HomeMy WebLinkAbout169076 02/17/2009 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: 169076
A
CHECK DATE: 2117/2009
DEPARTMENT ACCOUNT PO NUMBER INV OICE NUMBER AMOUNT DESCRIPTION
1201 84358800 19373 172245 55.00 TESTING FEES
3 h
Midwest Toxicofo gy I
Services, Inc
Q DATE INVOICE
2/4/2009 172245
603 East Washington Street, Suite 200, Indianapolis, IN 46204
BILL TO: SHIP TO:
City of Carmel Names location of collection
Attn: Smelly Lingelbaugh on invoices no ss
1 Civic Square
Carmel, IN 46032
AH
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
01129/09
Candy Martin
Pay your bills online at:
https: l/ ww w. 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 its at 317- 262 -2222.
Be sure to visit our website at www.ruidwesttoxicolog.v.coni.
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 207 (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.
Payee
Midwest Toxicology
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
02/04/09 172245 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 f.Lt6tMWARRANT NO.
ICO Ogy ALLOWED 20
W ashington St., Suite 200 IN SUM OF
lndianaoolis, IN 462041
$55.00
ON ACCOUNT OF APPROPRIATION FOR
General Fund
1201 Human Resources
Board Members
PO# or
DEPT. 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
$55.00 materials or services itemized thereon for
which charge is made were ordered and
received except
20
Sign r 7-
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund