HomeMy WebLinkAbout179324 11/11/2009 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: $55.00
INDIANAPOLIS IN 46204 CHECK NUMBER: 179324
CHECK DATE: 11111/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1201 4358800 191959 55.00 TESTING FEES
Sgt
Widwest 7o.Vcology Invoice
Services, Inc. DATE INVOICE
11/5/2009 191959
603 East Washington Street, Suite 200, Indianapolis, IN 46204
BILL TO: SHIP 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 rACILi I Y
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 Midwest Indianapolis
10/27/09
Lavernezetta Moore 0575
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.
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 s 191 SR h_" 7,'T 7"
Total
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.
w, ALLOWED 20
IN SUM OF
J
�5.,��
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or INVOICE NO. ACCT #!TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
5s• 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
20
Sign re\
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund