155829 01/23/2008 CITY OF CARMEL, INDIANA VENDOR: 204038 Page 1 of 1
ONE CIVIC SQUARE MIDWEST TOXICOLOGY SVS,INC CHECK AMOUNT: $633.00
CARMEL, INDIANA 46032 603 E WASHINGTON ST SUITE 200
INDIANAPOLIS IN 46204 CHECK NUMBER: 155829
CHECK DATE: 112312008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1201 R4358800 16631 142001 165.00 DRUG TESTING
1201 R4358800 16631 142146 275.00 DRUG TESTING
1201 R4358800 16631 142192 55.00 DRUG TESTING
1201 R4358800 16631 142317 55.00 DRUG TESTING
1201 R4358800 16631 142444 83.00 DRUG TESTING
i
i
914idwest Toxicofo 93' I n v oic e
Q� Services, Inc.
OOD DATE INVOICE
d 1/10/2008 142317
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
Y
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
1/7/08
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.
We appreciate your business and thank you for your prompt payment. 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.
Widwest Toxicofogy Invoi
Q Services, Inc DATE INVOICE
1/9/2008 142192
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
1/7/08
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 $55.00
Make Checks Payable To: MIDWEST TOXICOLOGY SERVICES, INC.
For questions regarding this invoice, contact as at 317 262 -2200 or fax us at 317 262 -2222.
Be sure to visit our website at www.midwesttoxicology.com.
Midwest Toj6cofogy I nv oic e
�Q Services, Inc.
DO D „rte DATE INVOICE
603 East Washington Street, Suite 200, Indianapolis, IN 46204 1/9/2008 142146
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
1/5/08
4 ND Drug Test CS Non -DOT Drug Test 55.00 220.00
Collected at Community Occ. Health Center Carmel Carmel, IN
1/7/08
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 $275.00
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.inidwevttoxicology.com.
Midwest Toxicology Invoice
Services, Inc.
DATE INVOICE
1 /8/2008 142001
603 East Washington Street, Suite 200, Indianapolis, IN 46204 F
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
3 ND Drug Test CS Non -DOT Drug Test 55.00 165.00
Collected at Community Occ. Health Center Carmel Carmel, IN
1/4/08
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 $165.00
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 Toxicology Invo
Services, Inc.
DATE INVOICE
OHO D
1/14/2008 142444
60 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
REC
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
1/9/08
1 ND Alcohol OS Non -DOT Alcohol Test On -Site 28.00 28.00
1/9/08
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.
We appreciate your business and thank you for your prompt payment. Total $83.00
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.cont.
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 Toxicologvy
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
01/10/08 142317 Non -DOT Drug Test collected at Comm Occ 1 55.00
01/09/08 142192 Non -DOT Drug Test collected at Comm Occ 1 55.00
01/09/08 142146 Non -DOT Drug Test collected at Comm Occ (5) $275.00
01/08/08 142001 Non -DOT Dr ug Test collected at Comm Occ (3) $165.00
01/14K0_8 142444 Non -Dot Drug Test Alcohol Test On -Site (1) $83.00
Total
0
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 WARRANT NO.
Midwest OXICO ogy ALLOWED 20
6.03 E. Washington St., Suite 200 IN SUM OF
Indianapolis, IN 46620
$633.00
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
pa is 7 588 $55.00 materials or services itemized thereon for
which charge is made were ordered and
16631 received except
partial 142146 588 $275.00
16631
P814:101 I 1 t4VU 1 1) L) 10
partial 142444 588 $83.0
20
Sign r�
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund