216454 01/15/2013 CITY OF O NRMEL, INDIANA VENDOR: 204038 Page 1 of 1
0 ONE CIVIC SQUARE MIDWEST TOXICOLOGY SVS,INC CHECK AMOUNT: $142.00
o CARMEL, INDIANA 46032 603 E WASHINGTON ST SUITE 200
o� INDIANAPOLIS IN 46204 CHECK NUMBER: 216454
CHECK DATE: 1/1512013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1201 4358800 155 88 . 00 TESTING FEES
1110 4341999 245 34 . 00 OTHER PROFESSIONAL FE
1201 4358800 280637 20 . 00 SHORT PAID INVOICE
Midwest 7oxicoCogy Invoice
Q'_ Services,GLC
v,
Date Invoice#
603 E.Washington Street,Suite 200,Indianapolis,IN 46204 Due on receipt
1/8/2013 245
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
-P:Q. 114uraber - ` —Project/Jobsite Control# Rep
5528 DAC
Qty. Item Code Description Price Each Class Amount
1 ND Alcohol CS Non-DOT Alcohol Test 28.00 Indiana 28.00
Collected at Community Occ. Health Center(MedCheck)-Carmel
1/4/13
Bryan Hood
1 CS Surcharge Alcohol Please note that you are being charged an additional fee due to your 6.00 Indiana 6.00
collection site breath alcohol charges.
A finance charge will be assessed on all invoices not paid in 30 days.Thank you for your business!
Total $34.00
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 www.midwesttoxicology.com
VOUCHER NO. WARRANT NO.
ALLOWED 20
Midwest Toxicology Services, Inc.
IN SUM OF $
603 E. Washington Street, Suite 200
Indianapolis, IN 46204
$34.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1110 245 43-419.99 $34.00 I hereby certify that the attached invoice(s), or
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
Monday, January 14, 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))
01/08/13 245 fit for duty $34.00
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
Midwest TxTicofogy Invoice
Services, Inc. r[k Vir,V1.E N Tv D U E DATE INVOICE#
UPON. RECEIPT 10/10/2012 280637
603 East Washington Street,Suite 200,Indianapolis,IN 46204
BILL TO: Fs—HiP To:
City of Carmel i Names & location of collection
i on invoices - no ss#!!
Attn: Jim Spelbring Email results to Barb Lamb &cc Jim
1 Civic Square
Carmel, IN 46032 Still Mail results to Jim
KK
CONTROL# P.O.NUMBER JOB SITE# TERMS FACILITY#
5528 Due on receipt 142376
ITEM CODE CITY DESCRIPTION PRICE EACH CLASS AMOUNT
ND Drug Test... 4 Non-DOT Drug Test 55-00 Indiana
Collected at Community Occ. Health Center
(MedCheck)-Carmel, IN
10/02/12
Anthony Hoover
David Haboush
Stephen Reeves
10/04/12 'r1j
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 I 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
/Z\ VN 14 2 3
D 0 1 01
OCT By—
f 2 2 2 012
I By
I I
A finance charge will be assessed qA all invoices not paid in 30 days. Thank you for your business.
ank you for your Dustness Total $255.00
Alake 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 webshe at)vii,)uniidivestto.vicologP.coni.
�f idwest 7oxicoCogy Invoice
(�; Services, GGC
Date Invoice#
603 E.Washington Street,Suite 200,Indianapolis,IN 46204 Due on receipt
1/7/2013 155
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
P.O. Number Project/Jobsite Control# Rep
5528 DAC
Qty. Item Code Description Price Each Class Amount
1 ND Drug Test CS Non-DOT Drug Test 55.00 Indiana 55.00
Collected at St.Vincent Carmel Hospital
1/3/13
Anthony Mowery
1 ND Alcohol CS Non-DOT Breath Alcohol Test 28.00 Indiana 28.00
Collected at St.Vincent Carmel Hospital
1/3/13
Anthony Mowery
1 CS Surcharge Alcohol Please note that you are being charged an additional fee due to your 5.00 Indiana 5.00
collection site breath alcohol charges.
D
JAN 14 2013
By
A finance charge will be assessed on all invoices not paid in 30 days.Thank you for your business!
Total $88.00
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 www.midwesttoxicology.com
VOUCHER NO. WARRANT NO.
ALLOWED 20
Midwest Toxicology
IN SUM OF $
603 East Washington Street, Suite 200
Indianapolis, IN 46204
$108.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel HR Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1201 280637 43-588.00 $20.00 I hereby certify that the attached invoice(s), or
bill(s) is (are)true and correct and that the
1201 155 43-588.00 $88.00
materials or services itemized thereon for
which charge is made were ordered and
received except
Monday, January 14, 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))
10/10/12 280637 Correction $20.00
01/07/13 155 $88.00
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