158538 04/15/2008 CITY OF CARMEL, INDIANA VENDOR: 204038 Page 1 of 1
Q� ONE CIVIC SQUARE MIDWEST TOXICOLOGY SVS,INC
CARMEL, INDIANA 46032 603 E WASHINGTON ST SUITE 200 CHECK AMOUNT: $336.00
INDIANAPOLIS IN 46204 CHECK NUMBER: 158538
CHECK DATE: 4/15/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1201 4358800 148364 112.00 TESTING FEES
1201 4358800 148440 168.00 TESTING FEES
1201 4358800 148601 56.00 TESTING FEES
1
i
Midwest ToXicofogy Invoice
offiwi;i DATE INVOICE
603 East Washington Street, Suite 200, Indianapolis, IN 46204 3/31/2008 148364
BILL TO: SHIP TO:
City of Carmel No names or ss #'s
Attn: Shelly Lingelbaugh
1 Civic Square
Carmel, IN 46032
sc
CONTROL P.O. NUMBER JOB SITE TERMS FACILITY
5528 Due on receipt 142376
QTY ITEM CODE DESCRIPTION PRICE EACH AMOUNT
2 ND Drug Test CS Non -DOT Drug Test 55.00 110.00
Collected at Community Occ. Health Center Carmel Carmel, IN
3/24/08
2 Collection Site S... Please note that you are being charged an additional fee due to your 1.00 2.00
collection site 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 $112.00
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.ntidwestioxicology.com.
Midwest 7oxicofogy I nvoic e
04iii DATE INVOICE
603 East Washington Street, Suite 200, Indianapolis, IN 46204 4/1 /2008 148440
BILL TO: SHIP TO:
City of Carmel No names or ss #'s
Attn: Shelly Lingelbaugh
1 Civic Square
Carmel, IN 46032
SC
I
CONTROL P.O. NUMBER JOB SITE TERMS FACILITY
5528 Due on receipt 142376
QTY ITEM CODE DESCRIPTION PRICE EACH AMOUNT
3 ND Drug Test CS Non -DOT Drug Test 55.00 165.00
Collected at Community Occ. Health Center Carmel Carmel, IN
3/25/08
3 Collection Site S... Please note that you are being charged an additional fee due to your 1.00 3.00
collection site charges.
Pay your bills online at:
https:// www. intuitbillpay. 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 $168.00
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.midwevttoxicology.com.
Midwest To.zicofogy I nvoi ce
o ffi w� DATE INVOICE
4/2/2008 148601
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
SC
I
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 Carmel, IN
3/25/08
1 Collection Site S... Please note that you are being charged an additional fee due to your 1.00 1.00
collection site charges.
Pay your bills online at:
https:// www. intuitbillpay. 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 $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 317 -262 -2222.
Be sure to visit our website at fmminidwesttoxicology.com.
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))
04/02/08 148601 Random Drug Testing $56.00
03/31/08 148364 Random Drug Testing $112.00
04/01/08 148440 Random Drug Testing $168.00
Total
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 I4..j.4/eg_WARRANT NO.
.Midwest oxicology ALLOWED 20
603 E. Washington St., Suite 200 IN SUM OF
Indianap^rs, IN 620
$336.00
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
12ul 1486U1 588 $56.00 materials or services itemized thereon for
1201 0 which charge is made were ordered and
received except
1201 148440 588 $168.00
20
Si u
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund