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Home My WebLink About179765 11/24/2009 CITY OF CARMEL, INDIANA VENDOR: 204038 Page 1 of 1 ONE CIVIC SQUARE MIDWEST TOXICOLOGY SVS,INC i CHECK AMOUNT: $1,817.00 CARMEL, INDIANA 46032 603 E WASHINGTON ST SUITE 200 INDIANAPOLIS IN 46204 CHECK NUMBER: 179765 CHECK DATE: 11/2412009 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1201 4358800 192378 1,762.00 TESTING FEES 1201 4358800 192386 55.00 TESTING FEES 121 Widwest Toxicology Invoice Services, Inc. OMMD DATE INVOICE 11/11/2009 192378 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 DOT Test OS 7 DOT Drug Test 55.00 385.00 Collected Onsite 11/02/09 Aaron Hoover Utilities Larry Eidson Jr Utilities Micah Beck Utilities 11/03/09 Jeffrey Vanwinkle Street Fred Martz Street Pifer Parks Street 11/04/09 James Bentley Street DOT Alcohol OS 4 DOT Breath Alcohol Test 28.00 112.00 Collected Onsite 11/02/09 Aaron Hoover Utilities Larry Eidson Jr- Utilities Micah Beck Utilities 11/04/09 James Bentley Street 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 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.inidwesttoxicology.coni. Pagel i Widwest Toxicology Inv 0 9 %;io DATE INVOICE 603 East Washington Street, Suite 200, Indianapolis, IN 46204 11 /11 /2009 192378 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 OS 23 Non -DOT Drug Test 55.00 1,265.00 Collected Onsite 11/02/09 Craig Miser DOCS Christopher Walker Fire James Blanchard DOCS David Haboush Fire Ashley Williams Police Mark Paris Police 11/03/09 Paul Pace Utilities Phillip Hobson Police Andrew Wehner Utilities William Kehl Fire Sally LaFollette Fire Jared Kinney Fire Marvin Stewart CCCC Frank Vallone Fire Dawn Pattyn Fire Bruce Gipson Fire 11/04/09 William Gilbert Police Mark Gugel Fire Brad Marcum Fire Jeffrey Steele Fire Shawn Reynolds Fire Daniel Spearman Utilities William Akers CCCC 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 $1,762.00 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 wwminidwesttoxicology.com. Page 2 9Kidwest 7oxicoCogy In voic e DATE INVOICE o w wi i i c. 0 603 East Washington Street, Suite 200, Indianapolis, IN 46204 11/11/2009 192386 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 TSB CONTROL P.O. NUMBER JOB SITE TERMS FACILITY 5528 Due on receipt 142376 ITEM CODE QTY DESCRIPTION PRICE EACH AMOUNT ND Drug Test OS 1 Non -DOT Drug Test 55.00 55.00 Collected Onsite 11/3/2009 Gregory Dewald Police 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.inidwestioxicology.coni. 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)) 11/11/09 192378 Non DOT DOT Random Testing $1,762.00 11/11/09 192386 Non DOT Testing 55.00 Total $1,817.00 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 NOI. 1123/09 WARRANT NO. ALLOWED 20 Midwest Toxicology IN SUM of 603 East Washington St, Suite 200 Indianapolis, IN 46204 $1,817.00 ON ACCOUNT OF APPROPRIATION FOR GENERAL FUND 1201 Human Resources Board Members PO# or INVOICE NO. ACCT #/TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and that the 1201 192378 588 $1,762.00 materials or services itemized thereon for 1201 192386 588 $55.00 which charge is made were ordered and received except 20 ��Sig tur Title Cost distribution ledger classification if claim paid motor vehicle highway fund