245856 06/03/15 +u_.qqy
f CITY OF CARMEL, INDIANA VENDOR: 357526
® ONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: $*****1,030.10*
r /rte CARMEL, INDIANA 46032 DEPT CH 10241 CHECK NUMBER: 245856
'9.,,'`TON� PALATINE IL 60055-0241 CHECK DATE: 06/03/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 4239011 19523645 25.10 SPECIAL DEPT SUPPLIES
102 4239011 19581212 906.00 SPECIAL DEPT SUPPLIES
102 4239011 19729577 99.00 SPECIAL DEPT SUPPLIES
ORDER -ORDER DATEDUE_DATE
29836634 05/04/15 06/07/15
D&B#:01-243-0880
WHSEDEA# PG0229321 Fed ID:11-3136595 CONTAINS MULTIPLE INVOICES
, ® ma,
m m
his order has been processed by our GIV D.C. ," '
80 summill VIEW LANE
BASTIAN, VA 243L4
his is a b ckordered shipment for order:2983 634 or ginal invoice:19368 44
1 499-2106 EA AC POWER CORD 1 1 25:10 25.10 1
----------------- -------
LEASE REFEZ TO BACK OF PAPERWORK FOR DISCLOS ES/TE S OF SALE
MERCHANDI E TOTAL r 25.10
Invoice Date + 30 days 25.10
lease remi payments only to the following a dress: <_-
Henry Schei , Inc.
Dept CH 10211
alatine, I, 60055-0241'�
ILL . SHIP To -INV-I - - NV -E AMO" - ITEM STATUS KEY REM KEY
1308571 1308572 19 5 2 3 6 4 5 2 5.10 B-Backordered;Item will follow SK-School Kit
D-Discontinued;Item no longer available NC-No Charge
ORDERO ORDERDATE INV I E DA EF BOXES F-Special offer
M-Manufacturer will ship Item directly to you
0 4 15 5/08/15 1 P-Prescription Drug;Return Authorization Required
29836634 0 5
/ / R-Refrigerated Item;May be shipped separately
CUSTOMER PO# PAGE $ -Special Schein Pricing
T-Taxable Item
JON 0 5 0 415 1 OF 1 *I-Item h MSDS unavailable;please reorder
purchase(s)are subject to a bundled discount or rebate.Any such discounts must be Equipment:
calculated pursuant to the forms of the applicable purchase offer,promotion,or discount opened andand used equipment may not be returned for credit.Before opening
program.Participation in a promotional discount program is only permissible in accordance equipment,we suggest that you check the shipping container and packing listto
with discount program rules.By participation in such program,you agree that,to your ensure that you are getting exactly what you ordered.Equipment must be returned
knowledge,your practice complies withthe discount program requirements. in the original unopenedpackaging,unmarked and properly packaged.Speical order
equipment is not returnable.AIf equipment returns are subject to a restocking tee.
DELIVERYTERMS: Equipment is backed by the manufacturer's repair or replacement warranty.Please
Unless otherwise agreed,freight terms are FOB Shipper's Dock("Fx Works"outside read and return all warranty information required immediately upon taking delivery of
North America).Title passes at the time the shipment is loaded at the shipper's dock. your new equipment.Open or defective equipment is subject to the manufacturers
Continental U.S.: warranty.
All orders will be subject to a handling charge.This charge includes freight,except for Prescription Drug Returns:
additional carrier charges related to special delivery services and hazardous material Please note that,in order to comply with Federal and State Pedigree requirements,
shipments.Special orders are subject to additional freight charges. Henry Schein's policy on the return of Rx Drugs is as follows:
Alaska.Hawaii&Pacific Protectorates: Rx Drugs which Henry Schein has purchased from wholesalers are riot returnable.
Standard shipping methods provide direct,reduced cost,expedited air delivery These items will be identified in your invoice with the rode WH.
service to all accounts in Alaska and Hawaii.Customers in the Pacific Protectorates Rx Drugs whim are purchased by Henry Schein directly from the manufacturer may
are offered direct surface transport,or postal services for reliable delivery. be returned providing that the following key elements are mel:
No additional surcharges apply,except when special services are requested.
Low-level hazardous items(dangerous goods in accepted quantities and Consumer 1)Only returns due to error in order or delivery will be allowed.
Commodity ID 8000)are now available via UPS 2nd-day air. 2)Returns of Rx Drugs will only be.accepted it HSI is notified within 14 calendar days
Guam.Puerto Rico,U.S.Trust Territories&Virgin Islands: of receipt of the shipment and valid return authorization is issued by HSI.
