155422 01/10/2008 i
CITY OF CARMEL, INDIANA VENDOR: 204038 Page 1 of 1
ONE CIVIC SQUARE MIDWEST TOXICOLOGY SVS,INC
s 0 CHECK AMOUNT: $330.00
CARMEL, INDIANA 46032 sos e WASHINGTON ST suire zoo
INDIANAPOLIS IN 46204 CHECK NUMBER: 155422
CHECK DATE: 1/10/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1201 4358800 140854 165.00 TESTING FEES
?201 4358800 141018 110.'OO,TESTING FEES
1201 4358800 141054 55.00 TESTING FEES
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Midwest To.Cicofogy Invoice
Q Services, Inc. DATE INVOICE
g 12/19/2007 140854
r 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
QTY ITEM CODE DESCRIPTION PRICE EACH AMOUNT
3 ND Drug Test Non -DOT Drug Test 55.00 165.00
Collected on -site
12/14/07
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 $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 rvww.inidivesttovicology.cone.
Midwest 7o.zicoCogy
I
Servues, Inc
DATE INVOICE
12/21/2007 141018
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
RE
CONTROL P.O. NUMBER JOB SITE TERMS FACILITY
5528 Due on receipt 142376
QTY ITEM CODE DESCRIPTION PRICE EACH AMOUNT
2 ND Drug Test M... Non -DOT Drug Test at Midwest Indy 55.00 110.00
12/19/07
Pay your bills online at:
https://www.intuitbi[Ipay.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 $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.midwesttoxicology.corn.
e
Widwest 7oXicofo 9y Invoic
Services, Inc
DATE INVOICE
603 East Washington Street, Suite 200, Indianapolis IN 46204 12/21 /2007 141054
BILL TO: SHIP TO:
City of Carmel No names or ss #'s
Attn: Shelly Lingelbaugh
1 Civic Square
Carmel, IN 46032
REC
CONTROL P.O. NUMBER JOB SITE TERMS FACILITY
5528 Due on receipt 142376
QTY ITEM CODE DESCRIPTION PRICE EACH AMOUNT
1 ND Drug Test M... Non -DOT Drug Test at Midwest Indy 55.00 55.00
12/20/07
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 $55.00
Make Checks Payable To: MIDWEST TOXICOLOGY SERVICES, INC.
For questrolts regarding this invoice, contact us at 317- 262 -2200 or fax us at 317 -262 -2222.
Be sure to visit our wehsite at www.tnidwesttoxicologv.con'.
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))
12/19/07 140854 Non -DOT Drug Test on -site 3 $165.00
12/21107 141018 Non -DOT Alcohol T est at Midwest (2) $110.00
12/21/07 141054 Non -DOT Alcohol Test at Midwest (1) $55.00
Total
,.:.1
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.
x
eat
20
Clerk Treasurer `s
VOUCHER t)q)/0,7A)8--WAR RANT NO.—
Midwest I o 'Icology ALLOWED 20
603 E. Washington St., Suite 200 IN SUM OF
Ind IN 46:204
$330.00
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
1201 14U8b4 b88 $165.00 materials or services itemized thereon for
1201 141niR r; A Iq 411 In no which charge is made were ordered and
received except
1201 141054 588 $55.00
20
Sirture
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund