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Home My WebLink About214013 10/23/2012 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: $290.00 INDIANAPOLIS IN 46204 CHECK NUMBER: 214013 CHECK DATE: 10/23/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1201 4358800 279846 55 . 00 TESTING FEES 1201 4358800 280637 200 . 00 TESTING FEES 1201 4358800 280690 35 . 00 TESTING FEES Midwest TaVcology PAYMENT DUE Invoice offiwiiic. kIPON, PECEIPT DATE INVOICE# Q 603 East Washington Street,Suite 200,Indianapolis,IN 46204 9/30/2012 279846 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... 1 Non-DOT Drug Test 55.00 Indiana 55.00 Collected Onsite 9/27/12 James Foster Lam_ D 222012 By A finance charge will be assessed all invoices not id in 30 days.Thank you for your business. d c ank youror you��usmess• 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. Midwest 7o.xieoCogy Invoice 04� PAYMENT DUE DATE INVOICE# UPON RECEIPT 10/10/2012 280637 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... 4 Non-DOT Drug Test 55.00 Indiana 2 Collected at Community Occ. Health Center (MedCheck)-Carmel, IN 10/02/12 Anthony Hoover David Haboush Stephen Reeves 10/04/12 Marc Deitsch ND Alcohol CS 1 Non-DOT Breath Alcohol Test 28.00 Indiana 28.00 Collected at Community Occ. Health Center (MedCheck)-Carmel, IN 10/03/12 Bryan 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. D z OCT 2 2 2012 By- A finance charge will be assessed all invoi es not id in 30 days. Thank you for your business. d ank your#or you��usiness. Total $255.00 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 wivrv.midwestioxicolog.i.con:. Midwest 7oXicofogy PAYMENT M E Invoice 44i;io U PON RECEPT DATE INVOICE# 10/11/2012 280690 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 DAC CONTROL# -" P.O.-NUMBER JOB SITE# TERMS FACILITY# 5528 Due on receipt 142376 ITEM CODE QTY DESCRIPTION PRICE EACH CLASS AMOUNT DOT Alcohol ... 1 DOT Breath Alcohol Test 28.00 Indiana 28.00 Collected at Community Occ. Health Center (MedCheck)-Carmel 4/12/11 James Bentley 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. Note: During account audit we found these tests had not been invoiced. If you have any questions, please call MRO Team D at 317-269-3035. J U,, a iZ By A finance charge will be assessed oA all invoi es not id in Ways.Thank you for your business. ank youc#or you��ustness. Total $35.00 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.cont. 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)) 09/30/12 279846 $55.00 10/10/12 280637 $200.00 10/11/12 280690 $35.00 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 $290.00 ON ACCOUNT OF APPROPRIATION FOR Carmel HR Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1201 279846 43-588.00 $55.00 I hereby certify that the attached invoice(s), or bill(s) is (are)true and correct and that the 1201 280637 43-588.00 $200.00 materials or services itemized thereon for 1201 1 280690 1 43-588.00 1 $35.00 which charge is made were ordered and received except Monday, October 22, 2012 Director, HR Title Cost distribution ledger classification if claim paid motor vehicle highway fund