HomeMy WebLinkAbout177317 09/15/2009 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: 177317
CHECK DATE: 9/15/2009
DEPART AC COUNT P O NUMBER INVOICE N UMBER AMOUNT DESCRIPTION
1201 4358800 187537 55.00 TESTING FEES
'"R
Midwest Toxicolo
gy Invoice
o ffi WiR i DATE INVOICE
603 East Washington Street, Suite 200, Indianapolis, IN 46204 9/2/2009 187537
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 Comm. Occ. Health Carmel, IN
8/28/09
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.itzidwesttoxicology.com.
ad b 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.
Midwest Toxicolo&
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
09/02/09 187537 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
VOUCHEFO1 WARRANT NO.
gy
ALLOWED 20
W ashington St., Suite 200 IN SUM OF
Indianapolis, IN 46204
$55.00
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
materials or services itemized thereon for
which charge is made were ordered and
received except
20
Sig azure f
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund