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Home My WebLink About213572 10/09/2012 CITY OF CARMEL, INDIANA VENDOR: 204038 Page 1 of 1 0 ONE CIVIC SQUARE MIDWEST TOXICOLOGY SVS,INC CHECK AMOUNT: $2,580.00 CARMEL, INDIANA 46032 603 E WASHINGTON ST SUITE 200 INDIANAPOLIS IN 46204 CHECK NUMBER: 213572 CHECK DATE: 10/9/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1201 4358800 279473 110 . 00 TESTING FEES 1201 4358800 279599 1, 827 . 00 TESTING FEES 1201 4358800 279700 423 . 00 TESTING FEES 1201 4358800 279795 220 . 00 TESTING FEES Midwest 7oxicofogy Invoice Q Services, Inc. D �Q�°- ��p_ _ ��1� � OCT 0 8 2012 DATE INVOICE# 603 East Washington Street,Suite 200,Indianapolis,IN 46204 9/28/2012 279599 By 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 OS 9 DOT Drug Test 55.00 Indiana 495.00 Collected Onsite 9/27/12 Aaron Hoover Ronald Williams James Bentley Cameron Mason Mark Ottinger Shaun Priuett Calvin Cooper Jr. Nathaniel Morris Raphael Burke DOT Alcohol ... 4 DOT Breath Alcohol Test 28.00 Indiana 112.00 Collected Onsite 9/27/12 Ronald Williams James Bentley Cameron Mason Nathaniel Morris Fuel Surcharge 1 Fuel Surcharge 10.00 Indiana 10.00 A finance charge will be assessed all invoi es not id in 30 days. Thank you for your business. d ank you c#or you��usmess• Total $1,827.00 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 ww)s nmidrvesttoxicology.com. Page 2 Midwest Toxicofogy ® Invoice P��i�'OENT ®��offiw� DATE INVOICE# UPON RECEIPT 603 East Washington Street,Suite 200,Indianapolis,IN 46204 9/28/2012 279599 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 ND Drug Test... 22 Non-DOT Drug Test 55.00 Indiana 1,210.00 Collected Onsite 9/26/12 Teresa Anderson Susan Bell James Thompson Jr. Dawn Pattyn Matthew Hoffman Steven Frye Mark Paris 9/27/12 Adam Schriner Richard Castor Andrew Wyant Marc Deitsch Joshua Haus Kenneth Rhodes Michael Turner Anthony Isenberger Gregory Hollander Aldwin Castaneda Brian Smith Wendy Bodenhorn Leland Goodman James Spelbring Bradley Hedrick A finance charge will be assessed all invoi es not id in 30 days. Thank you for your business. wall youcfor 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 wwminidwesttoxicology.com. Page 1 Widwest Tozicofogy Invoice E DATE INVOICE# @99ti@ DU�UPON RECEIPT 9/28/2012 279473 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#!! Email results to Barb Lamb & cc Jim . 1 Civic Square Still Mail results to Jim Carmel, IN 46032 EAA 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 9/19/12 Jack Forrer 9/20/12 Matthew Van Scoik D Q a I OCT 0s 2012 By A finance charge will be assessed on all invoices not paid in 30 days.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 317-262-2222. Be sure to visit our website at ivivw.midwesttovicology.cotn. 91didwest ToXicofogy Invoice @V� PA 6 ��nEe�T ®�E i DATE INVOICE#UPON RECEIPT 603 East Washington Street,Suite 200,Indianapolis,IN 46204 9/30/2012 279795 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 at Community Occ. Health Center (MedCheck)-Carmel, IN 09/28/12 Charles Driver Jr. Edward Gauthier Richard Thomas Thomas Gilbert D Q � OCT 08 2012 By A finance charge will be assessed all invoi es not id in 30 Pays.Thank you for your business. iankyour#oryou��usiness. Total $220.00 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 wm,mn idwesttoricology.com. Midwest Tx6coeogy PAYMENT DUE Invoice Services, Inc. LTj0N PIECEIPT DATE INVOICE# o�oD � � •.__ . :ter-- —� F9/30/2012 279700 603 East Washington Street, .�Suite 200,Indianapolis,IN 46204 Zo\ BILL TO: SHIP TO: City of Carmel Names & location of collection Attn: Jim Spelbring on invoices - no ss# Email results to Barb Lamb &cc Jim . 1 Civic Square Still Mail results to Jim Carmel, IN 46032 DAC CONTROL# P.O. NUMBER JOB SITE# TERMS FACILITY# 5528 Due on receipt 142376 ITEM CODE QTY DESCRIPTION PRICE EACH CLASS AMOUNT ND Drug Test... 7 Non-DOT Drug Test 55.00 Indiana 385.00 Collected Onsite 9/28/12 - Chad Amos Robert Robinson William Workman Todd Utzig John Duffy Mark Voskuhl Marc Gehlbach DOT Test OS 1 DOT Drug Test 28.00 Indiana 28.00 Collected Onsite 9/28/12 Tim Coffey Fuel Surcharge 1 Fuel Surcharge 10.00 Indiana 10.00. fID OCT 08 2012 �I. i By A finance charge will be assessed all invoi es not id in 30 days. Thank you for your business. d ank youc#or you��usiness. Total $423.00 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.ntidwesttoxicology.cont. VOUCHER NO. WARRANT NO. ALLOWED 20 Midwest Toxicology IN SUM OF $ 603 East Washington Street, Suite 200 Indianapolis, IN 46204 $2,580.00 ON ACCOUNT OF APPROPRIATION FOR Carmel HR Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1201 279599 43-588.00 $1,827.00 I hereby certify that the attached invoice(s), or bill(s) is (are)true and correct and that the 1201 279473 43-588.00 $110.00 materials or services itemized thereon for 1201 279795 43-588.00 $220.00 which charge is made were ordered and 1201 279700 43-588.00 $423.00 received except Monday, October 08, 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)) 09/28/12 279599 $1,827.00 09/28/12 279473 $110.00 09/30/12 279795 $220.00 09/30/12 279700 $423.00 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