OF APPROPRIATION FOR Carmel HR Department PO Dept. INVOICE NO. ACCT #!TITLE AMOUNT Board Members 1201 j 210104 43- 588.00 $220.00 1 hereby certify that the attached invoice(s), or 1201 210108 43- 588.00 $717.00 bills) is (are) true and correct and that the 1201 210172 43- 588.00 $55.00 materials or services itemized thereon for 1201 210245 43- 588.00 $165.00 which charge is made were ordered and 1201 I 210479 I 43- 588.00 $110.00 1201 211027 I 43- 588.00 I $55.00 received except n Friday, July 30, 2010 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)) 07/15/10 210104 $220.00 07/15/10 210108 $717.00 07/16/10 210172 $55.00 07/16/10 210245 $165.00 07/21/10 I 210479 I I $110.00 07/27/10 I 211027 $55.00 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