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Home My WebLink About213101 09/25/2012 CITY OF CARMEL, INDIANA VENDOR: 204038 Page 1 of 1 �40 ONE CIVIC SQUARE MIDWEST TOXICOLOGY SVS,INC CHECK AMOUNT: $275.00 i+a CARMEL, INDIANA 46032 603 E WASHINGTON ST SUITE 200 INDIANAPOLIS IN 46204 CHECK NUMBER: 213101 CHECK DATE: 9/25/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1201 4358800 277817 110 . 00 TESTING FEES 1201 4358800 278123 55 . 00 TESTING FEES 1201 4358800 278310 110 . 00 TESTING FEES 91didwest Toxicology Invoice z Servaces, Inc. Q DATE INVOICE# 8/31/2012 277817 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... 1 Non-DOT Drug Test 55.00 Indiana 55.00 Collected at Community Occ. Health Center (MedCheck)-Carmel-Carmel, IN 08/29/12 Lisa Motz-0534 ND Drug Test... 1 Non-DOT Drug Test 55.00 Indiana 55.00 Collected at St.Vincent Carmel Hospital-Carmel, IN 08/27/12 Robert Vanvoorst-7153 D SEP 2 4 2012 By A fin�n-Achar a will t o�ss�ssec,�n 11 i voices not��id in 30hd s. T an r�g r ctur business. or a pu►gpose o c ren con r en ra r�y we are n onger s o rng e u o ►nvo►ces. 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 www.midwesttoxicologv.con:. Midwest 7oXicofogy Invoice Inc. oaw� DATE INVOICE# 9/13/2012 278123 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# 5528 Due on receipt 142376 ITEM CODE QTY DESCRIPTION PRICE EACH CLASS AMOUNT ND Drug Test... 1 Non-DOT Drug Test 55.00 Indiana 55.00 Collected at Community Occ. Health Center- Medcheck Carmel, IN 9/5/2012 Walter Bay D Q � SEP 2 4 2012 By A finance charge will be assessed all invoi es not id in 30 days. Thank you for your business. dank your#or yourP�us►ness. 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.com. Widwest ToX,icology Invoice DATE INVOICE# [9/14/2012 278310 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# 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, IN 9/10/2012 Will Taylor Specimen#35960526 9/12/2012 Will Taylor Specimen#35960525 D z n SEP 2 4 L0117 By A fiynschar a will le rssFsse�f.8,n i►Ii voices noVrid in 3. da s.T�an�r g r�QUr business. or a pufpose o c►en con► en►a t we are n onger s o ►ng e u o invoices. 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 wwmittidwesttoxicology.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. Payee Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s)or bill(s)) 08/31/12 277817 $110.00 09/13/12 278123 $55.00 09/14/12 278310 $110.00 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 VOUCHER NO. WARRANT NO. ALLOWED 20 Midwest Toxicology IN SUM OF $ 603 East Washington Street, Suite 200 Indianapolis, IN 46204 $275.00 ON ACCOUNT OF APPROPRIATION FOR Carmel HR Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1201 277817 43-588.00 $110.00 I hereby certify that the attached invoice(s), or _ bill(s) is (are)true and correct and that the 1201 278123 43-588.00 $55.00 materials or services itemized thereon for 1201 1 278310 1 43-588.00 1 $110.00 which charge is made were ordered and received except Monday, September 24, 2012 Director, HR Title Cost distribution ledger classification if claim paid motor vehicle highway fund