166806 12/10/2008 r
R. w E CITY OF CARMEL, INDIANA VENDOR: 204038 Page 1 of 1
ONE CIVIC SQUARE MIDWEST TOXICOLOGY SVS,INC CHECK AMOUNT: $144.00
CARMEL, INDIANA 46032 603 E WASHINGTON ST SUITE 200
INDIANAPOLIS IN 46204 CHECK NUMBER: 166806
CHECK DATE: 12/10/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
-1201 4358800 166739 55.00 TESTING FEES
1201- 4355800 167287 34.00 TESTING FEES
1201 4358800 167320 55.00 TESTING FEES
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Midwest To.Kicofogy I nvoice
Servzces, Inc.
DATE INVOICE
603 East Washington Street, Suite 200, Indianapolis, IN 46204
11/26/2008 167320
BILL TO: SHIP TO:
City of Carmel Names location of collection
Attn: Shelly Lingelbaugh on invoices no ss
1 Civic Square
Carmel, IN 46032
MG
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, IN
11/25/08
Kurt Shanayda
Pay your bills online at:
https:// www. intuitbilIpay. com /midwesttoxicologyservicesinc.
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 $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.midwesttoxicology.com.
Midwest To)dcofogy Invoi
DATE INVOICE
11/19/2008 166739
603 East Washington Street, Suite 200, Indianapolis, IN 46204
BILL TO: SHIP TO:
City of Carmel Names location of collection
Attn: Shelly Lingelbaugh on invoices no ss
1 Civic Square
Carmel, IN 46032
AH
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 IN
11/17/08
Amanda Bennett
Pay your bills online at:
https://www.intuitbiIIpay.com/midwesttoxicologyserv.icesinc.
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 $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 wwmmidrvesttoxicology.com.
Midwest 7oXicofo gy Invoic
O S e, vices,
Inc
DATE INVOICE
12/1/2008 167287
603 East Washington Street, Suite 200, Indianapolis, IN 46204
I
BILL TO: SHIP TO:
City of Carmel Names location of collection
Attn: Shelly Lingelbaugh on invoices no ss
1 Civic Square
Carmel, IN 46032
AH
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 Community Occ. Health Center Carmel IN
10/02/08
Travis Tabak
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.
Pay your bills online at:
https: /www.intuitbiIIpay. com /midwesttoxicologyservicesinc.
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 317 262 -2200 or fax its at 317- 262 -2222.
Be sure to visit our website at w vmtitidwesttoxicology.coin.
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.
Midwest Toxicolo &y
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
12/01/08 167287 DOT Breath Alcohol Test $34.00
11/26/08 167320 Non -DOT Drug Test $55.00
11/19/08 166739 Non -DOT Drug Test $55.00
Total
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
VOUCHER NC2-108/08 _WARRANT NO.
WI eS OXICOIOgy ALLOWED 20
IN SUM OF
603 E. Washington St., Suite 200
Indianapolis IN
$144.00
ON ACCOUNT OF APPROPRIATION FOR
General Fund
1201 Human Resources
Board Members
PO# or INVOICE NO. ACCT #(TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
588 $34.00 materials or services itemized thereon for
1201 JA7,m 0 which charge is made were ordered and
received except
1201 166739 588 $55.00
20
i
A
Sig e
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund