170497 04/01/2009 CITY OF CARMEL, INDIANA VENDOR: 204038 Page 1 of 1
ONE CIVIC SQUARE MIDWEST TOXICOLOGY SVS,INC CHECK AMOUNT: $990.00
CARMEL, INDIANA 46032 603 E WASHINGTON ST SUITE 200
INDIANAPOLIS IN 46204 CHECK NUMBER: 170497
CHECK DATE: 4/112009
DEPARTMENT ACCOUNT PO NUMBER INVOI NUMBER �AMO DESCR IPTION
1120 4340701 175481 /55.00 MEDICAL EXAM .FEES
1201. R4358800 19373 176103 .110.00 TESTING FEES
1201 R4358800 19373 176225.. X8'25.00 TESTING FEES
4.i
Midwest 7oXicotogy
Invo
Services, Inc.
Q DATE INVOICE
F3/19/2009 176103
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 #I!
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 2 Non -DOT Drug Test 55.00 110.00
Collected at Comm. Occ. Health Center Carmel, IN
3113/09
Nicholas Robinson
Gary Farson
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 $110.00
Make Checks Payable To: MIDWEST TOXICOLOGY SERVICES, INC.
For questions regarding this invoice, contact its at 317 262 -2200 or fax us at 317- 262 -2222.
Be sure to visit our wehsite at rvww.inidwesttovicology.coni.
r
Midwest 7ojoicofogy Invoi
DATE INVOICE
603 East Washington Street, Suite 200, Indianapolis, IN 46204
3/20/2009 176225
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 15 Non -DOT Drug Test 55-00 825.00
Collected at Community Occ. Health Carmel, IN
3116109
William Giles
Mindy Collins
Amy Underwood
3117/09
Carole Gilbride
Todd Robbins
Matthew Molter
John Jokantas
Sarah Harris
Andrew Gerdt
Richard Lovitt
3/18/09
James Mitchell
Donovan Anderson
Darin Troyer
Richard Craig
Ryan Meyer
Pay your bills online at:
https:l /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 $825.00
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 www.midwesttoxicology.com.
Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
r. 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))
Drug Testing 1 5) $825.0
-em to ment Drug Test (2)
Total ttq!is no
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 NO NO.
g y ALLOWED 20
as Ington St., Suite 200 IN SUM OF
Indianapolis, IN 46204
$935.00
ON ACCOUNT OF APPROPRIATION FOR
General Fund
1201 Human Resources
Board Members
D INVOICE NO. ACCT #/TITLE AMOUNT I hereby certify that the attached invoice(s), or
3 bill(s) is (are) true and correct and that the
pa4ial 176225 588 5.00 materials or services itemized thereon for
partial 176103 58 0 which charge is made were ordered and
received except
20
Sign, ure
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Midwest 2oxicoCogy
Invoi
Services, Inc.
DATE INVOICE
f 3/11/2009 175481
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 #I!
1 Civic Square
Carmel, IN 46032
AH
CONTROL P.O. NUMBER JOB SITE TERMS FACILITY
5528 Due on receipt 142376
fTEM 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
03/06/09
Roger Kilburn
Pay your bills online at:
https://www.intuitbillpay.com/midwesttoxicologyservicesinc.
A finance charge will be assessed on ali 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 sure to visit our website at ww".utidtvesttoxicology.cottt.
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
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
175481 Drug Test $55.00
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 NO. f. WARRA NO.
Midwest Toxicology ALLOWED 20
IN SUM OF
603 E. Washington Street, Ste. 200
Indianapolis, IN 46204
$55.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO, ACCT #MTLE AMOUNT Board Members
1120 175481 43- 407.01 $55.00 1 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
MAR 3 0 2009
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund