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170990 04/16/2009 CITY OF CARMEL INDIANA VENDOR: 204038 Page 1 of 1 ONE CIVIC SQUARE MIDWEST TOXICOLOGY SVS,INC CHECK AMOUNT: $4,956.00 CARMEL, INDIANA 46032 603 E WASHINGTON ST SUITE 200 INDIANAPOLIS IN 46204 CHECK NUMBER: 170990 CHECK DATE: 4/16/2009 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 120.1 R4358800 19373 175886 3,361.00 TESTING FEES 1201 R4358800 19373 176241. 275.00 TESTING FEES 1201 R4358800 19373 176469 55.00 TESTING FEES 1201 R4358800 19373 176668 33.0.00 TESTING FEES 1201 R4358800 19373 176828 16'5.00 TESTING FEES 12.01 R4158800 19373 177261 275.00 TESTING FEES _1201 R4358800,.19373 177300 165.00 TESTING FEES 1201 R4358800 19373 177518 275..00 TESTING FEES 1201 8435,8800 19,373 177545 55.00 TESTING FEES i Midwest Txx cofogy Invoice om wiii DATE INVOICE 3/24/2009 176469 ..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 TSB CONTROL P.O. NUMBER JOB SITE TERMS FACILITY 5528 Due on receipt 142376 ITEM CODE QTY DESCRIPTION PRICE EACH AMOUNT ND Drug Test OS 1 Non -DOT Drug Test 55.00 55.00 Collected Onsite City of Carmel Gregory Dewald 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 $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 sage to visit our website at www.niitlwestio.vicology.com. 911idwest Toxico fo Invo ogwyi DATE INVOICE 603 East Washington Street, Suite 200, Indianapolis, IN 46204 3/27/2009 176668 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 6 Non -DOT Drug Test 55.00 330.00 Collected at Community Occ. Health Center Carmel, IN 3/20/09 Alison Finkelmeier Anita Ahern Bryan Hood 3123/09 William Erickson 3/24/09 Daniel Elmore Nick Eckstein Pay your bills online at: https: /www.intuitbiI[ pay. com /midwesttoxicologyservicesinc. A finance charge will be assessed on all invoices notpaid 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 $330.00 Make Checks Payable To: MIDWEST TOXICOLOGY SERVICES, INC. For questions regarding this invoice, contact us at 317- 262 -2200 orfax its at 317 -262 -2222. Be sure to visit our website at www.ntidwesttoxicologv.cont. Midwest ToXicoto 8y Invoi Services, Inc #Q DATE INVOICE 3/23/2009 176241 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 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 5 Non -DOT Drug Test 55.00 275.00 Collected at Comm. Occ. Health Center Carmel IN 3118/09 Christopher Walker Ashley Williams Andrew Wyant 3/19/09 Bruce Frost Denise Snyder Pay your bills online at: https:// www. intuitbillpay. 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 $275.00 Make Checks Payable To: MIDWEST TOXICOLOGY SERVICES, INC. For questions regarding this itivoice. coutuet us at 3I7- 262 -2200 or fax us at 317 -262 -2222. Be sure to visit our wehsite at www.njidwesttoxicology.cont. Midwest T 'cote Invo 9J' s ,Services, Inc. Q" DATE INVOICE r4. 3/30/2009 176828 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 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 3 Non -DOT Drug Test 55.00 165.00 Collected at Community Occ. Health Center Carmel, IN 3124109 Matt Larson Mark Garrison Daniel Tabeling Pay your bills online at: https:l lwww. 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 $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 317 262 -2222. Be sure to visit our wehsite at wwrt,.midwesttoxicology.coni. ,Tidwest 76xicofogy Invo og DATE INVOICE 603 East Washington Street, Suite 200, Indianapolis, IN 46204 4/3/2009 177300 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... 3 Non -DOT Drug Test 55.00 165.00 Collected at Midwest Indianapolis 4/2/09 Joshua Reddick Stephanie Dufek Matthew Layton Pay your bills online at: https:// www. intuitbillpay. 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 $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 377 -261 -1222. Be sure to visit our website at wivw.niidwesttoxicolo y.cont. Midwest Tozicofogy Invo DATE INVOICE 603 East Washington Street, Suite 200, Indianapolis, IN 46204 4/3/2009 177261 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 5 Non -DOT Drug Test 55.00 275.00 Collected at Community Occ. Health Center Carmel, IN 3129109 Matthew VanBruaene Timothy Byrne 3130109 Thomas Kukla Emma Shipley 3/31/09 Chris Deddens Pay your bills online at: https:// www. intuitbilipay. 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 $275 Make Checks Payable To: MIDWEST TOXICOLOGY SERVICES, INC. For questions regarding this invoice, contact its at 317- 262 -2200 or fax its at 317 262 -2222. Be sure to visit our website at www midivesttoxicology.cons. WiQwest Toxicology Invoi 04R DATE INVOICE 603 East Washington Street, Suite 200, Indianapolis, IN 46204 3/31/2409 175886 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 OS 45 Non -DOT Drug Test Admin., Docs, Engineering, Fire, Police, Utilities 55.00 2,475.00 Collected Onsite Admin 3116109 Gary Lindenmayer 2453 Docs 3/17/09 Daren Mindham 2253 Adam Schriner 1005 3/18109 William Hohit- 1023 Engineering 3116109 Robert Dykstra 2338 Fire 3116/09 Mark Hulett 297 Robert Vanvoorst 101 Timothy Fagin 2164 Timothy Conner 077 Adam Holden 871 Steven Holubik 541 Anthony Keaton 597 3117/09 Frank Cummins 2163 Gregory Starr 745 Kevin Young 3609 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 Make Checks Payable To: MIDWEST TOXICOLOGY SERVICES, INC. For questions regarding this invoice, contact us at 317- 262 -1204 or fax us at 317- 262 -2222. Be sure to visit our website at www.nndwesttoxicolog_v.cont. Pagel Midwest Toxicology In voi ce N wi i i DATE INVOICE 3/31/2009 175886 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 Kip Benbow 2162 3/18/09 Bruce Knott 736 Rebecca Lannan 646 Keith Smith 2598 Renee Butts 785 Michael Medlen 596 David Haborsh 426 Adam Harrington 933 James Foster 827 Robert Hensley 110 Daniel Edwards 732 Police 3116109 Jeffrey Laker 477 Susan Bell 2151 Linda Ross 2153 Jeffrey Horner 516 David Strong 216 Patricia Jable 3300 3/18/09 Luckie Carey 32 Todd Clark 900 Curtis Scott 556 Phillip Hobson 554 Michael Pitman 962 Shane VanNatter 2923 Utilities 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 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 niidivesttoxicology.eotn. Page 2 Midwest 7oxicofogy I n vo ic e o ffl w� DATE INVOICE 603 East Washington Street, Suite 200, Indianapolis, IN 46204 3/31/2009 175886 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 3117109 E. Craig Carter 167 Paul Arnone 433 Ralph Gruwell 1078 Jeffrey Kozlovich 2300 3118109 Clay Campbell 2583 Anthony Isenberger 3000 Sean Whitlow 979 DOT Test OS 10 DOT Drug Test Street 55.00 550.00 Collected Onsite 3/16/09 Ralph Burke 2633 Jason Force 2231 Kurt Kirby 1034 Travis Tabak 967 Randall Johnson 2192 Adam Towns 2365 Michael Williamson 2637 Timothy Browning 2363 3118/09 Crystal Montgomery 2798 Jeff Stewart 727 A finance charge will be assessed on all invoices not paid in 30 days. Thank you foryour business. Thank you for your business! Total 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 wehsite at www.nridwesttoxicologj% coast. Page 3 Midwest Tx6corogy Invoic N *R i DATE INVOICE 3/31/2009 175886 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 DOT Alcohol OS 7 DOT Breath Alcohol Test Street 28.00 196.00 Collected Onsite 3/16/09 Jason Force 2231 Travis Tabak 967 Randall Johnson 2192 Adam Towns 2365 Michael Williamson 2637 Timothy Browning 2363 3/18109 Jeff Stewart 727 Fuel Surcharge 2 Fuel Surcharge 10.00 20.00 DOT Test OS 2 DOT Drug Test Utilities 55.00 110.00 Collected Onsite 3/17/09 Jeff Cooper -456 3/18/09 James Hagg 174 Fuel Surcharge 1 Fuel Surcharge 10.00 10.00 Pay your bills online at: https: /www.intuitbiII pay. 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 $3,361.00 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.midwesttoa:icoiogy.cont. Page 4 id est 4"a icofo Invo M idwest X 8y Services, Inc. GQ� DATE INVOICE 4/9/2009 177661 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 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!4109 Michael Glentzer Pay your bills online at: https:// www. intuitbillpay. com lmidwesttoxicologyservicesinc, 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.inidwesttoxi.coiogy.conr. 9144west 7oXicofogy I nvo i ce Services, c. In �1 DATE INVOICE �a 603 East Washington Street, Suite 200, Indianapolis, IN 46204 4/8/2009 177545 BILL TO: SHIP TO: City of Carmen Names location of collection Attn: Shelly Lingelbaugh on invoices no ss 1 Civic Square Carmel, IN 46032 TSB 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 3/31/2009 Connor Murphy Pay your bills online at: https://wv 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 invo ices. 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. Prescribed by 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. .Midwest ToxicoloVyee Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 03/24109 176469 Random Drug Testing (1) 03/27109 1768680 03/23/09 176241 re -employment Random Drug Testing (6) $33 om rug resting (5) 03/30109 176828 275.00 0410210P 177 nn p oymen rug Testing (3) $165.00 Drug I es ing $165.00 Pre-employment Random Drug Testing (5) $275.00 Testing 3,361.00 4/8/200,C) 177545 PFe employment Drug Random Drug Testing (4) $220.00 4/9/ sing $55.00 Testing $55.00 Total 56.00 1 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 NU NO. ogy ALLOWED 20 Washington St., Suite 200 IN SUM OF Indianapolis, IN 46904 $4,956.00 ON ACCOUNT OF APPROPRIATION FOR General Fund 1201 Human Resources Board Members PO# or INVOICE NO. ACCT #/TITLE AMOUNT I hereby certify that the attached invoice(s), or DEPT. 19 373 bill(s) is (are) true and correct and that the PaFtial 11 716489 555 55.00 materials or services itemized thereon for partial 176668 588 Aiin no which charge is made were ordered and 19373 received except 588 75.00 p artial 19373 partial 177300 588 165.00 19373 partial 175886 588 306 nn 20 +q 2 E) 11758815 88 $55.00 S" nature 1 partial 177518 Title 19373 Cost distribution ledger classification if partial clgi7r?r6�notor veh ighway fu155.00