HomeMy WebLinkAbout193480 01/05/2011 CITY OF CARMEL, INDIANA VENDOR: 204038 Page 1 of 1
ONE CIVIC SQUARE MIDWEST TOXICOLOGY SVS,INC CHECK AMOUNT: $106.00
s ��o CARMEL, INDIANA 46032 603 E WASHINGTON ST SUITE 200
INDIANAPOLIS IN 46204 CHECK NUMBER: 193480
CHECK DATE: 1/5/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1201 R4358800 21677 223098 106.00 TESTING FEES
Widwest Toxicology Invoice
Q'a Services, Inc
DATE INVOICE#
12/15/2010 223098
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
NM
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 The Doctor Is In Nora Immediate Care Center
12/12/10
Jeffrey Horner
ND Alcohol CS 1 Non -DOT Breath Alcohol Test 28.00 28.00
Collected at The Doctor Is In Nora Immediate Care Center
12/12110
Jeffrey Horner
Collection Site S... 1 Please note that you are being charged an additional fee due to your 5.00 5.00
collection site urine collection charge.
BAT Surcharge 1 Please note that you are being charged an additional fee due to your 18.00 18.00
collection site breath alcohol charges.
JAN J 4 Loll
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 $106.00
Make Checks Payable To: MIDWEST TOXICOL OGV SERVICES, INC.
For questions regarding this invoice, contact us at 317 -262 -2200 or fax us at 317- 261 -2122.
Be sure to visit our wehsite at www.ntidwesnoxicolog-y.com.
VOUCHER NO. WARRANT NO.
ALLOWED 20
Midwest Toxicology IN SUM OF
603 East Washington Street, Suite 200
Indianapolis, IN 46204
$106.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel HR Department
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
J ?1�67 I 223098 I 43 588.00 i $106.00 1 hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
1 l' materials or services itemized thereon for
which charge is made were ordered and
received except
Tuesday, January 04, 2011
Dire tor, 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))
12/15/10 223098 $106.00
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