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Home My WebLink About219415 04/24/2013 CITY OF CARMEL, INDIANA VENDOR: 204038 Page 1 of 1 ` ONE CIVIC SQUARE MIDWEST TOXICOLOGY SVS,INC p CHECK AMOUNT: $275.00 CARMEL, INDIANA 46032 603 E WASHINGTON ST SUITE 200 on io. INDIANAPOLIS IN 46204 CHECK NUMBER: 219415 CHECK DATE: 4124/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1201 4358800 7539 55 . 00 TESTING FEES 1201 4358800 7795 55 . 00 TESTING FEES 1201 4358800 8736 110 . 00 TESTING FEES 1201 4358800 8912 55 . 00 TESTING FEES Midwest 7oxicoCogy Invoice (� Services, GLC OdD paw a Payment Due Date Invoice# 603 E.Washington Street,Suite 200,Indianapolis, IN 46204 Upon Receipt 3/31/2013 7795 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 ProjecdJobsite 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 3/27/13 Mark Callahan D Q � APR 2 2 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 Invoice Date Invoice# d w * Payment Due 603 E.Washington Street,Suite 200,Indianapolis,IN 46204 Upon Receipt 313112013 7539 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 3/27/13 Kristyn Campbell D z APR 2. 2 2013 By A finance charge will be assessed on all invoices not paid in 30 days.Thank you for your business! 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 www.midwesttoxicology.com Midwest 7o*ofogy Invoice @:2ffm Payment Due Date Invoice# Upon Receipt 4/11/2013 8736 603 E.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 P.O. Number Project/Jobsite Control#` Rep 5528 DAC Qty. Item Code Description Price Each Class Amount 2 ND Drug Test CS Non-DOT Drug Test 55.00 Indiana L _110.00 Collected at Community Occ. Health Center(MedCheck)-Carmel 4/7/13 Anthony Johnson 4/8/13 Eric Schildmeier 1 ND Alcohol CS Non-DOT Alcohol Test 28.00 Indiana 28.00 Collected at Community Occ. Health Center(MedCheck)-Carmel 4/4/13 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. D APR 2 2 2013 By A finance charge will be assessed on all invoices not paid in 30 days.Thank you for your business! Total $144.00 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 9�fidwest 7o�'c010gy Invoice Services,LLC O:QDtm Date Invoice# d' v. Payment Due Upon Receipt 4/12/2013 8912 603 E.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 I - P.O. Number Project/Jobsite Control# Rep 5528 DAC Qty. ,Item Code Description Price Each Class Amount 1 ND Drug Test 603 Non-DOT Drug Test 55.00 Indiana 55.00 Collected at MTS Indianapolis 4/10/13 Allen Hill D Q � APR 2 2 2013 By A finance charge will be assessed on all invoices not paid in 30 days.Thank you for your business! 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 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)) 03/31/13 7795 $55.00 03/31/13 7539 $55.00 04/11/13 j 8736 j $110.00 04/12/13 8912 $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 VOUCHER NO. WARRANT NO. Midwest Toxicology ALLOWED 20 IN SUM OF $ 603 East Washington Street, Suite 200 Indianapolis, IN 46204 $275.00 ON ACCOUNT OF APPROPRIATION FOR Carmel HR Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1201 7795 43-588.00 $55.00_ I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and that the 1201 7539 43-588.00 $55.00 materials or services itemized thereon for 1201 8736 43-588.00 $110.00 which charge is made were ordered and 1201 8912 43-588.00 $55.00 received except Monday, April 22, 2013 CL--- Director, HR Title Cost distribution ledger classification if claim paid motor vehicle highway fund