156716 02/21/2008 CITY OF CARMEL, INDIANA VENDOR: 204038 Page 1 of 1
ONE CIVIC SQUARE MIDWEST TOXICOLOGY SVS,INC CHECK AMOUNT: $83.00
CARMEL, INDIANA 46032 603 E WASHINGTON ST SUITE 200
o� INDIANAPOLIS IN 46204 CHECK NUMBER: 156716
CHECK DATE: 2/21/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1201 R4358800 16631 114074 28.00 DRUG TESTING
1201 R4358800 16631 144612 55.00 DRUG TESTING
y/
Witfwest 7o.Cicofogy In voi ce
offi a DATE INVOICE
603 East Washington Street, Suite 200, Indianapolis, IN 46204
2/1/2008 144074
BILL TO: SHIP TO:
City of Carmel No names or ss #'s
Attn: Shelly Lingelbaugh
1 Civic Square
Carmel, IN 46032
i
REC
CONTROL P.O. NUMBER JOB SITE TERMS FACILITY
5528 Due on receipt 142376
QTY ITEM CODE DESCRIPTION PRICE EACH AMOUNT
1 DOT Alcohol OS DOT Breath Alcohol Test On -Site 28.00 28.00
1/30/08
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.
We appreciate your business and thank you for your prompt payment. Total $28.00
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. cons.
911idwest Toxicology Invoi
DATE INVOICE
offi 2/8/2008 144612
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
SC
CONTROL P.O. NUMBER JOB SITE TERMS FACILITY
5528 Due on receipt 142376
QTY ITEM CODE DESCRIPTION PRICE EACH AMOUNT
1 ND Drug Test CS Non -DOT Drug Test 55.00 55.00
Collected at Community Occ. Health Center Carmel Carmel, IN
2/5/08
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 wwminidwesitoxicology.cont.
i
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
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 Toxicolo Payee
gy
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
02/08/08 144612 Non -DOT Drug Test collected at Comm Occ Health $55.00
Center Indiana (1)
02/01/08 114074 DOT Breath Alcohol Test On -Site $28.00
Total
3.00
1 hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6.
20
Clerk- Treasurer
VOUCHER I`��_$�B�WARRANT NO.
I Wes Oxico Ogy ALLOWED 20
603 E. Washington St., Suite 200 IN SUM OF
IndianaF elis, IN 484
$83.00
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
16631 bill(s) is (are) true and correct and that the
Part 14 4612 588 $55.00 materials or services itemized thereon for
0 which charge is made were ordered and
received except
20
�r
t n4a t u r
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund