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191751 11/10/2010 CITY OF CARMEL, INDIANA VENDOR: 204038 Page 1 of 1 o ONE CIVIC SQUARE MIDWEST TOXICOLOGY SVS,INC CHECK AMOUNT: $358.00 CARMEL, INDIANA 46032 603 E WASHINGTON ST SUITE 200 Vitro„ `0 1NDIANAPOUS IN 46204 CHECK NUMBER: 191751 CHECK DATE: 11/1012010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1201 4358800 217972 55.00 TESTING FEES 1201 4358800 218095 28.00 TESTING FEES 1201 4358800 218241 110.00 TESTING FEES 1201 4358800 218432 55.00 TESTING FEES 1201 4358800 218556 55.00 TESTING FEES 1201 4358800 218887 55.00 TESTING FEES Midwest ?o ieofo In voi ce x ey DATE INV OICE 10/28/2010 218887 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 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 Occ Health 10/25/10 Mindy Collins 8 Zola D Q 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 317 -262 -2200 or fax us at 317- 262 -2222. Be sure to visit our wehsite at rvrvw naidrnesttoxicolog}.cnnr. Midwest To_-,cicofogy In vo i ce <Q� Services, Inc DATE= INVOICE 603 East Washington Street, Suite 200, Indianapolis, IN 46204 10/25/2010 218556 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 Occ. Health Center Carmel 10/19/10 Marvin,Stewart D NUV 0 8 g ala 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! I 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 website at www.noidwesnoxicologv.cotn. JI-fidwest 7o icofo Invo x �y Services, Inc. -�Q' DATE INVOICE 603 East Washington Street, Suite 200, Indianapolis, IN 46204 10/25/2010 218432 BILL TO: SHIP TO: City of Carmel Names location of collection Attn: Jim Spelbring on invoices no ss i Civic Square Email results to Barb Lamb cc Jim Carmel, IN 46032 Still Mail results to Jim C1z 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 Occ. Health Center Carmel 10/21/10 Charles Driver D z r--- 1u i 0 8 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 $55.00 Make Checks Payable To: MIDWEST TOXICOLOGY SERVICES, INC. For questions regarding this invoice, contact us at 317 -262 -2200 or far us at 3I7 -262 -2222. Be sure to visit our website at www.ntidwesttoricology.cons. Midwest 7o icoCo Invo X gy fnc. 0 DATE INVpICE 10/22/2010 218241 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 Still Mail results to Jim Carmel, IN 46032 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 Occ. Health Center Carmel 10/19/10 Jerry Smith Adam Schriner D Q 1'111U V 0 8 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 $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 3.17 262 -2222. Be sure to visit our website at wrvw.ntidwesttoxicolog y.cont. Mid-west ToXicofogy I nvo ic e (mo Services, Inc. DATE INVOICE 603 East Washington Street, Suite 200, Indianapolis, IN 46204 10/21/2t]10 218O95 BILL TO: SHIP TO: City of Carmel Names location of collection Attn: Jim Spelbring on invoices no ss #II 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 1 DOT Drug Test 28.00 28.00 Collected Onsite 10/18/10 David Loveall 368 Street D L A U NOV 0 8 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 $28.00 Make Checks Payable To: MIDWEST' TOXICOLOGI' 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 To icofo Invo x gy a� Services, Inc. DATE INVOICE 10/20/2010 217972 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 Still Mail results to Jim Carmel, IN 46032 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 Occ. Health Carmel 10116!10 Kent Steury D a a 1'w v 0 8 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 $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 317 262 -2222. Be sure to visit our website at rnwx.nridwesttosicolog�.cona. VOUCHER NO. WARRA N O. ALLOWED 20 Midwest Toxicology IN SUM OF 603 East Washington Street, Suite 200 Indianapolis, IN 46204 $358.00 ON ACCOUNT OF APPROPRIATION FOR Carmel HR Department PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 1201 217972 43- 588.00 I $55.00 I hereby certify that the attached invoice(s), or 1201 218095 I 43- 588.00 I $28.00 bill(s) is (are) true and correct and that the 1201 I 218241 I I 43- 588.00 I $110.00 materials or services itemized thereon for 1201 I 218432 I 43- 588.00 $55.00 which charge is made were ordered and 1201 I 218556 I 43- 588.00 $55.00 1201 I L 218887 I 43- 588.00 $55.00 received except M onday, November 08, 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)) 10/20/10 217972 $55.00 10/21/10 218095 $28.00 10/22/10 218241 $110.00 10/25/10 218432 $55.00 10/25/10 218556 $55.00 10/28/10 218887 $55.00 1 hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and have audited same in accordance with IC 5- 11- 10 -1.6 20 Clerk- Treasurer