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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