158039 04/01/2008 CITY OF CARMEL, INDIANA VENDOR: 204038 Page 1 of 1
ONE CIVIC SQUARE MIDWEST TOXICOLOGY SVS,INC
CARMEL, INDIANA 46032 603 E WASHINGTON ST SUITE 200 CHECK AMOUNT: $704.00
INDIANAPOLIS IN 46204 CHECK NUMBER: 158039
CHECK DATE: 4/1/2008
DEPARTMENT AC COUNT PO NUMBER INVOICE NUMBE AM OUNT DESCRIPTION
1201 4358800 147253 55.00 TESTING FEES
1201 4358800 147458 112.00 TESTING FEES
j 1201 4358800 147693 56.00 TESTING FEES
1 1201 4358800 147820 56.00 TESTING FEES
1201 4358800 147858 55.00 TESTING FEES
I 1201 4358800 147915 202.00 TESTING FEES
r
1201 4358800 147950 56.00 TESTING FEES
1201 4358800 148006 112.00 TESTING FEES
Midwest 7oxicofo gy Invoice
j Services, Inc.
o DATE INVOICE
t
603 East Washington Street, Suite 200, Indianapolis, IN 46204 3/14/2008 147253
BILL TO: SHIP TO:
City of Carmel No names or ss #'s
Attn: Shelly Lingelbaugh
1 Civic Square
Carmel, IN 41,032
TJE
CONTROL P.O. NUMBER JOB SITE TERMS FACILITY
5528 Due on receipt 142376
QTY ITEM CODE DESCRIPTION PRICE EACH AMOUNT
1 ND Drug Test OS Non -DOT Drug Test On -Site 55.00 55.00
2/28/08
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.
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 website at www.midwesttoxicology.com.
I
Invoic
Midwest 7o.xicofogy
Services, Inc DATE INVOICE
i 3/19/2008 147458
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
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
3/13/08
3/14/08
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.intuitbilipay.com/midwesttoxicologyservicesinc.
I
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.rnidwesttoxicology.com.
Mi dwest 7o icolo Invoic
x gy
Q Seraices, Inc. DATE INVOICE
3/20/2008 147693
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
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
3/17/08
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 www.nzidwestt.oxicology.com.
Midwest Toxicology Inv
Services, Inc. DATE INVOICE
603 East Washington Street, Suite 200, Indianapolis, IN 46204 3/24/2008 147950
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
3/19/08
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. 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 www.nnidwesttoxicology.com.
Midwest Tx�cofogy Inv
offi DATE INVOICE
603 East Washington Street, Suite 200, Indianapolis, IN 46204 3/21/2008 147820
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
1 ND Drug Test CS Non -DOT Drug Test 55.00 55.00
Collected at Community Occ. Health Center Carmel Carmel, IN
3/14/08
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 www.midwesttoxicology.com.
I
Midwest Toxicology I n v oi ce
0 DATE INVOICE
603 East Washington Street, Suite 200, Indianapolis, IN 46204 3/25/2008 147858
BILL TO: SHIP TO:
City of Carmel No names or ss #'s
Attn: Shelly Lingelbaugh
1 Civic Square
Carmel, IN 46032
SRC
CONTROL P.O. NUMBER JOB SITE TERMS FACILITY
5528 Due on receipt 142376
QTY ITEM CODE DESCRIPTION PRICE EACH AMOUNT
1 ND Drug Test Non -DOT Drug Test 55.00 55.00
Collected at Midwest Indianapolis
03/21/08
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.
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 website at wwwanidwesttoxicology.com.
Midwest 7oXicofo 9y
In voic e
Q Services, Inc. DATE INVOICE
603 East Washington Street, Suite 200, Indianapolis, IN 46204 3/24/2008 147915
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
3/17/08
1 DOT Test CS NC DOT Drug Test 55.00 55.00
Collected at Community Occ. Health Center Carmel Carmel, IN
3/17/08
3 Collection Site S... Please note that you are being charged an additional fee due to your 1.00 3.00
collection site charges.
1 DOT Alcohol CS DOT Breath Alcohol Test 28.00 28.00
Collected at Community Occ. Health Center Carmel Carmel, IN
3/17/08
1 BAT Surcharge 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. 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 $202.00
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 Txzicofogy In voi ce
04 DATE INVOICE
603 East Washington Street, Suite 200, Indianapolis, IN 46204 3/2512008 148006
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
3/21/08
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.midwesttoxicology.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 ftyee
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
53 Random Drug Testing $55.00
03119W 14 /45V Random Drug Testing, pre employment drug test $112.00
03/2 UO 14162U_ Random Drug Testing $56.00
03/24/08 147950 an om Drug Testing $56.00
03/20 V0 147693 Random Drug Testing $56.00
03/25/08- 147858 Random Drug I es ing $55.00
03/24A)& 1479115 Random Drug I es ing $202.00
03/25/08- 148006U Rai idorn Drug Testing, pre-employment drug test $112.00
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
I
)����_WARRANT NO.
.VOUCHER 08
Midw est OXICO ogy ALLOWED 20
E Washington St., Suite 200 IN SUM OF
IndianaonliS IN 46204
$704.00
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
16631 bill(s) is (are) true and correct and that the
materials or services itemized thereon for
partial 147458 588 which charge is made were ordered and
16631 received except
a is 88 $56.00
Partial
artial 147693 588 '56.00
1
partial 147915 588 202 0 20
16631
00 S'g ature
"�Y�.ac�
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund