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162874 08/20/2008 CITY OF CARMEL, INDIANA VENDOR: 204038 Page 1 of 1 ONE CIVIC SQUARE MIDWEST TOXICOLOGY SVS,INC CHECK AMOUNT: $2,575.00 0 CARMEL INDIANA 46032 603E WASHINGTON ST SUITE 200 ''4 rox'do� INDIANAPOLIS IN 46204 CHECK NUMBER: 162874 CHECK DATE: 8/20/2008 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1201 4358800 157981 890.00 TESTING FEES 1201 4358800 158164 25.00 TESTING FEES 1201 4358800 158226 725.00 TESTING FEES 1201 4358800 158285 220.00 TESTING FEES f 1201 4358800 158405 275.00.TESTING FEES 1201 4358800 158608 165.00 TESTING FEES ,1201 4358800 158664 110.00 TESTING FEES 1201 4358800 158776 55.00 TESTING FEES 1201 4358800 158847 110.00 TESTING FEES Midwest Toxicology Invoic 9 *iiio DATE INVOICE 603 East Washington Street, Suite 200, Indianapolis, IN 46204 8/5/2008 158285 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 IN 07/31/08 ND Drug Test CS 2 Non -DOT Drug Test 55.00 110.00 Collected at Community Occ. Health Center Carmel IN 08/01/08 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 $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 317- 262 -2222. Be sure to visit our website at wwmmidwesttoxicology.com. 1 Midwest 7oxicofogy Invoic 04iii DATE INVOICE 603 East Washington Street, Suite 200, Indianapolis, IN 46204 8/4/2008 158226 BILL TO: SHIP TO: City of Carmel No names or ss #'s Attn: Shelly Lingelbaugh 1 Civic Square Carmel, IN 46032 JDT CONTROL P.O. NUMBER JOB SITE TERMS FACILITY 5528 Due on receipt 142376 ITEM CODE QTY DESCRIPTION PRICE EACH AMOUNT ND Drug Test OS 13 Non -DOT Drug Test 55.00 715.00 Collected onsite for Brookshire Golf Course 7/31/08 Fuel Surcharge 1 Fuel Surcharge 10.00 10.00 Pay your bills online at: https: /www.intuitbiI[ pay. 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 $725.00 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.nridwevttoxieology.com. Midwest ToXicotogy In voice o w wi i i c. DATE INVOICE v 603 East Washington Street, Suite 200, Indianapolis, IN 46204 8/11/2008 158664 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 08/06/08 Pay your bills online at: https://www.intuitbi11pay.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 $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.midwestioxicology.com. Midwest 7ozicofogy Inv oi ce Services, In DATE INVOICE 603 East Washington Street, Suite 200, Indianapolis, IN 46204 8/4/2008 158164 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 Miscellaneous 1 Refusal To Test 25.00 25.00 07/31/08 Pay your bills online at: https://www.intuitbi[]pay.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 longershowing the full SSN on invoices. Total $25.00 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.coin. Widwest Toxicology In v oice 09*� DATE INVOICE 7/31/2008 157981 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 JDT CONTROL P.O. NUMBER JOB SITE TERMS FACILITY 5528 Due on receipt 142376 ITEM CODE QTY DESCRIPTION PRICE EACH AMOUNT ND Drug Test OS 16 Non -DOT Drug Test 55.00 880.00 Collected onsite for Brookshire Golf Course 7/29/08 Fuel Surcharge 1 Fuel Surcharge 10.00 10.00 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. We appreciate your business and thank you for your prompt payment. Total $890.00 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. t Be sure to visit our website at www.nddwesttoxicology.com. ^`3a Midwest 7o.zicotogy In voice Services, Inc. DATE INVOICE •603 East Washington Street, Suite 200, Indianapolis, IN 46204 8/8/2008 158608 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 3 Non -DOT Drug Test 55.00 165.00 Collected at Community Occ. Health Center Carmel Carmel IN 08/02/08 08/03/08 08/05/08 Pay your bills online at: https://wv,tw.intuitbi11pay.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 www.midwesttoxicology.cont Widwest Toxicofogy Inv 44i c. In DATE INVOICE 8/6/2008 158405 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 4 Non -DOT Drug Test 55.00 220.00 Collected at Community Occ. Health Center Carmel Carmel IN 08/02/08 ND Drug Test CS 1 Non -DOT Drug Test 55.00 55.00 Collected at Community Occ. Health Center Carmel Carmel IN 08/04/08 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. 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.in idwesttoxicology.cont. i Midwest Twz colo gy Invoice @N DATE INVOICE 8/12/2008 158776 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 08/02/08 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. Midwest Toj&ofogy Invoic 44i;io DATE INVOICE 603 East Washington Street, Suite 200, Indianapolis, IN 46204 8/12/2008 158847 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 2 Non -DOT Drug Test 55.00 110.00 Collected at Community Occ. Health Center Carmel Carmel IN 08/07/08 Pay your bills online at: https: /www.intuitbil[ pay. com /midwesttoxicologyservicesinc. i 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 www.uiidwesttoxicology.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 ToxiCO106 yee Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 08/08/08 158608 Pre employment Drug Test (3) $165.00 08/06/01 158405 Pre employment Drug Test'(5) $275.00 08/11/0 158664 Pre employment Drug Test (2) $110.00 04/0 E 158164 Refusal to Test $25.00 W/3 15798 Pre employment Drug Test (16) $890.00 0870 1582215 P re-employment Drug Test (13) $725.00 re -emp oymen rug Test (4) $220.00 08/ i 158847 P re-employment rug lest (2) $110.00 D%I M A 158'l% -1 55. DO Total 15�d I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance with IC 5- 11- 10 -1.6. 20 Clerk- Treasurer I VOUCHER PMM$_WARRANT NO. Midwest oxico ogy ALLOWED 20 603 E. Washington St., Suite 200 IN SUM OF Indianapolis, 1N46204 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 n bill(s) is (are) true and correct and that the materials or services itemized thereon for 88 $275.00 which charge is made were ordered and 1201 158664 588 $110 0 received except :129:1 158164 0 1201 157981 588 $890.00 1201 no 1201 158285 588 0 1201 158847 588 $110.00 20 X01 t57 /79e 5T 0V Siqn)ture Cost distribution ledger classification if Title claim paid motor vehicle highway fund