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164344 09/30/2008 CITY OF CARMEL, INDIANA VENDOR: 204038 Page 1 of 1 ONE CIVIC SQUARE MIDWEST TOXICOLOGY SVS,INC CHECK AMOUNT: $4,156.00 CARMEL, INDIANA 46032 603 E WASHINGTON ST SUITE 200 INDIANAPOLIS IN 46204 CHECK NUMBER: 164344 CHECK DATE: 9/30/2008 DEPARTM ACC OUNT PO NUMBER INV OICE NUM BER AM OUNT DESCRIPTION '1201 4358800 160990 55.00 TESTING FEES 1201 4358800 161120 1,176.00 TESTING FEES 1201 4358800 161170 55:00 TESTING FEES 1201 4358800 161185 2,485.00 TESTING FEES 3 1201 4358'800 161574 55.00 TESTING FEES 1201 4358.800• 161691 220.00 TESTING FEES 1201 4358800 161812 110':00 TESTING FEES' a C' J. r r W� Midwest Toxicology In vo i ce _Services, Inc. OO DATE INVOICE 603 East Washington Street, Suite 200, Indianapolis, IN 46204 9/19/2008 161574 BILL TO: SHIP TO: City of Carmel Attn: Shelly Lingelbaugh 1 Civic Square Carmel, IN 46032 EK CONTROL P.O. NUMBER JOB SITE TERMS FACILITY 5528 Due on receipt 142376 ITEM CODE QTY DESCRIPTION PRICE EACH AMOUNT ND Drug Test CS 1 Non -DOT Drug Test 55.00 55.00 Collected at Community Occ. Health Center Carmel Carmel IN 9/16/2008 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 $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.utidwesttoxicology.coni. Widwest Txofcofogy In v oi ce Services, Inc. DATE INVOICE 9/19/2008 161691 603 East Washington Street, Suite 200, Indianapolis, IN 46204 BILL TO: SHIP TO: City of Carmel Attn: Shelly Lingelbaugh 1 Civic Square Carmel, IN 46032 EK CONTROL P.O. NUMBER JOB SITE TERMS FACILITY 5528 Due on receipt 142376 ITEM CODE QTY DESCRIPTION PRICE EACH AMOUNT ND Drug Test CS 4 Non -DOT Drug Test 55.00 220.00 Collected at Community Occ. Health Center Carmel Carmel IN 9/16/2008 9/16/2008 9/16/2008 9/17/2008 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. Thank you for your business! Total $220.00 Make Checks Payable To: MIDWEST TOXICOLOGY SERVICES, INC. For questions regarding this invoice, contact us at 317 262 -2200 or fax us at 377- 262 -2222. Be sure to visit our website at www.midwesttoxicology.coni. Midwest 7oXicofogy Inv oic e Seryzces, In c.. DATE INVOICE 603 East Washington Street, Suite 200, Indianapolis, IN 46204 9/23/2008 161812 BILL TO: SHIP TO: City of Carmel No Names or SS# on invoices Attn: Shelly Lingelbaugh 1 Civic Square Carmel, IN 46032 EK CONTROL P.O. NUMBER JOB SITE TERMS FACILITY 5528 Due on receipt 142376 ITEM CODE QTY DESCRIPTION PRICE EACH AMOUNT ND Drug Test CS 1 Non -DOT Drug Test 55.00 55.00 Collected at Community Occ. Health Center Carmel Carmel IN 9/17/2008 DOT Test 1 DOT Drug Test 55.00 55.00 Collected at Community Occ. Health Center Carmel Carmel IN 9/18/2008 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. Thank you for your business! Total $110.00 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. 9Kidwest Toxicology Invoice Services, Inc. DATE INVOICE 9/15/2008 161120 603 East Washington Street, Suite 200, Indianapolis, IN 46204 BILL TO: SHIP TO: City of Carmel no ss employee ID only!! Attn: Shelly Lingelbaugh 1 Civic Square Carmel, IN 46032 LW CONTROL P.O. NUMBER JOB SITE TERMS FACILITY 5528 Due on receipt 142376 ITEM CODE QTY DESCRIPTION PRICE EACH AMOUNT ND Drug Test 4 Non -DOT Drug Test Community Center 55.00 220.00 Collected Onsite 9/8/08 ND Drug Test 5 Non -DOT Drug Test Fire Department 55.00 275.00 Collected Onsite 9/8/08 ND Drug Test 2 Non -DOT Drug Test Police Department 55.00 110.00 Collected Onsite 9/8/08 ND Drug Test 2 Non -DOT Drug Test Utililties 55.00 110.00 Collected Onsite 9/8/08 DOT Test 1 DOT Drug Test Utilities 55.00 55.00 Collected Onsite 9/10/08 DOT Test 6 DOT Drug Test Street Department 55.00 330.00 Collected Onsite 9/10/08 DOT Alcohol 2 DOT Breath Alcohol Test Street Department 28.00 56.00 Collected Onsite 9/10/08 Fuel Surcharge 2 Fuel Surcharge for 9/8 9/10/08 10.00 20.00 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. Thank you for your business! Total $1,176.00 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.midwesitoxicology.com. Midwest 7oxicofogy I Services, Inc. DATE INVOICE 9/15/2008 161185 603 East Washington Street, Suite 200, Indianapolis, IN 46204 BILL TO: SHIP TO: City of Carmel no ss employee ID only!! Attn: Shelly Lingelbaugh 1 Civic Square Carmel, IN 46032 LW CONTROL P.O. NUMBER JOB SITE TERMS FACILITY 5528 Due on receipt 142376 ITEM CODE QTY DESCRIPTION PRICE EACH AMOUNT ND Drug Test 9 Non -DOT Drug Test Utilities 55.00 495.00 Collected Onsite 9/9/08 ND Drug Test 9 Non -DOT Drug Test Police Department 55.00 495.00 Collected Onsite 9/9/8 ND Drug Test 3 Non -DOT Drug Test Community Center 55.00 165.00 Collected Onsite 9/9/08 ND Drug Test 7 Non -DOT Drug Test Fire Department 55.00 385.00 Collected Onsite 9/9/08 ND Drug Test 1 Non -DOT Drug Test Department Unknown 55.00 55.00 Collected Onsite 9/9/08 DOT Test 1 DOT Drug Test Utilities 55.00 55.00 Collected Onsite 9/10/08 ND Drug Test 6 Non -DOT Drug Test Police Department 55.00 330.00 Collected Onsite 9/10/08 ND Drug Test 9 Non -DOT Drug Test Fire Department 55.00 495.00 Collected Onsite 9/10/08 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 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.midwestioxicology.com. Pagel Widwest ToXicofogy Invoice Services, Inc. DATE INVOICE 9/15/2008 161185 603 East Washington Street, Suite 200, Indianapolis, IN 46204 BILL TO: SHIP TO: City of Carmel no ss employee ID only!! Attn: Shelly Lingelbaugh 1 Civic Square Carmel, IN 46032 I LW CONTROL P.O. NUMBER JOB SITE TERMS. FACILITY 5528 Due on receipt 142376 ITEM CODE QTY DESCRIPTION PRICE EACH AMOUNT Fuel Surcharge 1 Fuel Surcharge 10.00 10.00 Pay your bills online at: https: /www.intuitbiII pay. com /midwesttoxicologyservicesinc. i i A finance charge will be assessed on all invoices not paid in 30 days. Thank you for your business. Thank you for your businessl Total $2,485.00 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.midwestioxicology.com. Page 2 Midwest 7oxicofogy Invoice Services, Inc. DATE INVOICE 9/15/2008 161170 603 East Washington Street, Suite 200, Indianapolis, IN 46204 BILL TO: SHIP TO: City of Carmel no ss employee ID only!! Attn: Shelly Lingelbaugh 1 Civic Square Carmel, IN 46032 EK CONTROL P.O. NUMBER JOB SITE TERMS FACILITY 5528 Due on receipt 142376 ITEM CODE QTY DESCRIPTION PRICE EACH AMOUNT DOT Test 1 DOT Drug Test 55.00 55.00 Collected at Community Occ. Health Center Carmel Carmel IN 9/10/2008 Pay your bills online at: https •A 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 us at 317 262 -2200 or fax us at 317 -262 -2222. Be sure to visit our website at www.midwesttoxicology.conL I Midwest 7oxicofogy Invoic Services, Inc. DATE INVOICE M t 9/11/2008 160990 603 East Washington Street, Suite 200, Indianapolis, IN 46204 BILL TO: SHIP TO: City of Carmel no ss employee ID only!! Attn: Shelly Lingelbaugh 1 Civic Square Carmel, IN 46032 AH CONTROL P.O. NUMBER JOB SITE TERMS FACILITY 5528 Due on receipt 142376 ITEM CODE QTY DESCRIPTION PRICE EACH AMOUNT ND Drug Test CS 1 Non -DOT Drug Test 55.00 55.00 Collected at Community Occ. Health Center Carmel Carmel IN 09/03/08 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 $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. 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. Pa Midwest Toxicology Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 09/19/0 161574 Pre employment Drug Test (1) $55.00 09/19/081 161691 Pre employment Drug Test (4) $220.00 09/23/08 161812 Pre employment Drug Test (2) $110.00 09/15/08 161120 Random drug testing (22) $1,176.00 09/15/08 161185 Random drug testing (45) $2,485.00 09/15/08 161170 Random drug testing (1) $55.00 09/11/08 160990 Pre employment Drug Test (1) $55.00 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 "12gloa WARRANT NO. Mid west I oxlco ogy ALLOWED 20 603 E. Washington St., Suite 200 IN SUM OF Indianannlis 46204 $4,156.00 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 00 materials or services itemized thereon for 1201 16 0 which charge is made were ordered and received except 61812 588 $110.00 1201 161185 588 2,485.00 1291 q 61170 1201 160990 588 $55 20 v Slgno Ke Title Cost distribution ledger classification if claim paid motor vehicle highway fund