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Home My WebLink About210957 07/17/2012 CITY OF CARMEL, INDIANA VENDOR: 204038 Page 1 of 1 ONE CIVIC SQUARE MIDWEST TOXICOLOGY SVS,INC CHECK AMOUNT: $1,970.00 ?o CARMEL, INDIANA 46032 603 E WASHINGTON ST SUITE 200 INDIANAPOLIS IN 46204 CHECK NUMBER: 210957 CHECK DATE: 7/17/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1201 4358800 271516 1, 550 . 00 TESTING FEES 1201 4358800 271604 55 . 00 TESTING FEES 1201 4358800 271837 90 . 00 TESTING FEES 1201 4358800 272013 110 . 00 TESTING FEES 1201 4358800 272596 165 . 00 TESTING FEES Midwest Taricofogy Invoice @9*W PAY ENT DUB DATE INVOICE# UPON RECEIPT 6/26/2012 271516 603 East Washington Street,Suite 200,Indianapolis,IN 46204 BILL TO: SHIP TO: City of Carmel Names & location of collection Attn: Jim Spelbring on invoices - no ss#!! 1 Civic Square Email results to Barb Lamb &cc Jim . Carmel, IN 46032 Still Mail results to Jim KK CONTROL# P.O. NUMBER JOB SITE# TERMS FACILITY# 5528 Due on receipt 142376 ITEM CODE QTY DESCRIPTION PRICE EACH CLASS AMOUNT ND Drug Test... 15 Non-DOT Drug Test 55.00 Indiana 825.00 Collected Onsite 06/19/12 Dennis Russ Sr. Brian Tolan Sean Whitlow Alexander Brown Vernon Peterson LY Darin TroyerSteven Baskerville Nancy Zellers 12 i William Miser John McAllister James Toney Ryan Meyer Bruce Graham Gregory Dawson Troy Smith ND Drug Test... 8 Non-DOT Drug Test 55.00 Indiana 440.00 Collected Onsite 06/20/12 Mike Medlen Cody Barlow Christhian Rodriguez Richard Viehe Jeffrey Grimes Wes Nicley Joseph Butts Bryan Mason Fuel Surcharge 1 Fuel Surcharge-06/20/12 10.00 Indiana 10.00 A finance charge will be assessed all invoi es not id in 30 days.Thank you for your business. dank you r#or you��ustness. Total 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 wx,iuntidwesttoxicology.conr. Pagel Midwest 7oxicofogy PAYMENT DUE Invoice :(�:, Services, Inc. Y �� ®@� r UPON RECEIPT DATE INVOICE# 603 East Washington Street,Suite 200,Indianapolis,IN 46204 6/26/2012 271516 BILL TO: SHIP TO: City of Carmel Names & location of collection Attn: Jim Spelbring on invoices - no ss#!! 1 Civic Square Email results to Barb Lamb & cc Jim . Carmel, IN 46032 Still Mail results to Jim KK CONTROL# P.O. NUMBER JOB SITE# TERMS FACILITY# 5528 Due on receipt 142376 ITEM CODE QTY DESCRIPTION PRICE EACH CLASS AMOUNT ND Drug Test... 4 Non-DOT Drug Test 55.00 Indiana 220.00 Collected Onsite 06/21/12 Robert Dykstra William Giles Marc Gehlbach Amy Stein ND Drug Test... 1 Non-DOT Drug Test 55.00 Indiana 55.00 Collected at Community Occ. Health Center (MedCheck)-Carmel 06/22/12 Christopher Stubbs D Q a JUL 16 2012 By— A finance charge will be assessed all invoices not id in 30 Mays.Thank you for your business. dank you cior your business. Total $1,550.00 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 wovm midwesttoxicology.com. Page 2 Midwest Toxicofogy Invoice DATE INVOICE# ogei;io PAYMENT DUE 6/26/2012 271604 603 East Washington Street,Suite 200,Indianapolis,IN 46204 UPON RECEIPT BILL TO: SHIP TO: City of Carmel Names & location of collection Attn: Jim Spelbring on invoices - no ss#!! I Civic Square Email results to Barb Lamb & cc Jim Carmel, IN 46032 Still Mail results to Jim DAC CONTROL# P.O. NUMBER JOB SITE# TERMS FACILITY# 5528 Due on receipt 142376 ITEM CODE QTY DESCRIPTION PRICE EACH CLASS AMOUNT DOT Test I DOT Drug Test 55.00 Indiana 55.00 Collected at Community Occ. Health Center (MedCheck)-Carmel 6/21/12 Josh Davis D JUL 16 2012 By I A finance charge will be assessed QA all invoigs not id in 30 days.Thank you for your business. ankyou oryou usiness. 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.iiiidwesttoxicology.com. afidwest Toxicology Invoice v DATE INVOICE# owwiii PAYMENT DUE 6/29/2012 271837 603 East Washington Street,Suite 200,Indianapolis,IN 46204 UPON RECEIPT BILL TO: SHIP TO: City of Carmel Names & location of collection Attn: Jim Spelbring on invoices- no ss#!! 1 Civic Square Email results to Barb Lamb & cc Jim . Carmel, IN 46032 Still Mail results to Jim DAC CONTROL# P.O. NUMBER JOB SITE# TERMS FACILITY# 5528 Due on receipt 142376 ITEM CODE QTY DESCRIPTION PRICE EACH CLASS AMOUNT DOT Test 1 DOT Drug Test 55.00 Indiana 55.00 Collected at Community Occ. Health Center (MedCheck)-Carmel 6/27/12 David Huffman DOT Alcohol ... 1 DOT Breath Alcohol Test 28.00 Indiana 28.00 Collected at Community Occ. Health Center (MedCheck)-Carmel 6/27/12 David Huffman BAT Surcharge 1 Please note that you are being charged an additional 7.00 Indiana 7.00 fee due to your collection site breath alcohol charges. D Q � JUL 16 2012 ; By A finance charge will be assessed all invoices not id in 30 Pays. Thank you for your business. d r ank youtor you��usmess� Total $90.00 Make Checks Payable To: MIDWEST TOXICOLOGY SERVICES,INC. For questions regarding this invoice,contact us at 317--262-2200 or fax us a1317--262-2222. Be sure to visit our website at www.midwesttoxicologv.com. Midwest Toxicology Invoice ojwo�m DATE INVOICE# PAYE�� ®�E 603 East Washington Street,Suite 200,Indianapolis,IN 46204 UPON RECEIPT [6/30/2012 272013 BILL TO: SHIP TO: City of Carmel Names & location of collection Attn: Jim Spelbring on invoices - no ss#!! 1 Civic Square Email results to Barb Lamb & cc Jim . Carmel, IN 46032 Still Mail results to Jim KK CONTROL# P.O. NUMBER JOB SITE# TERMS FACILITY# 5528 Due on receipt 142376 ITEM CODE QTY DESCRIPTION PRICE EACH CLASS AMOUNT ND Drug Test... 2 Non-DOT Drug Test 55.00 Indiana 110.00 Collected at Community Occ. Health Center (MedCheck)-Carmel 06/27/12 Gary Carter Mitchell Robinson D Q � JUL 16 2012 By A finance charge will be assessed all invoi es not id in 30 days.Thank you for your business. d c ank youtor yout°�usiness• 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 x,ww.niidx,esttoxicology.coni. Widwest Toxicology PAYMENT DUE Invoice @4w �� DATE INVOICE# UPON! RECEIPT 7/11/2012 272596 603 East Washington Street,Suite 200,Indianapolis,IN 46204 BILL TO: SHIP TO: City of Carmel Names & location of collection Attn: Jim Spelbring on invoices - no ss#!! 1 Civic Square Email results to Barb Lamb &cc Jim . Carmel, IN 46032 Still Mail results to Jim KK CONTROL# P.O. NUMBER JOB SITE# TERMS FACILITY# 5528 Due on receipt 142376 ITEM CODE QTY DESCRIPTION PRICE EACH CLASS AMOUNT ND Drug Test... 3 Non-DOT Drug Test 55.00 Indiana 165.00 Collected at Community Occ. Health Center (MedCheck)-Carmel 07/02/12 Anthony Harvey-9880 Richard Decrastos-5994 07/03/12 Gary Merrill-0949 D Q � JUL 16 2012 By A f ync�char a will le psusse�(.�n�11 i voices not ppid in 3%dags.TAan X%pr ywr business. or a pu►�oose o c►en con► en►a►4y we are n onger s o ►ng e u o invoices. Total $165.00 Make Checks Payable To: MIDWEST TOXICOLOGY SERVICES, INC. For questions regarding this invoice,contact us at 317-262-2200 or far us at 317-262-2222. Be sure to visit our website at wwmmidwesttoxicology.com. VOUCHER NO. WARRANT NO. ALLOWED 20 Midwest Toxicology IN SUM OF$ 603 East Washington Street, Suite 200 Indianapolis, IN 46204 $1,970.00 ON ACCOUNT OF APPROPRIATION FOR Carmel HR Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1201 271516 43-588.00 $1,550.00 I hereby certify that the attached invoice(s), or bill(s) is (are)true and correct and that the 1201 271604 43-588.00 $55.00 materials or services itemized thereon for 1201 271837 43-588.00 $90.00 which charge is made were ordered and 1201 272013 43-588.00 $110.00 received except 1201 272596 43-588.00 $165.00 Monday, July 16, 2012 Director, HR Title Cost distribution ledger classification if claim paid motor vehicle highway fund 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. Payee Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s)or bill(s)) 06/26/12 271516 $1,550.00 06/26/12 271604 $55.00 06/29/12 271837 $90.00 06/30/12 272013 $110.00 07/11/12 272596 $165.00 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