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Home My WebLink About180193 12/08/2009 CITY OF CARMEL, INDIANA VENDOR: 204038 Page 1 of 1 ONE CIVIC SQUARE MIDWEST TOXICOLOGY SVS,INC CHECK AMOUNT: $728.00 ,?a CARMEL, INDIANA 46032 603 E WASHINGTON ST SUITE 200 INDIANAPOLIS IN 46204 CHECK NUMBER: 180193 CHECK DATE: 12/812009 DEPARTMENT ACCOUNT PO N UMBER INVOICE NUMBER AMOUNT DES CRIPTI ON 1201 4358800 192776 563.00 TESTING FEES 1201 4358800 192952 55.00 TESTING FEES 1201 4358800 193304 55.00 TESTING FEES 1201 4358800 193545 55.00 TESTING FEES i Widwest Toxicofogy Inc Q Services, Inc. DATE INVOICE k 11/16/2009 192776 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 ANB CONTROL P.O. NUMBER JOB SITE TERMS FACILITY 5528 Due on receipt 142376 ITEM CODE QTY DESCRIPTION PRICE EACH AMOUNT ND Drug Test CS 9 Non -DOT Drug Test 55.00 495.00 Collected at Community Occ. Health Center Carmel, IN 10 -26 -09 Matthew Broadnax Tim Coffey 11 -2 -09 Gregory Webb 11 -4 -09 Trent McIntyre D Gary LaFollette DEC 0 7 Kent Steury 11 -5 -09 BY Jeffery Bondurant Dawn Pattyn 11 -6 -09 John Thomas ND Alcohol CS 2 Non -DOT Breath Alcohol Test 28.00 56.00 Collected at Community Occ. Health Center Carmel, IN 10 -26 -09 Matthew Broadnax Tim Coffey BAT Surcharge 2 Please note that you are being charged an additional fee due to your 6.00 12.00 collection site breath alcohol charges. 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 $563.00 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.rnidwesttoxicology.com. Midwest Toxicology Invo DATE INVOICE 603 East Washington Street, Suite 200, Indianapolis, IN 46204 11/18/2009 192952 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 SM 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 Center in Carmel, IN 11/7/09 Jeremy Johnson 1762 D Q DEC 0 7 c B y 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.midwesttoxicology.com. 9Kidwest 7o.xicoCogy In ,Services, Inc. DATE INVOICE 12/1/2009 193545 603 East Washington Street, Suite 200, Indianapolis, IN 46204 S BILL TO: HIP TO: Names location of collection City of Carmel on invoices no ss Attn: Jim Spelbring Email results to Barb Lamb cc Jim 1 Civic Square Still Mail results to Jim Carmel, IN 46032 LW CONTROL P.O. NUMBER JOB SITE TERMS F 5528 Due on receipt ITEM CODE CITY DESCRIPTION PRICE EACH AMOUNT ND Drug Test 1 Non -DOT Drug Test 55.00 55.00 Collected at Midwest Indianapolis 11!12/09 Elizabeth Earlywine bPC P 7 M9 Hy A finance charge will be assessed on all invoices not paid in 30 days. Thank you for your business. Total $55.00 Thank you for your business! Make Checks Payable To: MIDWEST TOXICOLOGY SERVICES, INC. For questions regarding this invoice, contact us at 317 262 -2200 or fax its at 317 262 -2222. Be sure to visit our rvebsite at iv n,rv.inidivesttoxicology.coni. Midwest To.#cofogy I @*Oi DATE INVOICE 603 East Washington Street, Suite 200, Indianapolis, IN 46204 12/1/2009 193304 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 ANB 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 Carmel, IN 11 -12 -09 William McGee D Q DEC 0 7 2009 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.midwesttoxicologv.com. Prescribed by State Board Qf 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)) 11/16/09 192776 Random Drug Testing 563.00 11/18/09 192952 Non -DOT Testing 55.00 12/01/09 193545 Non -DOT Testing 55.00 12/01/09 193304 Non -DOT Testing 55. Total $728.00 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 2 07 09 WARRANT NO. ALLOWED 20 Midwest To xicology IN SUM OF 603 East Washington Street, Suite 200 Indianapolis, IN 4 $7 28.00 ON ACCOUNT OF APPROPRIATION FOR General Fund 1201 Human Re sources Board Members PO# or INVOICE NO. ACCT #/TITLE AMOUNT I hereby certify hat the attached invoice(s), or DEPT. y y bill(s) is (are) true and correct and that the 201 192776 588 $563.00 materials or services itemized thereon for 1201 192952 588 $55.00 which charge is made were ordered and 1201 193545 588 $55.00 received except 1201 193304 588 $55.00 20 r i natu e Title Cost distribution ledger classification if claim paid motor vehicle highway fund