HomeMy WebLinkAbout212696 09/12/2012 CITY OF CARMEL, INDIANA VENDOR: 204038 Page 1 of 1
ONE CIVIC SQUARE MIDWEST TOXICOLOGY SVS,INC
0 k CHECK AMOUNT: $228.00
CARMEL, INDIANA 46032 603 E WASHINGTON ST SUITE 200
INDIANAPOLIS IN 46204 CHECK NUMBER: 212696
CHECK DATE: 9112/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4340701 276731 63 . 00 MEDICAL EXAM FEES
1201 4358800 276731 165 . 00 TESTING FEES
Widwest Toxicofogy
Inc. PAYM ENT ® E
Invoice
0 s
UPON RECEIPT DATE INVOICE#
8/28/2012 276731
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
TGS
CONTROL# P.O. NUMBER JOB SITE# TERMS -FACILITY-#` T-t"=
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(Medcheck)
Carmel, IN
8/21/2012
Joshua Miller
Jimmie Kitterman
John Etter
ND Alcohol CS 2 Non-DOT Breath Alcohol Test 28.00 Indiana 56.00
Collected at Community Occ. Health (Medcheck)
Carmel, IN
8/21/2012
John Etter
8/22/2012
Byran Hood
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.
M° SEP 1 0 2012
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By
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A fi► nc char a will l e�ss�ssec.�n pj voices not id in 30bd s. T an�rmPrYQur business.
or the putgpose o c►en con i en►a►4y we are n onger s o ►ng e u o invoices. Total $228.00
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 wwminidwesttoxicology.com.
VOUCHER NO. WARRANT NO.
ALLOWED 20
Midwest Toxicology
IN SUM OF $
603 East Washington Street, Suite 200
Indianapolis, IN 46204
$228.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel HR Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
I hereby certify that the attached invoice(s), or
1201 276731 43-588.00 $165.00_
276731 $63.00
bill(s) is (are)true and correct and that the
a7" � �
materials or services itemized thereon for
which charge is made were ordered and
received except
Monday, September 10, 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))
08/28/12 276731 $165.00
08/28/12 276731 Police $63.00
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