206357 02/14/2012 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: $165.00
INDIANAPOLIS IN 46204
CHECK NUMBER: 206357
CHECK DATE: 2/14/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1201 R4358800 26423 258241 55.00 TESTING FEES
1201 R4358800 26423 258888 110.00 TESTING FEES
Widwest 7oxicology Invo
Services, Inc. 4f 'jz3
Q` DATE INVOICE
1 /31/2012 258241
603 East Washington Street, Suite 200, Indianapolis, IN 46204
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
KK
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 (MedCheck) Carmel
01/25/12
Amanda Foley
D Q
FEB 13 2012
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 $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 wehsite at wwminidwesttoxicologâ–şy.coin.
Midwest 7oxicotogy 2 0z -3 z O
DATE INVOICE603 East Washington Street, Suite 200, Indianapolis, IN 46204 2/7/2012 258888
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
KK
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 (MedCheck) Carmel
01/31/12
Jimmie Kittermen 3108
Clay Campbell 3397
D Q
FEB 13 2012
By
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.midwesttoxicology.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.
Payee
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
01/31/12 258241 $55.00
02/07/12 258888 $110.00
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
VOUCHER NO. WARRANT NO.
ALLOWED 20
Midwest Toxicology
IN SUM OF
603 East Washington Street, Suite 200
Indianapolis, IN 46204
$165.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel HR Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
26423 258241 43- 588.00 $55.00 I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
26423 258888 43- 588.00 $110.00
materials or services itemized thereon for
which charge is made were ordered and
received except
Monday, February 13, 2012
Director, H R
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund