180488 12/16/2009 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: $110.00
y`? INDIANAPOLIS IN 46204
CHECK NUMBER: 180488
CHECK DATE: 12/16/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1201 4358800 192958 55.00 TESTING FEES
_1201 4358800 194319 55.00 TESTING FEES
w
Midwest 7o.ricofogy Invo
�(a� Services, Inc
DATE INVOICE
12/8/2009 194319
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
LW
CONTROL P.O. NUMBER JOB SITE TERMS FACILITY
5528 Due on receipt 142376
ITEM CODE QTY DESCRIPTION PRICE EACH AMOUNT
ND Drug Test 1 Non -DOT Drug Test 55.00 55.00
Collected at Community Occ Health
11/19/09
Paul Borowicz
D EC 14 2009
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 mehsite at www.midwesttoxicology.com.
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.
Payee
Midwest Toxicology
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
12/08/09 194319 Drug Testing 55.00
Total $55.00
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 N01 211 410 9 WARRANT NO.
ALLOWED 20
4 Midwest T oxicology
IN SUM OF
603 E. Washington Stre Suite 200
Indianapolis, IN 46204
$55.00
ON ACCOUNT OF APPROPRIATION FOR
General Fund
1201 Human Resources
Board Members
PO# or D PT. INVOICE NO. ACCT #/TITLE AMOUNT I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
201 94319 588 55.00 materials or services itemized thereon for
which charge is made were ordered and
received except
20
S' Hato e
a
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Midwest Toxicofogy Invo
Q� Services, Inc.
DATE INVOICE
12/8/2009 192958
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 D $55, A $28
Carmel, IN 46032
JMN
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 Collected at COHC Carmel (Carmel, Indiana) 55.00 55.00
11/16/09
Anthony W. Isenberger
D
DEC 14 2009 1
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 $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 www.niidwestioxicology.com.
T
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.
Payee
Midwest Toxicology Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
12/08/09 192958 Drug Testin
Total $55.00
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 1\101 2 14 09 WARRANT NO.
ALLOWED 20
Midwest To xicology
IN SUM OF
603E. Washington Street, Suite 200
Indianapolis, IN 4620
$55.
ON ACCOUNT OF APPROPRIATION FOR
General Fund
1201 Human Reso
Board Members
PO# or
DEPT. INVOICE NO. ACCT #!TITLE AMOUNT I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
9295$ 588 $55.00 materials or services itemized thereon for
which charge is made were ordered and
received except
20
natu
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund