HomeMy WebLinkAbout178288 10/14/2009 CITY OF CARMEL, INDIANA VENDOR: 204038 Page 1 of 1
ONE CIVIC SQUARE MIDWEST TOXICOLOGY SVS,INC CHECK AMOUNT: $55.00
CARMEL, INDIANA 46032 603 E WASHINGTON ST SUITE 200
INDIANAPOLIS IN 46204 CHECK NUMBER: 178288
CHECK DATE: 10/14/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AM DESCRIPTION
1201 4358800 189878 55.00 TESTING FEES
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Midwest Toxicology Invo
04� DATE INVOICE
603 East Washington Street, Suite 200, Indianapolis, IN 46204 10/6/2009 189878
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
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CONTROL P.O. NUMBER JOB SITE TERMS FACILITY
5528 Due on receipt 142376
ITEM CODE QTY DESCRIPTION PRICE EACH AMOUNT
DOT Test 1 DOT Drug Test 55.00 55.00
Collected at Community Occ. Health Center Carmel, IN
10/2/09
George M. Kalogeros
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 website at www.midwesttoxicology.com.
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Aresorits"d llg 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
1 co) Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
a 09 r7 g T, 5 4-
Total 'Y,
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. j WARRANT NO.
S ALLOWED 20
IN SUM OF
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or INVOICE NO. ACCT #!TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
Izvl 1 -55- 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
nature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund