218161 03/13/2013 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: $165.00
?° INDIANAPOLIS IN 46204 CHECK NUMBER: 218161
CHECK DATE: 3/13/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1201 4358800 3930 55 . 00 TESTING FEES
1201 4358800 3782 110 . 00 TESTING FEES
----------------- -
Midwest 7o.�icoCo
'Q Services,LL gy
oo oam� Invoice
i
603 E.Washington Street,Suite 200, Indianapolis,IN 46204 Date Invoice#
Due on receipt
2/19/2013 3782
rAttnn*
Ship To
armel
Spelbring Names & location of co llection
quare on invoices - no ss#!!
IN 46032 Email results to Barb Lamb & cc Jim .
Still Mail results to Jim
P.O. Number ----
Project/Jobsite Control#
Rep
5528 DAC
Qty. Item Code
Description
2 ND Drug Test CS Non-DOT Drug Test Price Each Class Amount
Collected at Community Occ. Health Center(MedCheck)-Carmel 55.00 Indiana
110.00
2/13/13
Andrea Stumpf
Matthew Worthley
D Q 0
MAR 1 12013
By
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 $110.00
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.midwesttoxicolo .com
�Y
@ w D Invoice
Date
Invoice#
603 E.Washington Street,Suite 200,Indianapolis,IN 46204 Due on receipt
2/20/2013 3930
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 Community Occ.Health Center(MedCheck)-Carmel
2/18/13
Stephen Rejko
D Q �
MAR 1 2013
By
A finance charge will be assessed on all invoices not paid in 30 days.Thank you for your business!
Total
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
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))
02/19/13 3782 $110.00
02/20/13 3930 $55.00
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
I
VOUCHER NO. WARRANT NO.
ALLOWED 20
Midwest Toxicology
IN SUM OF $
603 East Washington Street, Suite 200
Indianapolis, IN 46204
$165.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel HR Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1201 3782 43-588.00 $110.00 I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
1201 3930 43-588.00 $55.00
materials or services itemized thereon for
which charge is made were ordered and
received except
Monday, March 11, 2013
/&-J"C "'j -
Director, HR
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund