HomeMy WebLinkAbout168610 02/04/2009 CITY OF CARMEL, INDIANA VENDOR: 204038 Page 1 of 1
ONE CIVIC SQUARE MIDWEST TOXICOLOGY SVS,INC CHECK AMOUNT: $55.00
CARMEL, INDIANA 46032 603 E WASHINGTON ST SUITE 200
INDIANAPOLIS IN 46204 CHECK NUMBER: 168610
CHECK DATE: 21412009
DEPARTMENT ACCOUNT PO NUMBER INVO NUMBER AMOUNT DESCRIPTION
1201 R4356800 19373 171031 55.00 TESTING FEES
u�
Midwest Toxicology Invoice
Inc
o ffi DATE INVOICE
a 1/16/2009 171031
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
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
01/14/09
David Turner
Pay your bills online at:
https: /www,intuitbilipay. corn /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 TOXIGOLOGV 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 wwiv.►eidwesttoxicology.coair.
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 ToxiC010§ree
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
P re-employment Drug Test (1 55.00
Total
I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and 1 have audited same in accordance
with 1C 5- 11- 10 -1.6.
20
Clerk- Treasurer
VOUCHER V /02/09 NO.
Mid west oxico ogy ALLOWED 20
IN SUM OF
603 E. Washington St., Suite 200
Indoanapolis,A 462
$55.00
ON ACCOUNT OF APPROPRIATION FOR
General Fund
1201 Human Resources
Board Members
PO4 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
Partial 1 71031 b8b $55.00 materials or services itemized thereon for
which charge is made were ordered and
received except
20
f� Sign r
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund