176854 09/02/2009 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: $990.00
nor
INDIANAPOI_16 IN 46204 CHECK NUMBER: 176854
CHECK DATE: 9/2/2009
DEP ARTMENT ACCOU PO NUMBER INVOICE NUMBER AM DESCRIPTION
1201 4358800 186209 605.00 TESTING FEES
1201 4358800 186392 165.00 TESTING FEES
1201 4358800 186807 220.00 TESTING FEES
Midwest Toxicology I
04� DATE INVOICE
603 East Washington Street, Suite 200, Indianapolis, IN 46204 8/24/2009 186807
S
BILL TO: HIP 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 4 Non -DOT Drug Test 55.00 220.00
Collected at Comm. Occ. Health Carmel, IN
8113109
Mathew Eckstein
8115109
James Davis
8119109
Eric Frenzel
8120109
David Copley
A finance charge will be assessed on all invoices notpaid in 30 days. Thank you for your business.
Thank you for your business! Total $220.00
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 ivebsite at rv;4?w.niidsvesttoxicology.con:.
Midwest Toyicofogy I n v o i ce
Q Services, Inc
DATE INVOICE
603 East Washington Street, Suite 200 Indianapolis, IN 46204 8/17/2009 186392
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 3 Non -DOT Drug Test 55.00 165.00
Collected at Comm. Occ. Carmel, IN
8112109
Chad Hughes
Troy Smith
8/13/09
Joshua Haus
A finance charge will be assessed on al! invoices not paid in 30 days. Thank you for your business.
Thank you for your business! Total $165.00
Make Checks Payable To: MIDWEST TOXICOLOGY SERVICES, INC.
For questions regarding this invoice, contact us at 317- 262 -2200 or fax us at 3.17 -262 -2222.
Be sure to visit our website at wwminidwesttoxicolob y.com.
W idwest 7o)t cofogy Inv
Services, Inc.
DATE INVOICE
t4
603 East Washington Street, Suite 200, Indianapolis, IN 46204 r8/13/2009 186209
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
DOT Test CS NC 1 DOT Drug Test 55.00 55.00
Collected at Comm. Occ. Health Carmel, IN
8/10/09
Calvin Cooper
ND Drug Test CS 10 Non -DOT Drug Test 55.00 550.00
Collected at Community Occ. Health Carmel, IN
8/5/09
Matthew Layton
Robert Dykstra
8/6/09
William Stites
Curtis Scott
Jonathan Palmer
8/7/09
Michael Mabie
Michael Miller
8/9109
Richard Lovitt
8110/09
Aaron Dietz
Jacob DeFord
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 $605.00
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 svww.tnidwesttoxicology.co n.
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
Midwest Toxicology
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
08/17/09 186392 Random Drug Testing (3) $165.00
08113/09 186209 Random Drug Testing (11) $605.00
08/24/09 186807 Random Drug Testing (4) $220.00
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 NW NO.
�1A+�l�n►Pe� T•,•�� ALLOWED 20
60-3 VVC40ilillyton St., u1 e IN SUM OF
Indianapolis, IN 46204
$990.00
ON ACCOUNT nIATION FOR
1201 Human Resources
Board Members
Po r r INVOICE NO. ACCT #/TITLE AMOUNT I hereby certify that the attached invoice(s), or
1201 0 bill(s) is (are) true and correct and that the
materials or services itemized thereon for
120 1 86209 588 $605.00 which charge is made were ordered and
1201 JAPOrl-7 received except
0
20
Slgna 1 Irle
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund