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Home My WebLink About198206 06/06/2011 CITY OF CARMEL, INDIANA VENDOR: 204038 Page 1 of 1 ONE CIVIC SQUARE MIDWEST TOXICOLOGY SVS,INC CHECK AMOUNT: $440.00 CARMEL, INDIANA 46032 603 E WASHINGTON ST SUITE 200 o INDIANAPOLIS IN 46204 CHECK NUMBER: 198206 CHECK DATE: 6/6/2011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1201 R4358800 21677 235523 330.00 TESTING FEES 1201 R4358800 21677 235894 55.00 TESTING FEES 1201 R4358800 21677 236039 55.00 TESTING FEES Midwest Toxicofogy Inv oic e 04� DATE INVOICE 603 East Washington Street, Suite 200, Indianapolis, IN 46204 5/25/2011 236039 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 DAC 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 5/18/11 Christopher Pearcy D Q JUN U 6 2011 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 wwmmidwesttoxicology.com. Midwest Toxicology Invoice Serrrices, Inc. D DATE INVOICE v 603 East Washington Street, Suite 200, Indianapolis, IN 46204 5/24/2011 235894 BILL TO: SHIP TO: City of Carmel Attn: Jim Spelbring 1 Civic Square Carmel, IN 46032 MMD 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 05/14/2011 Tyra L. Clemons- 9078 D Z JUN U b 2011 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. 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 -2122. Be sure to visit our website at www.midwestioxicology.com. Midwest Toxicofogy Invo Services, Inc DATE INVOICE dr 603 East Washington Street, Suite 200, Indianapolis, IN 46204 F5/20/201 1 235523 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 DOT Test 1 DOT Drug Test 55.00 55.00 Collected at St. Vincent Carmel Hospital 4/28/11 Scot Stroup ND Drug Test CS 5 Non -DOT Drug Test 55.00 275.00 Collected at Community Occ. Health Center Carmel 5/9/11 Brendan Davis 5/10/11 Andrew Loveall 5/11/11 Matthew Bickel 5/13/11 Nicholas Scott 5/16/11 Andrew Pearcy D JUN 06 2011 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 $330.00 Make Checks Payable To: MIDWEST TOXICOLOGY SERVICES, INC. For questions regarding this invoice, contact us at 317- 262 -2200 or far us at 317 262 -2222. Be sure to visit our website at wwmniidwesttoxicology.cont. 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)) 05/20/11 235523 $330.00 05/24/11 235894 $55.00 05/25/11 I 236039 4 I $55.00 I 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 VOUCHER NO. WARRANT NO. ALLOWED 20 Midwest Toxicology IN SUM OF 603 East Washington Street, Suite 200 Indianapolis, IN 46204 $440.00 ON ACCOUNT OF APPROPRIATION FOR Carmel HR Department PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 21677 I 235523 I 43- 588.00 I $330.00 1 hereby certify that the attached invoice(s), or 21677 I 235894 I 43- 588.00 I $55.00 bill(s) is (are) true and correct and that the 21677 I 236039 I 43- 588.001 $55.00 materials or services itemized thereon for which charge is made were ordered and received except Monday, June 06, 2011 Director, HR Title Cost distribution ledger classification if claim paid motor vehicle highway fund