177767 09/29/2009 F CITY OF CARMEL, INDIANA VENDOR: 204038 Page 1 of 1
ONE CIVIC SQUARE MIDWEST TOXICOLOGY SVS,INC CHECK AMOUNT: $165.00
CARMEL, INDIANA 46032 603 E WASHINGTON ST SUITE 200
INDIANAPOLIS IN 46204 CHECK NUMBER: 177767
CHECK DATE: 9129/2009
DEPARTMENT ACCOUNT PO NUMBER I NUMBER A MOUNT DESCRIPTION
1201 4358800 187892 55.00 TESTING FEES
1201 4358800 188290 55.00 TESTING FEES
1201 4358800 188349 55.00 TESTING FEES
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I
Tidwest 2'oxicofogy Invoice
Services, Inc.
DATE INVOICE
603 East Washington Street, Suite 200, Indianapolis, IN 46204
9/15/2009 188349
BILL TO: SHIP TO:
City of Carmel Names location of collection
Attn: Shelly Lingelbaugh on invoices no ss
1 Civic Square
Carmel, IN 46032
MG
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
918109
Gregory Bedell
A finance charge will be assessed on all invoices not paid in 30 days. Thank you for your business.
Thank you for your business! I 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 wrvwanidwesttoxicology.conc.
i
,Vidwest Toxicology Invoi
o ffi w� DATE INVOICE
603 East Washington Street, Suite 200, Indianapolis, IN 46204
9/15/2009 188290
BILL TO: SHIP TO:
City of Carmel Names location of collection
Attn: Shelly Lingelbaugh on invoices no ss
1 Civic Square
Carmel, IN 46032
MG
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
9/10/09
Aaron Hoover
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 as at 317 262 -2222.
Be sure to visit our website at wwmmidivesttoxicology.com.
Midwest ToXicoCogy Invo
_Services, Inc.
fi DATE INVOICE
603 East Washington Street, Suite 200, Indianapolis, IN 46204 9/912009 187892
BILL TO: SHIP TO:
City of Carmel Names location of collection
Attn: Shelly Lingelbaugh on invoices no ss
1 Civic Square
Carmel, IN 46032
DMH
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
9/2/09
Brian Ballard
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.
1
Prescribed by Slate 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.
Midwest Toxicolopy
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
09/15/09 188349 Pre employment drug test (1) $55.00
5/09 188290 Random Drug Test (1) $55.00
87892 Pre employment drug test (1) $55.00
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 N ®9 /09 WARRANT NO.
ALLOWED 20
603 E Washington St., ul e 200 IN SUM OF
Indianapolis, IN 46204
$165.00
ON ACCOUNT8F A PRIgTION FOR
enerall IFundd
1201 Human Resources
Board Members
PO# or D PT. INVOICE NO. ACCT #!TITLE AMOUNT I hereby certify that the attached invoice(s), or
1201 188349 588 0 bill(s) is (are) true and correct and that the
materials or services itemized thereon for
188290 588 $55.00 which charge is made were ordered and
12n1 1 received except
0
20
Sign to
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund