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Home My WebLink About175024 07/22/2009 CITY OF CARMEL, INDIANA VENDOR: 204038 Page 1 of 1 0 ONE CIVIC SQUARE MIDWEST TOXICOLOGY SVS,INC CHECK AMOUNT: $199.00 CARMEL, INDIANA 46032 603 E WASHINGTON ST SUITE 200 INDIANAPOLIS IN 46204 CHECK NUMBER: 175024 CHECK DATE: 7122/2009 DEPARTMENT ACCOUN PO NU MBER INVOICE NUMBER AMOUNT DESCRIPTION 1201 4358800 183850 144.00 TESTING FEES 1201 4358800 184381 55.00 TESTING FEES Midwest Toxicofogy In voi ce Setices, Inc. DATE INVOICE 603 East Washington Street, Suite 200, Indianapolis, IN 46204 7/15/2009 1843$1 BILL TO: SHIP TO: City of Carmel Names location of collection Attn: Shelly Lingelbaugh on invoices no ss 1 Civic Square Carmel, IN 46032 ANB 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 Carmel, IN 7 -13 -09 Michael Wendt 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 Parable 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 www.midwesttoxicologl,.coni. 3fidu est 7oxicofo ay Invo 0 DATE INVOICE 603 East Washington Street, Suite 200, Indianapolis, IN 46204 7/7/2009 183850 BILL TO: SHIP TO: City of Carmel Names location of collection Attn: Shelly Lingelbaugh on invoices no ss #tt 1 Civic Square Carmel, IN 46032 DMH CONTROL P.O. NUMBER JOB SITE TERMS FACILITY 5528 Due on receipt 142376 ITEM CODE OTY DESCRIPTION PRICE EACH AMOUNT ND Drug Test CS 2 Non -DOT Drug Test 55.00 110.00 Collected at Community Occ. Health Center Carmel, IN 6/29/09 Robert Lovell 7/2/09 Donald Snow ND Alcohol CS 1 Non -DOT Breath Alcohol Test 28.00 28.00 Collected at Community Occ. Health Center Carmel, IN 7/2/09 Donald Snow 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 $144.00 Make Checks Payable To: MIDWEST TOXICOLOGY SERVICES, INC. For questions regarding this invoice, contact us at 317 262 -2200 or fax us at 3.17 262 2122. Be sure to visit our website at www.nridFvestto.vicolog.v.coui. Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995) y 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 Toxicology yee Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 07/07/09 183850 Random Drug Test, Accident Drug Alcohol Test $144.00 07/15/09 184381 Pre employment Drug Test $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 N 15 /20 09 WARRANT NO. i ALLOWED 20 E. Washington t., Suite 200 IN SUM OF Indianapolis IN 46204 $199.00 ON ACCOUNT F APPROPRIATION FOR �eneral Fund 1201 Human Resources Board Members PO# or DEPT INVOICE NO. ACCT #/TITLE AMOUNT I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and that the materials or services itemized thereon for 1201 184381 588 G which charge is made were ordered and received except 20 Sign u Title Cost distribution ledger classification if claim paid motor vehicle highway fund