219415 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