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Home My WebLink About172449 05/13/2009 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: $275.00 INDIANAPOLIS IN 46204 CHECK NUMBER: 172449 CHECK DATE: 5113!2009 DE PARTMENT ACCOUNT PO NUMB INVOICE NUMBE AMOUNT D ESCRIPTION 1201 R43.58800 19373 178759 55.00 TES'T'ING FEES X201 R4358800 19373 179382 165.00 TESTING FEES "1201 R4358800 19373 179635 55.00 TESTING FEES Midwest Toxicology Invoi Seruiees, Inc DATE INVOICE 5/6/2009 179635 603 East Washington Street, Suite 200, Indianapolis, IN 46204 BILL TO: SHIP TO: City of Carmel Names location of collection Attn: Shelly Lingelbaugh on invoices no ss 1 Civic Square Carmel, IN 46032 KK CONTROL P.O. NUMBER JOB SITE TERMS FACILITY 5528 Due on receipt 142376 ITEM CODE QTY DESCRIPTION PRICE EACH AMOUNT ND Drug Test M... 1 Non -DOT Drug Test 55.00 55.00 Collected at Midwest Indianapolis 4130109 Kent Paulin Pay your bills online at: https:/Iwww.intuitbiltpay.com/midwesftoxicologyservicesinc. 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: A1dDWEST•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 wehsite at www.ntidwestio.vicolol yi.cottt. Midwest Toxicofogy Invoi aQ Servues, Inc DATE INVOICE 603 East Washington Street, Suite 200, Indianapolis, IN 46204 5/4/2009 179382 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 Community Occ. Health Center Carmel, IN 4128109 Michael Calvert 4130109 Andrew Fritts Matthew Bickel Pay your bills online at: https: l/ www. intuitbiIIpay. com /midwesttoxicologyservicesinc. 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 $165.00 Make Checks Payable To: MIDWEST TOXICOLOGY SERVICES, INC. For questions regarding this invoice, contact us at 317- 262 -2200 orfax us at 3.17- 262 -2222. Be sure to visit our website at www.ntidwesttoxi.cology.conr. r q 36dwest Toxicofogy Invoice Services, Inc. DATE INVOICE 603 East Washington Street, Suite 200, Indianapolis, IN 46204 4/23/2009 178759 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 4!20109 Hannah Calhoun Pay your bills online at: https:// www. intuitbiIIpay. com /midwesttoxicologyservicesinc. 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 websile at www.midwesttoxicology.com. 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. Midwest Toxicology ayee Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 5 04109 179382 Pre employment drug test (3) $165.00 79635 Pre employment drug test (1) $55.00 04723709 WVb9 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/ 1 /e9 WARRANT NO. Midwest OXICO Ogy ALLOWED 20 603 E. Washington St., Suite 200 IN SUM OF Indianapolis, IN 46620 $275.00 ON ACCOUNT OF APPROPRIATION FOR General Fund 1201 Human Resources Board Members D PT. or INVOICE NO. ACCT #/TITLE AMOUNT I hereby certify that the attached invoice(s), or 19373 bill(s) is (are) true and correct and that the 65.00 materials'or services itemized thereon for p artial 179635 which charge is made were ordered and 19373 received except partial 8759 588 $55.00 20 'gnatur Title Cost distribution ledger classification if claim paid motor vehicle highway fund