HomeMy WebLinkAbout158994 04/30/2008 1
CITY OF CARMEL, INDIANA VENDOR: 204038 Page 1 of 1
ONE CIVIC SQUARE MIDWEST TOXICOLOGY SVS,INC CHECK AMOUNT: $56.00
CARMEL, INDIANA 46032 603 E WASHINGTON ST SUITE 200
INDIANAPOLIS IN 46204 CHECK NUMBER: 158994
CHECK DATE: 4/30/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1201 4358800 150516 56.00 TESTING FEES
i
i
r
96dwest 7o 'cofo Inv
9y
Services, Inc.
DATE INVOICE
4/24/2008 150516
603 East Washington Street, Suite 200, Indianapolis, IN 46204
BILL TO: SHIP TO:
City of Carmel No names or ss #'s
Attn: Shelly Lingelbaugh
1 Civic Square
Carmel, IN 46032
MG
CONTROL P.O. NUMBER JOB SITE TERMS FACILITY
5528 Due on receipt 142376
QTY ITEM CODE DESCRIPTION PRICE EACH AMOUNT
1 ND Drug Test CS Non -DOT Drug .Test- 55.00 55.00
Collected at Community Occ. Health Center Carmel, IN
4/18/08
1 Collection Site S... Please note that you are being charged an additional fee due to your 1.00 1.00
collection site urine collection charge.
Pay your bills online at:
https:// www. intuitbilipay. com /midwesttoxicologyservicesinc.
I
A finance charge will be assessed on all invoices not paid in 30 days. Thank you for your business.
We appreciate your business and thank you for your prompt payment. Total $56.00
Make Checks Payable To: MIDWEST TOXICOLOGY SERVICES, INC.
For questions regarding this invoice, contact us at 317- 262 =2200 or fax us at 31 262 2222.
Be sure to visit our website at www.niidwestfoxicology.com.
a r
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 ftyee
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
150516 Random Drug Testing $56.00
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 N/28/08 WARRANT NO.
I west Toxicology ALLOWED 2
603 E. Washington St., Suite 200 IN SUM OF
I taK-1-a pe u l N -46294
$56.00
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
56.00 materials or services itemized thereon for
which charge is made were ordered and
received except
20
tu
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund