HomeMy WebLinkAbout167663 01/07/2009 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: $165.00
INDIANAPOLIS IN 46204
roe o CHECK NUMBER: 167663
CHECK DATE: 11712009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1201 R4358800 19373 169298 110.00 TESTING FEES
1201 R435880 19373 169614 55.00 TESTING FEES
Midwest Toxicofogy Invoic
•Q� Services, Inc.
DATE INVOICE
603 East Washington Street, Suite 200, Indianapolis, IN 46204 12/24/2Q08 169614
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
12/18108
Jeffrey Grimes
Pay your bills online at:
https:l lwww. intuitbilipay. 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 TOXICOLOGV SERVICES. INC.
For questions regarding this invoice, contact us at 317 162 -2200 or fax us at 3.17 -162 -2222.
Be sure to visit our wehsite at www.mitlwesttoxicologp.corn.
Midwest 7o.Cicotogy Inv oi ce
ffi w� DATE INVOICE
603 East Washington Street, Suite 200, Indianapolis, IN 46204 12/17/2008 169298
BILL TO: SHIP TO:
City of Carmel Names location of collection
Attn: Shelly Lingelbaugh on invoices no ss
1 Civic Square
Carmel, IN 46032
EK
CONTROL P.O. NUMBER JOB SITE TERMS FACILITY
5528 Due on receipt 142376
ITEM CODE QTY DESCRIPTION PRICE EACH AMOUNT
DOT Test 1 DOT Drug Test 55.00 55.00
Collected at Community Occ. Health Center Carmel IN
12/15/08
Travis Tabak
ND Drug Test CS 1 Non -DOT Drug Test 55.00 55.00
Collected at Community Occ. Health Center Carmel IN
12/15/08
Jeffrey Carpenter
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.
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 us at 317- 262 -2200 or fax us at 317 262 -2222.
Be sure to visit our website at wwncn:idwesttoxicalogy.cotn.
Prescrit•ed 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.
Midwest Toxicolodree
Purchase Order No.
Terms
r
Date Due
s Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
12124/09 169614 Pre employment Drug Test (1 $55.00
169298 Random Drug Test (2) $110.00
Total
0
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
VOUCHERIM�WARRA
eS oXICO Ogy} ALLOWED 20
E. Washington St., Suite 200 IN SUM OF
Ind 4620
$165.00
ON ACCOUNT OF APPROPRIATION FOR
General Fund
1201 Human Resources
Board Members
PT INVOICE NO. ACCT /TITLE AMOUNT 1 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
198:73 1
p artial 1692PR 0 0 which charge is made were ordered and
received except
Ar 20
I ature ti
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund