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Home My WebLink About239539 11/25/2014 %" ''f. CITY OF CARMEL, INDIANA VENDOR: 357526 ONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: $*****1,570.19* ��. �_� CARMEL, INDIANA 46032 DEPT CH 10241 CHECK NUMBER: 239539 �'�Irmf6�, PALATINE IL 60055-0241 CHECK DATE: 11/25/14 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 102 4239011 14386737 908.35 SPECIAL DEPT SUPPLIES 102 4239011 14469713 231.84 SPECIAL DEPT SUPPLIES 102 4239011 14628953 430.00 SPECIAL DEPT SUPPLIES ORDER 9 I ORDER DATE IDUE DATE: . 23943693 11/05/14 12/05/14 D&B#:01-243-0880 WHSEDEA# RHO162494 Fed ID: 11-3136595 0_11M,�Ig_zr g",* !a life, rhis order has been processed by our MIDWEST D.C. 5315 WES" 74TH 3TREET INDIANAP LIS,IN 46268 1 602-8100 EA COLLAR STIFNECK SELECT ADULT 24 24 5.50 132.00 3 2 890-6868 3/PK LIFEPAK 12 PAPER EKG 15 15 10.65 159.75 4 3 120-8808 EA COMBITUBE ROLL-UP KIT 41FR 10 10 40.96 409.60 3 4 220-1398 3/ST BODY STRAP SET DISP YELLOW 36 36 5.75 207.00 3 PLEASE REFEZ TO BACK OF PAPERWORK FOR DISCLOS ES/TEZMS,OF SALE MERCHANDI! E TOTAL 908.35 nvoice Date + 30 days 908.35 lease remi: payments only to the following aldress: Henry Scheii, Inc. Dept CH 10211 Palatine, I 60055-0241 is LI TO SHIP TO INVOICE# IMMICE AMOUNT ITEM STATUS KEY REM KEY B-Backordered:Item will follow SK-School Kit 1308571 1817102 14386737 908.3S D-Discontinued;Item no longer available NC-No Charge F-Special offer OPDER# ORDER DATS T NVOTC!R DATE # OF BOXES M-Manufacturer will ship Item directly to you P-Prescription Drug;Return Authorization Required 23943693 11/0S/14 11/05/14 4 R Refrigerated Item;May be shipped separately $ Special Schein Pricing CUSTOMER PQ# PAGF# T-Taxable Item U-Temporarily unavailable;please reorder TOM SMALL I OF I Item has MSDS LP300 ootids/credits redeemable for certain goods or services,in accordance with discount program rules.Upon discount receipt by redemption of your earned points/credits,you are receiving or Equipment: will receive notice of the discount value.Accordingly,you should retain these records. Opened and used equipment may not be returned for credit.Before opening equipment,we suggest that you check the shipping container and parking list to DELIVERY TERMS: ensure that you are getting exactly what you ordered.Equipment must be returned Unless offierwise agreed,freight terms are FOB Shipper's Dock('Ex Works"outside in the original unopenedpackaging,unmarked and properly packaged.Speical order North America).Title passes at the tune the shipment is loaded at the shipper's dock. equipment is riot returnable.Alrequipment returns are subject to a restocking fee. Equipment is backed by the manufacturer's repair or replacement warranty.Please Continental U.S.: read and return all warranty information required immediately upon taking deliver of All orders will he subject to a handling charge.This charge includes freight,except for your new equipment.Open or defective equipment is subject to the manufacturers additional carrier charges related to special delivery services and hazardous material warranty. shipments.Special orders are subject to additional'freight charges. Prescription Dn.rg Returns: Alaska.Hawaii&Paufic Protectorates: Please note that,in order to comply with Federal and State Pedigree requirements, Standard shipping methods provide direct,reduced cost,expedited air delivery Henry Schein's poliry on the return of Fix Drugs is as follows: service to all accounts in Alaska and Hawaii.Customers in the Pacific Protectorates Rx Drugs which Hen r�v Schein has purchased front wholesalers are not returnable. are offered direct surface transport,or postal services for reliable delivery. These items wdl be identified in your invoice with the code LVH. No additional surcharges apFtly,except when special services are requasted. Rx Drugs which are purchased btir Henry Schein directly from the;manufacturer may I Low-level items(dangerous goods in accepted quantities and Consumer be returned providing that tate fotowing key elements are met: Commodity ID 8000)are now available via UPS 2nd-dad air. 1 Only returns clue to error in order or delivery will be allowed. Guam.Puerto Rico,U.S.Trust Territories&Virgin Islands: 2)Returns of Rx Drugs will only be accepted if HSI is notified within 14 calendar days • All orders will be subject to a handling charge. chis charge includes freightthrough of receipt of the shipment and valid return authorization is issued by HSI. the United States Postal Service(USPS). 