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Home My WebLink About230457 03/26/14 r C.1q "'; CITY OF CARMEL, INDIANA VENDOR: 357526 b ONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: $********50.04* +, CARMEL, INDIANA 46032 DEPT CH 10241 CHECK NUMBER: 230457 ?y.. .-off, PALATINE IL 60055-0241 CHECK DATE: 03/26/14 <�pN� DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 102 4239011 2925512-01 50.04 SPECIAL DEPT SUPPLIES ORDER# ORDER DATE IQUE DATE 17393911 03/13/14 04/12/14 D&B#:01-243-0880 WHSE DEA# R"01 62494 Fed ID: 1 1-3136595 �s mmm ms This order has been processed by our MIDWEST D.C. 5315 WES 74TH 3TREET INDIANAP LIS,IN 46268 OM SMALL 0 1314 17-571-266 1 890-4792 EA SHARPSTAR SHARPS CONTAINE 5-QT 12 12 4.17 50.04 1 HE PRICES 3TATED ABOVE MAY REFLECT A DISCOUN OR BE SUBJECT TO A REBATE YOU UST FULLY D ACCURATELY REPORT THIS STATED DISCOUNr PRICE, OR IF APPLI ABLE, Y NET PRI ING, AFTER GIVING EFFECT TO ANY REBATES, TO MEDICARE, MEDICAID, RICARE AND ANY OTHER FEDERAL OR STATE PROGRAM UPON ZEQUES7 BY ANY SUCH FROGRA.M. IT ISYOUR ZESPONSIBILITY TO REVIEW ANY AGREEMENTS OZ OTHER DOCUMENTS APPLICABLE TO THESE P ICES TO DETERMINE IF THEY ARE SUB ECT TO A REBATE. THE FEDERAL OVERNMENTI POSES CERTAIN RESTRICTIONS ON, AN REQUI ES PU LIC REPORTING OF, TRANSFERS 0 VALUE TO A PRACTITIONER. IF YOU A E PARTICIPATING IN A PROMOTIONAL ISCOUNT PR GRAM (E.G. POINTS, DISCOUNT REDEM TIONS R OTHER SPECIAL AWA DS) , ITH YOUR P RCHASES YOU MAY EARN POINTS/CREDI S REDEEMABLE FOR CERTAIN GOODS OR ERVICES, Ii ACCORDANCE WITH DISCOUNT PROGRAM RULES. UPON DISCOUNT RECEIPT BY EDEMPTION F YOUR EARNED POINTS/CREDITS, YOU ARE RE'EIVINC OR WILL RECE VE OTICE OF TIE DISCOUNT VALUE. ACCORDINGLY, YOU SHOUL RETAIN THESE RECOR S. MERCHANDI E TOTAL 50.04 Invoice Date + 30 days 50.04 LL TO SHIPTO INVOICEINVOICE41 INVOICE ITEM STATUS KEY REM KEY B-Backordered:Item will follow 1308571 18171022925512-01SK-School Kit 5 0 .04 I)-Discontinued:Item no longer available NC-No Charge ER ORDER DATE INVOICE ATE E P-Special Schein free Goods M-Manufacturer will ship Item directly to you P-prescription Drug:Return Authorization Required 17393911 03/13/14 3/13/14 2 R -Refrigerated Item:May be shipped separately T MER FA $ -Special Schein Pricing T-Taxable Item U-Temporarily unavailablc:please reorder TOM SMALL 0313 1 OF 2 -Item has MSDS Continued on Next Page.......... LP300 &I HENRY EIN" SHIP TO/SOLD TO: EMSCarmel Fire Department MI 135 Duryea Road, Melville, NY 11747 540 W 136th St INVOICE Station 46 Michael Kaufmann Carmel,IN 46032-8806 0100001308571029255112110010000000050040313140 BILL TO: Carmel Fire Dept MI 2 Civic Sq Carmel, IN 46032-7543 Carmel Fire Dept 2 Civic Sq BILL TO I SHIP TO I INVOICE AMOUNT Carmel, IN 46032-7543 1308571 1817102 1 50. 04 INVOICE4 I INVOICE DATE 2925512-01 3/13/14 CUSTOMER PO TOM SMALL 0313 Please detach here and mail the above with your payment ORDER# ORDER DATE DUE DATE 17393911 03/13/14 1 04/12/14 D&B#:01-243-0880 WHSE DEA# RHO]62494 Fed ID: 11-3136595 1Y, Please remi payments only to the following a dress: Henry Schein, Inc. ept CH 102 1 Palatine, I 60055-0241 ILL TO SHIP TO INVOICE# INVOICE AMOUNT ITEM STATUS KEY REM KEY B-Backordered:Item will follow SK-School Kit 1308571 1817102 2925512-01 50 .04 n-Discontinued:Item no longer available NC-No Charge P-Special Schein Free Goods RD R ORDER DATE INVOICE ATE B XE M-Manufacturer will ship Item directly to you P-Prescription Drug:Return Authorization Required 17393911 03/13/14 3/13/14 2 R -Refrigerated Item:May be shipped separately T MER P PA E $ -Special Schein Pricing CUST-Taxable I"m U-Temporarily unavailable;please reorder TOM SMALL 0313 2 OF 2 hem has MSDS LP300 ------------ _ �___ __ � _ _- __ ....... _..._ ; -A HENRY SCHEINgl EMS ERMS OF -----__.-_ ____._____ ____ _______.. ___---- _....._-----------------------___. __------ -___.._______..-_.___ _. ___-____ --------------- .._............_-_---___..................... .__...........-. ------------------I We make every effort to maintain prices for the duration of a Payment by CHECK or by the HENRY SCHEIN CREDIT CARD, catalog,however.we reserve the right to make price adjustments in VISA,MASTERCARD,DISCOVER and AMERICAN EXPRESS response to manufacturer; price changes Guaranteed Satisfaction: It you have tried a product and it is Defective or does not perform or Bill Yourt` er To Your Open AtQr satis`actorily,we will provide a credit,refund,or exchange;its your choice. Simply call o.ir customer service department within 30 days payable to licensed practitioners in the U.S.AL invoices are of receipt of the merchandise to arrange for the return. Fora payable within 30 days, warranty repair or if you were sent something you did not order, simply call: Rx Products & Controlled Substances: Matrx Medical 1-800-845-3550 Regulations require us to limit the safe of Rx and controlled substances only to registered,licensed healthcare professionals. If you are a new customer or have recently moved,please furnish us with a copy of your updated state registration. For controlled substances,furnish a copy of your DEA certificate;verifying your shipping address. Class It drugs can be ordered only by mail. International Orders. Pleaseote: -- We proudly serve healthcare professionals and governments Cipe€,pd handpieces and eq�ip nen#;mav not be r?!urned for r credit,but 4^e II be repaired or replaced.n accordance with throughout ice,world. To place orders or icer inquiries of export manufacturer warranties.Before opening handpieces or terms and conditions,please contact our International Department: equipment,we suggest that you check the shipping container 1-800-84 3550 and packing list to verify that you have received exactly;.ghat Prescription Drug Returns Instructions: you ordered.Cpened Computer Software is not returnable. Other restrictions may also apply. A Return Authorization is Required for all prescription Drugs,Simply call Our Customer Service Department @ 1-800-845-3:50. & e�.ab� 1 VOUCHER NO. WARRANT NO. ALLOWED 20 Henry Schein IN SUM OF $ Dept Ch 10241 Palatine, IL 60055 $50.04 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1120 2925512-01 102-390.11 $50.04 1 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 MAR 2 4 2014 i. Fire Chief 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)) 2925512-01 $50.04 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