163308 09/03/2008 F CITY OF CARMEL, INDIANA VENDOR: 204038 Page 1 of 1
0 ONE CIVIC SQUARE MIDWEST TOXICOLOGY SVS,INC CHECK AMOUNT: $220.00
CARMEL, INDIANA 46032 603 E WASHINGTON ST SUITE 200
INDIANAPOLIS IN 46204 CHECK NUMBER: 163308
CHECK DATE: 9/3/2008
DE PARTMENT A PO NU MBER INVOICE NUMBE AMOUNT DESCRIPTION
1201 4358800 159023 110.00 TESTING FEES
1201 4358800 159447 55.00 TESTING FEES
—1201 4358800 159753 55.00 TESTING FEES
i
Midwest 7oXicofogy
Invoice
Services, Inc.
DATE INVOICE
603 East Washington Street, Suite 200, Indianapolis, IN 46204 8/25/2008 159753
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 Toxicology I n v oi ce
Servzces, Inc.
Q DATE INVOICE
OHO D
603 East Washington Street, Suite 200, Indianapolis, IN 46204 8/14/2008 159023
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 2 Non -DOT Drug Test 55.00 110.00
Collected at Community Occ. Health Center Carmel Carmel IN
08/11/08
08/12/08
Pay your bills online at:
https:// www. intuitbiIIpay. 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 $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 wwminidwesttoxicology.com.
9Kidzvest 7o-XicoCogy
In v o ic e
o DATE INVOICE
603 East Washington Street, Suite 200, Indianapolis, IN 46204 8/20/2008 159447
BILL TO: SHIP TO:
City of Carmel No names or ss #'s
Attn: Shelly Lingelbaugh
1 Civic Square
Carmel, IN 46032
AH
I
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
08/15/08
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.ntidwesttoxicology.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 ToxicoloPy
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
08/20/0 159447 Pre employment Drug Test (1) $55.0
08/14/08 159023 Pre employment Drug Test (2) 1 $11
OM5/08 1 159753 Pre employment Drug Test (1) $55.00
Total
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
VOUCHEIO�jlcq WARRANT NO.
M idwest Toxicology ALLOWED 20
603 E. Washington St., Suite 200 IN SUM OF
indm an ape l o s, 1 N 4 204
$220.00
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
bills) is (are) true and correct and that the
$55.00 materials or services itemized thereon for
Which charge is made were ordered and
received except
1201 159753 588 $55.00
20
atu re
.!dam
Cost_ distribution ledger classification if Title
claim paid motor vehicle highway fund