3)The Prescription Drug Marketing Act requires any customer returning Fix Drugs • Special delivery orders and hazardous material shipments can be shipped via United to complete and return a Prescription Drug Return Authorization form.Federal law Parcel Services(UPS)for an additional charge.No minimum order amount or weightrequires that the healthcare entity returning Rx Drugs document that the product applies.Speak to your International Representative for details. was kept under proper storage and handling conditions while in their possession and during the return of the product.To get a copy of the form and proper return Outside U.S.(50 states) authorization,please contact Customer Service. if your order is being shipped outside the U.S.(50 states),please refer to the 4)In addition,Pedigree regulations require:that the healthcare entity returning International Terms&Conditions at lien ryschein.roiii.Unless otherwise agreed, Rx Drugs certifies freight terms are FOB Shipper's Dock("Ex Works"outside North Amcrica)` that the product being returned is the same exact product purchased from HSI. Title passes at the time the shipment is loaded at the shipper's dock. 5)Henry Schein will not issue credit for any returned Rx Drugs which have been Customer is responsible for compliance with any applicable import requirements. tampered with,are out of date or where the labeling has been altered in any way. RXP_ROOU_CTS&CONTROLLED SUBUANCES: CHOOSEYOUR PAYMENT METHOD Regulations require us to limit the sale of Rx and controlled substances only to registered, 2%Cash Back or Maximum Rewards on all purchases with the Henry Schein- ]Im. sed healthcare professionals.If you are a new customer or have recently moved, Credit Card.To apply now,call:1.806.396.9296 or online please furnish us with a copy of your updated state DEA registration.For controlled www.henrysclieiii.coiln/creditcard Reduce the cost and administration of paying substances,furnish a copy of your DEA registration verifying your shipping address. Please note:that all orders for controlled substances are subjectto a due:diligence review Henry Schein-Pay electronically(ACH Debit)or set up AutoPay. process.Schedule II controlled substances can be ordered electronically or by mail. Please call Customer Service for details. For information on our Controlled Substance Ordering System please visit For your convenience,we provide several payment alternatives.Orders billed to your wv%,w.henrvschein.com/e222;if you prefer to continue using Federal 222 Forms to order account may be,paid by ACH Debit,Check by Phone,or Check.If you prefer. Sr;hedule II controlled substances,please mail the form to: you may useyour Henry Schein Credit Card,American Express,Visa,MasterCard or Henry Schein,Inc.• Suite 300,5315 West 74th Street• Indianapolis,IN 46268 Discover Card when placing your order.All sales are subject to our normal terms and REGULATORY REQUIREMENT: conditions.All sales are subject to credit approval.Invoices are payable within agreed Local regulatory requirements may apply to use or installation of certain products. terms of sale. Be sure to understand and comply with any such requirements prior to purchase,use, Open Accounts Receivable: or installation of products. All unpaid accounts receivable past due are subject to a 1.5%finance charge. To arrange for a product return,simply call Customer Service as noted below: Henry Schein Medical 3408 Program Henry(Schein MedicallEMS Customer Service: 1.800.472.4346 Sam-9pm,et. Customer Service: 1.877.344.3402 8:30am-5:30pm,et. Customer Service: 1.800.845.3550 8:30am-5:30pm,et Place an Order 1.800.772.4346 8anh-9pnh,et. Place an Order. 1.877.344.3402 8:30am-5:30pm,et. Place an Order 1.800.845.3550 8:30am-5:30pm,et Fax an Order. 1-800.329.910924 Hours. Fax an Order. 1.888.865.2253 24(lours. Fax an Order. 1.800.533.4793 24 Hours. Internet: www.henryschein.com/medical E-Commerce Support: 1.800.711.6032 Gam-bpm,et. Internet: www.lienrVschein.com/ents E-Mail: custserv^shenryschein.com Internet: wyay.henryschein.com/340B E-Mail: scott.bruner@henryschein.com E-Mail: custonier.support@henryschein.cem Please see:littp://v tviv.Henryschein.comNS-EN/Medical/LegaRerms.ASPX for Conditions&Exceptions. ORDER -: - ORDER DATE DUE DATE 24178157 11/13/14 1 12/13/14 D&B#:01-243-0880 WHSE DEA# RHO162494 Fed ID:11-3136595 �0 - �ct a �o = h o Y ,.