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Home My WebLink About216124 01/09/2013 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: $401.00 INDIANAPOLIS IN 46204 CHECK NUMBER: 216124 CHECK DATE: 1/9/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1201 4358800 286402 90 . 00 TESTING FEES 1201 4358800 286834 55 . 00 TESTING FEES 1201 4358800 286837 220 . 00 TESTING FEES 1110 4341999 287186 36 . 00 OTHER PROFESSIONAL FE 9didwest To.#cofogy Services., LLC Invoice PAYMENT DUE DATE INVOICE# UPON RECEIPT - 603 East Washington Street,Suite 200,Indianapolis,IN 46204 12/27/2012 287186 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— _FXCIbTr#—',— 5528 Due on receipt 142376 ITEM CODE CITY DESCRIPTION PRICE EACH CLASS AMOUNT ND Alcohol CS 1 Non-DOT Breath Alcohol Test 28.00 Indiana 28.00 Collected at Community Occ. Health Center (MedCheck)-Carmel 12/18/12 Bryan Hood BAT Surcharge 1 Please note that you are being charged an additional 8.00 Indiana 8.00 fee due to your collection site breath alcohol charges. I I A finance charge will be assessed on all invoices not paid in 30 days.Thank you for your business. Make Checks Payable To: MIDWEST TOXICOLOGY SERVICES, LLC Total $36.00 For questions regarding this hivoict,contact us at 317-269-3029 or fax us at 317-262-2222. Be sure to visit our website at www.midwesttoxicology.com. VOUCHER NO. WARRANT NO. ALLOWED 20 Midwest Toxicology Services, Inc. —4 IN SUM OF $ 603 E. Washington Street, Suite 200 Indianapolis, IN 46204 $36.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Police Department PO#i Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members Prior Year I hereby certify that the attached invoice(s), or 1110 I 287186 43-419.99 I $36.00 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 Thursday, January 03, 2013 Chief of Police 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)) 12/31/12 287186 fit for duty test $36.00 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 W Widwest Txdcofogy G� Services, LLC Invoice ff PAYMENT DUE -```� 'UPON DATE INVOICE# 12/13/2012 286402 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 ND Drug Test... 1 Non-DOT Drug Test 55.00 Indiana 55.00 Collected at St.Vincent Carmel Hospital 12/10/12 Trent McIntyre ND Alcohol CS 1 Non-DOT Breath Alcohol Test - 28.00 Indiana 28.00 Collected at St. Vincent Carmel Hospital 12/10/12 Trent McIntyre 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 Qa JAN � 7 2013 By_._ A finance charge will be assessed all invoi es not id in 30 days. Thank you for your business. ►ank youcforyou��ustness• Total $90.00 Make Checks Payable To: MIDWEST TOXICOLOGY SERVICES,LLC For questions regarding this invoice,contact us at 317-269-3029 or fax us at 317-262-2222. Be sure to visit our ivebsite at www.tnidivesttoxicolog.l,.cont. Midwest rIoxicoCogy Invoice Services, LLC MM 4; � �� ®�� DATE INVOICE# V 0' UPON RECEIPT 12/18/2012 286837 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 ND Drug Test... 4 Non-DOT Drug Test 55.00 Indiana 220.00 Collected at Community Occ. Health Center (MedCheck)-Carmel 12/12/12 Steven Baskerville 12/13/12 Megan McVicker Stephanie Marshall 12/14/12 Logan Brock D Q � AN p 7 2013 By A finance charge will be assessed on all invoices not paid in 30 days.Thank you for your business. Total $220.00 Make Checks Payable To: MIDWEST TOXICOLOGY SERVICES,LLC For questions regarding this invoice,contact us at 317-269-3029 or far as at 317-262-2222. Be sure to visit our website at www.midwesttoxicology.com. 96dwest Twdcofogy Invoi ce Services, LLC DATE INVOICE# F � � 603 East Washington Street,Suite 200,Indianapolis,IN 46204 12/18/2012 286834 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 SMH1 CONTROL# P.O. NUMBER JOB SITE# TERMS FACILITY# 5528 Due on receipt 142376 ITEM CODE QTY DESCRIPTION PRICE EACH CLASS AMOUNT ND Drug Test... Non-DOT Drug Test 55.00 Indiana 55.00 Collected at MedCheck-Carmel 12/13/2012 Matthew Steele L/ �J n --N_ !J JAN A 7 2013 By A fiync�chame will, �ssfssec,�n l fovoices not��id in 30 d�s. Than�Cr r our business. or a pu pose o c ien con i en is ity we are n onger sho ing e u IN o invoices. Total $55.00 Make Checks Payable To: MIDWEST TOXICOLOGY SERVICES,LLC For questions regarding this invoice,contact us at 317-269-3029 or fax us at 317-262-2222. Be sure to visit our website at wwminidwesttoxicology.com. VOUCHER NO. WARRANT NO. Midwest Toxicology ALLOWED 20 IN SUM OF $ 603 East Washington Street, Suite 200 Indianapolis, IN 46204 $365.00 ON ACCOUNT OF APPROPRIATION FOR Carmel HR Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members Prior Year I hereby certify that the attached invoice(s), or 1201 286402 43-588.00 $90.00 Prior Year bill(s) is (are)true and correct and that the 1201 286837 43-588.00 $220.00 Prior Year materials or services itemized thereon for 1201 1 286834 1 43-588.00 1 $55.00 which charge is made were ordered and received except Monday, January 07, 2013 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)) 12/13/12 286402 $90.00 12/18/12 286837 $220.00 12/18/12 286834 $55.00 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