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173453 06/10/2009 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: $413.00 INDIANAPOLIS IN 46204 CHECK NUMBER: 173453 CHECK DATE: 6/10/2009 DEPARTMENT ACCO PO NUMBER INVOI NUMBER AMOUNT DESCRIPTION 1201 4358800 180820 83.00 TESTING FEES 1201 R4358800 19373 180860 165.00 TESTING FEES 1201 R4358800 19373 180931 55.00 TESTING FEES 1201 R4358800 19373 181499 110.00 TESTING FEES Midwest Toxicofogy I n v oice Services, inc Q DATE INVOICE 5/22/2009 180860 603 East Washington Street, Suite 200, Indianapolis, IN 46204 BILL TO: SHIP TO: i City of Carmel Names location of collection Attn: Shelly Lingelbaugh on invoices no ss 1 Civic Square Carmel, IN 46032 MG CONTROL P.O. NUMBER JOB SITE TERMS FACILITY 5528 Due on receipt 142376 ITEM CODE QTY DESCRIPTION PRICE EACH AMOUNT ND Drug Test CS 3 Non -DOT Drug Test 55.00 165.00 Collected at Community Occ. Health Center Carmel, IN 5/13109 Jill Joseph 5/15109 Kimberly Kauffman 5119/09 Kimberly Kauffman Pay your bills online at: https: /www.intuitbiII pay. com /midwesttoxicologyservicesinc. A finance charge will be assessed on alf invoices not paid in 30 days. Thank you for your business. Thank you for your business! Total $165.00 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 www.niidwesttoxicology.cant. Midwest 7oyicofogy In vo i c e Q Services, Inc. DATE INVOICE 603 East Washington Street, Suite 200, Indianapolis, IN 46204 �?f 5/26/2009 180931 BILL TO: SHIP TO: e City of Carmel Names location of collection Attn: Shelly Lingelbaugh on invoices no ss 1 Civic Square Carmel, IN 46032 MG CONTROL P.O. NUMBER JOB SITE TERMS FACILITY 5528 Due on receipt 142376 ITEM CODE QTY DESCRIPTION PRICE EACH AMOUNT ND Drug Test CS I Non -DOT Drug Test 55.00 55.00 Collected at Community Occ, Health Center Carmel, IN 5/20/09 Ethan Dove 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. Thank you for your business! Total $55.00 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 www.midwesttoxicology.cont. Midwest Toxicofogy In 04� 0 DATE INVOICE 46 6/2/2009 181499 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 MG CONTROL P.O. NUMBER JOB SITE TERMS FACILITY 5528 Due on receipt 142376 ITEM CODE QTY 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 5127/09 Shelly Power Scott Hunt Pay your bills online at: https:N www. intuitbillpay. com /midwesttoxicologyservicesinc. A finance charge wilt be assessed on all invoices not paid in 30 days. Thank you for your business. Thank you for your business! 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 377 -262 -2222. Be sure to visit our website at wtvtv.midwesttoxicology.com. Invoice Midwest 7oXicoCogy 2! v DATE INVOICE 603 East Washington Street, Suite 200, Indianapolis, IN 46204 5/22/2009 180820 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 1 Non -DOT Drug Test 55.00 55.00 Collected Onsite 5/18/09 Ashley Williams 4549 ND Alcohol OS 1 Non -DOT Alcohol Test 28.00 28.00 Collected Onsite 5/18/09 Ashley Williams 4549 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 $83.00 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 www.midwesttoxicolog),.com. 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 Toxicolo ftyee Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 180860 Pre employment drug test (3) $165.00 Pre-employment drug test (1) $55.00 06102109! 181499 Pre-employment drug test (2) $110.00 05122109 180820 rug es an coo Test (1) $83.00 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 vb /U8 /0 VO NO. %ARRANT NO. Midwest 1oxig ALLOWED 20 -603 E. Washingten St., 31j�� IN SUM OF Indianapolis, IN 4 6204 $413.00 ON ACCOUNT(3@pkP FOR 1201 Human Resources Board Members 1r INVOICE NO. ACCT #/TITLE AMOUNT I hereby certify that the attached invoice(s), or partial 180860 5$8 bill(s) is (are) true and correct and that the materials or services itemized thereon for 19373 $55.00 which charge is made were ordered and partial 181499 received except 588 $83.00 20 ,1 Si ter n i Cost distribution ledger classification if Title claim paid motor vehicle highway fund