�,��"��, ; .:. • ,o his order as been processed by our MIDWESTD.C. 5315 WEST74TH TREET INDIANAP LIS,IN 46268 1 107-0530 100/13X PURPLE NITRILE PF GLOVE LARGE 50 50 *C 8.60 430.00 5 ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. LEASE REFEZ TO BACK OF PAPERWORK FOR DISCLOSJRES/TEZMS OF SALE MERCHANDI E TOTAL 430.00 Invoice Date + 30 days 430.00 Please remi payments only to the following a dress: Henry Schei , Inc. Dept CH 10211 Palatine, I 60055-0241 'B LL TO 414TP TO i o INVOICE AMOUNT ITEM STATUS KEY REM KEY B-Backordered;Item will follow SK-School Kit 1308571 181710 2 14628953 4 3 0.0 0 D-Discontinued;Item no longer available xc-xo Charge ..- F-Special offer RDER > ORDE AT - t7V ATE ES M-Manufacturer will ship Item directly to you �24178157 1 1/13/1 4 11/13/14 P Prescription Drug;RetuMay b shipped Required 5 R-Refrigerated Item;May be shi ed se aratel .. . ._ , . , 1, .... .. $ -Special Schein Pricing CUSTOMER -- PAGE T-Taxable Item D-Temporarily unavailable;please reorder TOM SMALL 1 OF 1 •-Item has MSDS points/credits redeemable for certain goods or services,in accordance with discount program rales.Upon discount receipt by redemption of your earned points/credits,you are receiving or EaLipment: will receive notice of the discount value.Accordingly,you should retain these records. Opened and used equipment may not be returned for credit.Before opening equipment,we suggest that you check the shipping container and packing list to DELIVERY TERMS: ensure that you are getting exactly what you ordered.Equipment must be returned Unless otherwise agreed,freight terms are FOB Shipper's Dock('Ex Works"outside in the original unopenedpackaging,unmarked and properly packaged.Speical order North America).Title:passes at the time the shipment is loaded at the shipper's dock. equipment is riot returnable.All equipment retums are subject to a restocking fee. Equipment is barked by the manufacturer's repair or replacement warranty.Please Continental U.S.: read and return all warranty information required immediately upon Laking delivery of All orders will be subject to a handling charge.This charge includes freight,except for your new equipment.Open or defective equipment is subject to the manufacturers additional carrier charges related to special delivery services and hazardous material viarranty. shipments.Special orders are subject to additional freight charges. prescription Dnp Returns: Alaska.Hawaii&Pacific Protectorates: Please note that,in order to comply with Federal and State Pedigree requirements, Standard shipping methods provide direct,reduced cost,expedited air delivery Flenry Schein's policy on the return of Rx Drugs is as follows: service to all accounts in Alaska and Hawaii.Customers in the Pacific Protectorates Rx Drugs which Henry Schein has purrhased from wholesalers are not returnable. are offered direct surface transport,or postal services for reliable delivery. These items will be identified in vour invoice with the rode Wii. No additional surcharges apply,except when special services are requested. Rx Drugs which are purchased be�Henry Schein directly from the manufacturer may Low-level hazardous items(dangerous goods in accepted quantities and Consumer be returned providing thatthe following key elements are met: Commodity ID 0000)are now available via LIPS 2nd-day air. 1 Only returns due to error in order or delivery will be allowed. Guam.Puerto Rico.U.S.Trust Territories&Virgin Islands: 2)Returns of Rx Drugs will only be accepted if HSI is notified within 14 calendar days • All orders will be Subject to a handling charge.This charge includes freight through of receipt of the shipment and valid return authorization is issued by HSI. the United States Postal Service(USPS). 3)The Prescription Drug Marketing Act requires arty customer returning Fix Drugs • Special delivery orders and hazardous material shipments can be:shipped via United to complete and return a Prescription Drug Return Authorization form.Federal law Parcel Services(UPS)for an additional charge.No minimum order amount orweight requires that the healthcare entity returning Rx Drugs document that the product applies.Speak to your International Representative for details. was kept under proper storage and handling conditions while in their possession and during the return of the product.To get a copy of the form and proper return Outside U.S.(50 states): authorization,please contact Customer Service. If)four order is beingshipped outside the U.S.