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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