HomeMy WebLinkAbout203945 11/21/2011 CITY OF CARMEL, INDIANA VENDOR: 204038 Page 1 of 1
f ONE CIVIC SQUARE MIDWEST TOXICOLOGY SVS,INC CHECK AMOUNT: $200.00
CARMEL, INDIANA 46032 603 E WASHINGTON ST SUITE 200
INDIANAPOLIS IN 46204
CHECK NUMBER: 203945
CHECK DATE: 11/2112011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1201 4358800 251356 200.00 TESTING FEES
Widwest To. cofogy Invo
o DATE INVOICE
603 East Washington Street, Suite 200, Indianapolis, IN 46204 11/7/2011 251356
BILL TO: SHIP TO:
City of Carmel Names location of collection
Attn: Jim Spelbring on invoices no ss
1 Civic Square Email results to Barb Lamb cc Jim
Carmel, IN 46032 Still Mail results to Jim
DAC
CONTROL P.O. NUMBER JOB SITE TERMS FACILITY
5528 Due on receipt 142376
ITEM CODE QTY DESCRIPTION PRICE EACH AMOUNT
DOT Test 1 DOT Drug Test 55.00 55.00
Collected at Community Occ. Health Center (MedCheck) Carmel
1114111
Kurt Kirby
DOT Alcohol CS 1 DOT Breath Alcohol Test 28.00 28.00
Collected at Community Occ. Health Center (MedCheck) Carmel
11/4/11
Kurt Kirby
BAT Surcharge 1 Please note that you are being charged an additional fee due to your 7.00 7.00
collection site breath alcohol charges.
ND Drug Test CS 2 Non -DOT Drug Test 55.00 110.00
Collected at Community Occ. Health Center (MedCheck) Carmel
1114111
Lisa Garrett
Donna Craig
D Q
NOV 21 2011
By
A finance charge will be assessed on all invoices not paid in 30 days. Thank you for your business.
Thank you for your business! Total $200.00
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 tivrviv.niidivesttaricolog{ ,-.cons.
VOUCHER NO. WARRANT NO.
ALLOWED 20
Midwest Toxicology
IN SUM OF
603 East Washington Street, Suite 200
Indianapolis, IN 46204
$200.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel HR Department
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
1201 251356 43- 588.00 $200.00 I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
Wednesday, November 16, 2011
n
Director, HR
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
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
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
11/07/11 251356 $200.00
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