(,50 states),please refer to the 4)In addition,Pedigree regulations require that the:healthcare entity returning International Terms&Conditions at henryschein.com.Unless otherwise agreed, Rx Drugs certifies freiglitterms are FOB Shipper's Dock("Ex Works"outside North America). =product product being returned is the same exact product purchased from HSI. Title passes at the fine the shipment is loaded at the shipper's dock. 5)Henry Schein will not issue credit for any returned Rx Drugs which have been Customer is responsible for compliance with any applicable import requirements. tampered with,are out of date or where the labeling has been altered in any way. RX P_ROCUC_T_S 8r CQNTROLL_ED SUBSTANCES: ___ ___.CHO_OSEYOUR._PAYMENT—MET-171013--_ Regulations require us to limit the sale of Rx and controlled substances only to registered, 2%Cash Back or Maximum Rewards on all purchases with the Henry Schein licensed healthcare professionals.If you are a new customer or have recently moved, Credit Card.To apply now,call:1.866.398.9296 or online please furnish us with a copy of your updated stale DEA registration.For controlled www.henrysclteirr.coniJcreditcard Reduce the cost and administration of paying substances,furnish a copy of your DEA registration verifl4ncq your shipping address. Please note:that all orders for controlled substances are subject to a due diligence review Henry Schein-Pay electronically(ACH Debit)or set up AutoPay. PProcess.Schedule II controlled substances can be ordered electronically or by mail. Please call Customer Service for details. or information on our Controlled Substance Ordering System please visit For your corrvenience,we provide several payment alternatives.orders billed to your tvvvw.henrvschein.com1e222;if you prefer to continue using Federal 222 Forms to order account may be paid by ACH Debit,Check by Phone,or Check.If you prefer. Schedule II controlled substances,please mail the form to: you may useyour Henry Schein Credit Card,American Express,Visa,MasterCard or Henry Schein,Inc.• Suite 300,5315 West 74th Street • Indianapolis,IN 46268 Discover Card when placing your order.All sales are subject to o ur normal terms and REGULATORY REQUIREMENT: eonditions.All sales are subject to credit approval.Invoices are payable within agreed Local regulatory requirements may apply to use or installation of certain products. terms of sale. Be sure to understand and comply with any such requirements prior to purchase,use, Open Accounts Receivable: or installation of products. All unpaid accounts receivable past due are subject to a 1.5%finance charge. To arrange for a product return,simply call Customer Service as noted below: Henry Schein Medical 3408 Program Henry Schein MedicallEMS Customer Service: 1.800.472.4346 8arrr_9pm,et. Customer Service: 1.877.344.3402 8:30am-5:30pm,el. Customer Service: 1.800.845.3550 8:30am-5:30prn,et Place an Order 1.800.772.4346 8anr9pm,et. Place an Order. 1.877.344.3402 8:30am-5:30pm,et. Place an Order 1.000.845.3550 8:30am-5:30pm,et Fax an Order. 1.800.329.9109 24 Hours. Fax an Order: 1.888.885.2253 24 Hours. Fax an Order. 1.800.533.4793 24 Flours. Internet: %vvay.henryschein.com/medical E-Commerce Support: 1.800.711.6032 Sam-bpm,et. Internet: www.lienryschein.com/ems E-Mail: custsery@henryschein.com Internet: wvnv.henryschein.comJ340B E-Mail: scoti.bruner@hearyschein.com E-Mail: customer.support@henryschein.com Please see:http://wtenv.Henryschein.com/US-EN/Medical/Legafferms.ASPX for Conditions&Exceptions. LP300 ORDER# I ORDER DATE DUE DATE 24022994 1 11/07/14 1 12/07/14 D&B#:01-243-0880 WHSE DEA# RH0162494 Fed ID:11-3136595 - �::.• ASEWxa '+ p P.. F � i � a e c � e 00 «. .,, a ®amu s .. a his order has been processed by our MIDWEST D.C. 5315 WES 74TH 3TREET INDIANAP LIS,IN 46268 ON 317-571-2600 ---------- --------------------------------- ------ ----- ------------- ------- ---------- --------------------------------- ------ ----- ------------- ------- 1 499-7818 EA COMBAT TOURNIQUET- BLK 4 4 24.04 96.16 1 2 499-6698 EA THE POCKET BVM 4 4 33.92 135.68 2 HIS PRODUCr IS BEING SHIPPED FROM OUR WEST C AST D13TRIBUIION CENTER. ------------- ------ ----- ------------- ------- ---------- --------------------------------- ------ ----- ------------- ------- LEASE REFEZ TO BACK OF PAPERWORK FOR DISCLOS11RES/TEZMS OF SALE ---------- --------------------------------- ------ ----- ------------- ----- ---------- --------------------------------- ------ ----- ------------- ----- estern Dis ribution Center 55 VISTA BVD - PARKS, NV 39434 ---------- --------------------------------- ------ ----- ------------- ------- ---------- --------------------------------- ------ ----- ------------- ------- MERCHANDI E TOTAL 231.84 Invoice Date + 30 days 231.84 Please remi payments only to the following a dress: Henry Schei , Inc. Dept CH 10211 Palatine, I 60055-0241 BILL TO SHIR TO INVOICE# ITEM STATUS KEY REM KEY 1308571 1308572 14469713 231.84 B-Backordered;Itemwillfollow -School Kit N D-Discontinued;Item no longer available NC-No Charge OIZDER ORDER DA E F-Special offer M-Manufacturer will ship Item directly to you P-Prescription Drug;Return Authorization Required 24022994 11/07/14 11/07/14 2 R-Refrigerated Item;May be shipped separately $ -Special Schein Pricing CUSTOMERT-Taxable Item YJON 1 OF 1 -Temporarily unavailable;please reorder -Item has MSDS LP300 (e.g.poirds,discount redemptions or other special awards),with your purchases you may ear •Items that cannot be returned to the manufacturer•Any item marked nonreturnable poirdslctedits redeemable for certain goods or services,in accordance with discount program E uipment: ries.Upon discount receipt by redemption of your earned points/credits,you are receiving or -� will receive notice of the discount value.Accordingly,you should retain these records. Opened and used equipment may not be returned for credit.Before opening equipment,we suggest that you check the shipping container and parking list to DELIVERY TERMS: ensure that you are getting exactly what you ordered.Equipment must be returned Unless otherwise agreed,freight terms are FOB Shipper's Dock(Ex Works"outside in tlhe original unopened packaging,unmarked and properly packaged.Speacal order North America).Title passes at the time the shipment is loaded at the shipper's dock. equipment is not returnable.All equipment returns are subject to a restocking fee. Equipment is backed by the manufacturer's repair or replacement warranty.Please ►se Continental U.S.: read and return all warranty information required immediately upon taking delivery of All orders will be subject to a handling charge.This charge includes freight,exceptfor your new equipment.Open or defective equipment is subject to the manufacturers additional carrier charges related to special delivery services and hazardous material warranty. shipments.Special.orders are subject to additional freight charges. Prescription Dn is Returns Alaska.Hawaii&Pacific Protectorates: Please note that,in order to comply with Federal and State Pedigree requirements, Standard shipping methods provide direct.reduced cost,expediter]air delivery Henry Schein's policy on the return of Pox Drugs is as follows: senrice to all accounts in Alaska and Hawaii.Customers in tike Pacific Protectorates Rx Drugs which Henry Schein has purchased from wholesalers are not returnable. are offered direct surface transport,or postal services for reliable deliveRl. These ifems will be identified in your invoice with the rode WH. No additional surcharges apply,except when special services are requested. Rx Drugs which are purchased by Henry Schein directly from the manufacturer may Low-level hazardous items(dangerous goods in accepted quantities and Consumer be returned providing thatthe following key elements are met: Commodity ID 0000)are now,available via UPS 2nd der air. 1 Only returns due to error in order or delive l will be allowed. Guam Puerto Rico,115.Trust Territories&Virgin Islands: 2;Returns of Rx Drugs%vill only be.accepted if HSI is notified within 14 calendar days • All orders will be subject to a handling charge. I his charge includes freight through of receipt of the shipment and valid return authorization is issued by HSI. the United States Postal Service(USPS). 3)The Prescription Drug Marketing Act requires any customer returning Fix Drugs • Special de livn. i orders and hazardous material shipments can be shipped via United to complete and return a Prescription Drug Return Authorization form.Federal law Parcel Services(UPS)for an additional charge.No mmnnum order amount or weight requires that the healthcare entity returning Rx Drugs document that the product applies.Speak to your International Representative for details. was kept under proper storage and handling conditions while in their possession and during the return of the product.To get a copy of the form and proper return Outside U.S.(50 states): authorization,please contact Customer Service. 11your order is being shipped outside the U.S.(50 states),please refer to the 4)In addition,Pedigree regulations require that the healthcare entity returning International Terms&Conditions at herinischein.com.Unless otherwise agreed, Rx Drugs certifies freightterms are FOB Shipper's Dark("Ex Works"outside North America). that the product being returned is the same exact product purchased from HSI. Title passes at the time the shipment is loaded at the shipper's dock. 5)Henry Schein will not issue credit for any returned Rx Drugs which have been _ Customer is responsible for compliance with any applicable import requirements. tampered with,are out of date or where the labeling has been altered in any xray. RX PRODUCTS& CONTROLLED SUBSTANCES: CHO®SEYOUR-PAYMENT-METHOD— Regulations AYir ENT-METHOD Regulations require us to limitthe sale of Rx and controlled substances only to registered, 2%Cash Back or Maximum Rewards on all purchases with the Henry Schein licensed healthcare professionals.If you are anew customer or have recently moved, Credit Card.To apply now,call:1.866.396.9296 or online please furnish us with a copy of your updated slate DEA registration.For controlled www.henryschein.com paying /creditcard Reduce the cost and administration of substances,furnish a copy of your DEH registration verifying your shipping address. Please note:that all orders for controlled substances are subject to a due diligence review Henry Schein-Pay electronically(ACH Debit)or set up AutoPay. process.Schedule II controlled substances can be ordered electronically or by mail. Please call Customer Service for details. For information on our Controlled Substance Ordering System please visit For your convenience,we provide several payment alternatives.Orders billed to your wv%,w.henryschein.com/e222;if you prefer to continue using Federal 222 Forms to order account may be paid by ACH Debit,Check by Phone,or Check.If you prefer, Schedule II controlled substances,please mail the form to: you may useyour Henry Schein Credit Card,American Express,Lisa,MasterCard or Henry Schein,Inc.• Suite 300,5315 West 74th Street • Indianapolis,IN 46268 Discover Card when planing your order.All sales are subject to our normal terms and REGULATORY REQUIREMENT: conditions.All sales are subject to credit approval.Invoices are payable within agreed Local regulatory requirements may apply to use or installation of certain products. terms of sale. Be Sure to understand and comply with any such requirements prior to purchase,use., open Accounts Receivable: or installation of products. All unpaid accounts receivable past due are subject to a 1 9,�v finance charge. To arrange for a product return,simply call Customer Service as noted below: Henry Schein Medical 3408 Program Henry Schein Medtcal/EMS Customer Service: 1.800.472.4346 Sam-91)m,et. Customer Service: 1.877.344.3402 8:30am-5:30pm,el. Customer Service: 1.800.845.3550 8:30am-5:30pm,et Place an Order 1.800.772.4346 Sam-9pm,et. Place an Order. 1.877.344.3402 8:30am-5:30pm,et. Place an Order. 1.800.845.3550 8:30am-5:30pm,et. Fax an Order. 1.800.329.9109 24]fours. Fax an Order. 1.888.895.2253 24 Hours. Fax an Order. 1.800.533.4793 24 Hours. Internet: tivwtv_henryschein.com/medical E-Commerce Support: 1.800.711.6032 Sam-Spm,et. Internet: www.henryschein.com/ears E-Mail: cuslserv@henryschein.com Internet: ivvnv.henryschein.com/3410B E-Mail: scott.bruner@henryschein.com E-Mail: custoniecstipport@henryschein.com Please see:http://www.Henryschein.comJUS-EN/Medical/LegalTerms.ASPX for Conditions&Exceptions. VOUCHER NO. WARRANT NO. ALLOWED 20 Henry Schein IN SUM OF$ Dept Ch 10241 Palatine, IL 60055 $1,570.19 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1120 14628953 102-390.11 $430.00 1 hereby certify that the attached invoice(s), or 1120 14469713 102-390.11 $231.84 bill(s) is(are)true and correct and that the 1120 j 14386737 j 102-390.11 j $908.35 materials or services itemized thereon for which charge is made were ordered and received except NOV 2 4 ?w /6 Fire Chief Title � I Cost distribution ledger classification if claim paid motor vehicle highway fund i 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)) 14628953 $430.00 14469713 $231.84 14386737 $908.35 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 5-11-10-1.6 120 Clerk-Treasurer