163863 09/17/2008 CITY OF CARMEL, INDIANA VENDOR: 204038 Page 1 of 1
ONE CIVIC SQUARE MIDWEST TOXICOLOGY SVS,INC CHECK AMOUNT: $110.00
CARMEL, INDIANA 46032 603 E WASHINGTON ST SUITE 200
INDIANAPOLIS IN 46204 CHECK NUMBER: 163863
CHECK DATE: 9/17/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1201 4358800 159976 55.00 TESTING FEES
1201 4358800 160496 55.00 TESTING FEES
i
I
911idwest 7oxicofogy In
0 4i;i o DATE INVOICE
r8/27/2008 159976
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
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
08/20/08
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.
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.
Midwest 7o.X,icofogy In voic e
DATE INVOICE
o 9/4/2008 160496
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
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
08/29/08
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 $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 wrvw.â–ºnidwesttoxicology.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 ToxicoloRy
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
08/27/08 159976 Pre employment Drug Test (1) $55.00
09/04/08 160496 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
VOUCHEF09M.5/88 _WARRANT NO.
WeS OXIcO Ogy ALLOWED 20
6103 E. Washington St., Suite 200 IN SUM OF
Indianapolis IN -2204
$110.00
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
1201 159976 58ts 75= bill(s) is (are) true and correct and that the
materials or services itemized thereon for
1201 160496 58 which charge is made were ordered and
received except
20
i,
gna
Cost distribution ledger classification if /JuTitle
claim paid motor vehicle highway fund