HomeMy WebLinkAbout214370 11/07/2012 \,f CITY OF CARMEL, INDIANA VENDOR: 204038 Page 1 of 1
ONE CIVIC SQUARE MIDWEST TOXICOLOGY SVS,INC CHECK AMOUNT: $35.00
i• .•o CARMEL, INDIANA 46032 603 E WASHINGTON ST SUITE 200
INDIANAPOLIS IN 46204 CHECK NUMBER: 214370
CHECK DATE: 11/7/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4340701 280637 35 . 00 MEDICAL EXAM FEES
51,fidwest To.,�icology Invoice
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603 East Washington Street,Suite 200,Indianapolis,IN 46204
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Names & location ofcollection
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CONTROL# P.O. NUMBER JOB SITE# TERMS FACILITY#
F_ 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
Anthony Hoover
David Haboush
Stephen Reeves
Marc Deitsch
ND Alcohol CS 1 Non-DOT Breath Alcohol Test 28.00 Indiana C28.00
Collected at Community Occ, Health Center
(MedCheck)-Carmel, IN
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.
A finance charge will be assessed%all in voiqes not ppid in 30 ys. Thank you for your business.
ank you for your businessfia Total �0)q0
ror qi4estions re,,arding this invoice,contact its at 317-262-2200 orfax us at 317-262-2222.
Be sure to visir our website
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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))
10/10/12 280637 fit for duty/Hood $35.00
1 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 Services, Inc.
IN SUM OF $
603 E. Washington Street, Suite 200
Indianapolis, IN 46204
$35.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1110 280637 43-407.01 $35.00
I hereby certify that the attached invoice(s), or
I I
bill(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
Friday, November 02, 2012
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund