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176352 08/19/2009 CITY OF CARMEL, INDIANA VENDOR: 204038 Page 1 of 1 b t ONE CIVIC SQUARE MIDWEST TOXICOLOGY SVS,INC CARMEL, INDIANA 46032 603 E WASHINGTON ST SUITE 200 CHECK AMOUNT: $1,822.00 INDIANAPOLIS IN 46204 CHECK NUMBER: 176352 CHECK DATE: 811 912 0 0 9 Z)EPARTM E NT ACCOUNT PO NUM INV NUMB AMOUNT D ESCRIPTION '1201 4358800 185546 1,623.00 TESTING FEES 1201 4358800 185798 199.00 TESTING FEES Midwest Toxicolog I n v o ic e Services, Inc DATE INVOICE Y S 8/3/2009 185546 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 KK CONTROL P.O. NUMBER JOB SITE TERMS FACILITY 5528 Due on receipt 142376 ITEM CODE QTY DESCRIPTION PRICE EACH AMOUNT DOT Test OS 9 DOT Drug Test Street Utilities 55.00 495.00 Collected Onsite 7/29109 Randy Massingill 841 Utilities Micah Beck 1026 Utilities James Bentley 972 Street Jeffrey Van Winkle 2039 Street Ronald Williams 5333 Street Michael Clark 2636 Street Damian Delph 2191 Street Joseph Facett 278 Utilities 7/30/09 Calvin Cooper Jr. 777 Utilities DOT Alcohol OS 1 DOT Breath Alcohol Test 28.00 28.00 Collected Onsite 7130109 Calvin Cooper Jr. 777 Utilities A finance charge will be assessed on all invoices not paid in 30 days. Thank you for your business. Thank you for your business! Total Make Checks Payable To: MIDWEST TOXICOLOGY SERVICES, INC. For questions regarding this invoice, contact us at 377 -262 -2200 or fax us at 317- 262 -2222. Be sure to visit our website at wwminidwesttoxicolog Pagel ti Midwest 7oXicafogy I n v o i c e Services, Inc. QATE INVOICE 603 East Washington Street, Suite 200, Indianapolis, IN 46204 8/3/2009 185546 BILL TO: SHIP TO: City of Carmel Names location of collection Attn: Shelly Lingelbaugh on invoices no ss 1 Civic Square Carmel, IN 46032 KK CONTROL P.O. NUMBER JOB SITE TERMS FACILITY 5528 Due on receipt 142376 ITEM CODE QTY DESCRIPTION PRICE EACH AMOUNT ND Drug Test OS 20 Non -DOT Drug Test CCCC, Fire, Police Utilities 55.00 1,100.00 Collected Onsite 7/29/09 Kevin Buhmann 557 Utilities Janet Arnone 250 CCCC Michael Dixon 34 Police Brian Tolan 2258 Utilities Amadou Diallo 2634 Utilities Gregory Dawson 5217 Police John McAllister 370 Police Dennis Russ 1048 Utilities Michael DeLong 868 Fire Kevin Young 3909 Fire 7130/09 Bradley Marcum 873 Fire Kurt Weddington 749 Fire Michael Fogarty 606 Police David Mulford 935 Fire Richard Alvarez 2122 Police 7/31/09 Thomas Payne 741 Fire Jeremy Johnson 2455 Fire Mark Callahan 075 Craig Phillips 569 Fire Mitchell Robinson 743 Fire A finance charge will be assessed on all invoices not paid in 30 days. Thank you for your business. Thank you for your business! Total $1,623.00 Make Checks Payable To: MIDWEST TOXICOLOGY SERVICES, INC. For questions regarding this invoice, contact us at 3.17- 262 -2200 or fax us at 317 261 2221. Be sure to visit our website at tvtvt+:ntidwesttoxicology.cont. Page 2 Midwest TxX cotogy Invo Services, Inc DATE INVOICE 8/6/2009 185798 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 DMH CONTROL P.O. NUMBER .JOB SITE TERMS FACILITY 5528 Due on receipt 142376 ITEM CODE QTY DESCRIPTION PRICE EACH AMOUNT DOT Test CS NC 2 DOT Drug Test 55.00 110.00 Collected at Community Occ. Carmel, IN 813!09 Randall Johnson Nicholas Southeriand ND Drug Test CS 1 Non -DOT Drug Test 55.00 55.00 Collected at Community Occ. Carmel, IN 8!3109 Nicholas Southerland DOT Alcohol CS 1 DOT Breath Alcohol Test 28.00 28.00 Collected at Community Occ. Carmel, IN 8!3109 Randall Johnson BAT Surcharge 1 Please note that you are being charged an additional fee due to your 6.00 6.00 collection site breath alcohol charges. A finance charge will be assessed on all invoices not paid in 30 days. Thank you for your business. Thank you for your business! Total $199.00 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 wmmmidwesttoxicology.coin. 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. Midwest Toxicolour Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 185546 Random Drug Testing (29) alcohol (1) $1 623.00 98 Random Drug Testing (3) alcohol (1) $199.00 Total 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 VOUCHEFO'8 7109WARRANT NO. s OXICO ogy ALLOWED 20 6Q3 E. Washington St., Suite 200 IN SUM OF Indisnarmlis, IN 46204 $1,822.00 ON ACCOUNT OF APPROPRIATION FOR General Fund 1201 Human Resources Board Members DEPT. or INVOICE NO. ACCT #/TITLE AMOUNT I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and that the i2ei 185548 588 '62= materials or services itemized thereon for 1201 185798 588 which charge is made were ordered and received except 20 Sig e Title Cost distribution ledger classification if claim paid motor vehicle highway fund