188915 08/18/2010 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: $34.00
INDIANAPOLIS IN 46204
CHECK NUMBER: 188915
CHECK DATE: 8/1812010
DEPARTMENT ACCOUNT PO NUMB INVOICE NUMB AMOUNT DESCRIPTION
1201 4358800 211716 34.00 TESTING FEES
Widwest 7o- ,icofogy Invo
Services, Inc. DATE INVOICE
8/4/2010 211716
603 East Washington Street, Suite 200, Indianapolis, IN 46204
BILL TO: SKIP TO:
City of Carmel Names location of collection
Attn: Jim Spelbring on invoices no ss #ll
1 Civic Square Email results to Barb Lamb cc Jim
Carmel, IN 46032 Still Mail results to Jim
NM
CONTROL P.O. NUMBER JOB SITE TERMS FACILITY
5528 Due on receipt 142376
ITEM CODE QTY DESCRIPTION PRICE EACH AMOUNT
DOT Alcohol CS 1 DOT Breath Alcohol Test 28.00 28.00
Collected at Carmel MedCheck
7126110
Stephen L. Jones, II
BAT Surcharge 1 Please note that you are being charged an additional fee due to your 6.00 6.00
collection site breath alcohol charges.
AU,) 16 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 $34.00
Make Checks Payable To: MIDWEST TOXICOLOGY SERVICES, INC.
For questions regarding this invoice, contact us at 317 -261 -2200 or fax us at 317 -262 -2211.
Be sure to visit our website at wsvrv.nridwesuoxicologv.conr.
VOUCH NO. WARRANT NO.
ALLOWED 20
Micivvest Toxicology
IN SUM OF
603 East Washington Street, Suite 200
Indianapolis, IN 46204
$34.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel HR Department
PO# Dept. INVOICE NO. ACCT# /TITLE AMOUNT Board Members
1201 I 211716 I 43- 588.00 $34.00 1 hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
Monday, August 16, 2010
L�
Director, HR
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))
08/04110 I 211716 k I $34.00
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