216124 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