HomeMy WebLinkAbout162432 08/07/2008 CITY OF CARMEL, INDIANA VENDOR: 204038 Page 1 of 1
ONE CIVIC SQUARE MIDWEST TOXICOLOGY SVS,INC
CARMEL, INDIANA 46032 603 E WASHINGTON ST SUITE 200 CHECK AMOUNT: $224.00
INDIANAPOLIS IN 46204
CHECK NUMBER: 162432
CHECK DATE: 8/7/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCR
1201 4358800 152131 224.00 TESTING FEES
.1
9lfidwest 7oxicotogy inv
Services, Inc.
DATE INVOICE
l
603 East Washington Street, Suite 200, Indianapolis, IN 46204 5/13/2008 152131
F O: SHIP TO:
f Carmel No names or ss #'s
Shelly Lingelbaugh c Square
Carmel, IN 46032
PH
CONTROL P.O. NUMBER JOB SITE TERMS FACILITY
5528 Due on receipt 142376
QTY ITEM CODE DESCRIPTION PRICE EACH AMOUNT
2 ND Drug Test CS Non -DOT Drug Test 55.00 110.00
Collected at Community Occ. Health Center Carmel Carmel, IN
5/08/08
2 ND Drug Test CS Non -DOT Drug Test 55.00 110.00
Collected at Community Occ. Health Center Carmel Carmel, IN
5/09/08
4 Collection Site S... Please note that you are being charged an additional fee due to your 1.00 4.00
collection site urine collection charge.
Pay your bills online at:
https:// www. ihtuitbillpay. 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 $224.00
A4ake Checks Payable To: MIDWEST TOXICOLOGY SERVICES, INC.
For questions regarding this invoice, contact us at 317- 262 -2100 or fax us at 317- 262 -2111.
Be sure to visit our website at wivw.mid;vesttoxicology.cotn.
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.
Payee
Midwest Toxicology
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
0511 Wng 1 S91 31 P re-employment Drug Test (4) $224.00
I
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
VOUCHER M04MB_WARRANT NO.
OXICO Ogy ALLOWED 20
603 E. W ashington St., Suite 200 IN SUM OF
Indianapolis IN 4620
$224.00
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
q281 152131 Odd 24.00 materials or services itemized thereon for
which charge is made were ordered and
received except
20
Sig aure
Cost distribution ledger classification if Title V
claim paid motor vehicle highway fund