1 3)The Prescription Drug Marketing Act requires any customer returning Rx Drugs
• All orders will be subject to a handling charge. Phis charge includes freightthrough to complete and return a Prescription Drug Return Authorization form.Federal law
the United States Postal Service(USPS). requires that the healtticare.entity returning Rx Drugs document that the product
• Special delivery orders and hazardous material shipments can be shipped via United was kept under proper storage and handling conditions while in their possession
Parcel Services(UPS)for an additional charge.No minimum order amount orweight and during the return of the product.To gel a copy of the form and proper return
applies.Speak to your International Representative for details. authorization,please contact Customer Service.
Outside U.S.(50 states): 4)In addition,Pedigree regulations require that the healthcare entity returning
If your order is being shipped outside the U.S.(50 states),please refer to the Rx Drugs certifies
International Terms&Conditions at henRischein.com.Unless otherwise agreed, that the product being returned is the same exact product t purchased from HSI.
freight terms are FOB Shipper's Dock('Tx Works"outside North America). 5)Henry Schein will not issue credit for any returned Rx Drugs which have been
Title passes at the time the shipment is loaded at the shipper's dock. tampered with,are out of date or where the labeling has been altered in anyway.
Customer is responsible for compliance with any applicable import requirements. CHOOSE YOUR PAYMENT METHOD
RX PRODUCTS 8r GQNTROLLED SUBSTANCES: 2%Gash-Back or Maximum Rewards-on-all.purchases-with_the_Henry_8chein____
Regulations require us to limit the sale of Rx and controlled substances only to registered, Credit Card.To apply note,call:1.866.398.9296 or online
licensed healthcare professionals.If you area newstat customer tr have recently rowed, vRvw.henr schein.com/crediteard Reduce the cost and administration of m
please furnish us with a copy of your updated state DEA registration.For controlled Y Pat 9
substances,furnish a copy of your DEA registration verifying your shipping address. Henry Schein-Pay electronically(ACH Debit)or set up AutoPay.
Please note that all orders for controlled substances are subject to a due diligence review Please call Customer Service for details.
process.Schedule 11 controlled substances can be ordered electronically or by mail. For your convenience,we provide several payment alternatives.Orders billed to your
For information on our Controlled Substance Ordering System please visit account may be paid by ACH Debit,Check by Phone,or Check.If you prefer,
www.henryschein.com/e222;if you prefer to continue using Federal 222 Forms to order you may useyour Henry Schein Credit Card,American Express,Visa,MasterCard or
Schedule 11 controlled substances,please mail the form to: Discover Card when placing your order.All sales are subject to our normal terms and
Henry Schein,Inc.• Suite 300,5315 West74th Street • Indianapolis,IN 46268 c:onditions.All sales are subject to credit approval.Invoices are payable within agreed
REGULATORY REQUIREMENT: terms of sale.
Local regulatory requirements may apply to use or installation of certain products. Open Accounts Receivable.:
Be sure to understand and comply with any such requirements prior to purchase,use, All unpaid accounts receivable past due are subject to a 1.5%finance charge.
or installation of products.
To arrange for a product return,simply call Customer Service as noted below:
Henry Schein Medical 3408 Program Henry Schein MedicalfEMS
Customer Service: 1.800.472.4346 Sam-91)rn,et. Customer Service: 1.877.344.3402 8:30am-5:30pm,el. Customer Service: 1.800.845.3550 8:30ani-5:30pin,et
Place an Order: 1.800.772.4346 Sam-9prn,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 Horus. Fax an Order: 1.888.885.2253 24 Hours. Fax an Order. 1.800.533.4793 24 Hours.
Internet: twnv.henryschein.com/medical E-Commerce Support: 1.800.711.6032 8am-8pin,et. Internet: www.henryschein.com/erns
E-Mail: custserushenryschein_com Internet: twrw.henryschein.com/34013 E-Mail: scott.brunerChenryschein.com
E-Mail: customer.support@henrVschein.com
Please see:littp:/Jwwty.Henryschein.com/US-EN/Medical/LegalTerms.ASPX for Conditions&Exceptions.
LP300
ORDERO DATE DUE-DATE
30045091 05/11/15 11 06/11/15
D&B#:01-243-0880
WHSE DEA# RHO 162494 Fed ID:11-3136595
10
;
his order has been processed by our MIDWEST D.C.
I
5315 WES 74TH 3TREET
INDIANAP LIS,IN 46268
------------
1 602-8100 EA COLLAR STIFNECK SELECT ADULT 50 50 C 5.50 275.00 1
SE GOOD I EM, MAY BE SHIPPED`SEPARATELY.
2 647.74174 10/TRAY CURITY GAUZE 12PLY STER 411%4" 40 40 0.65 26.00 3
3 935-6155 50/PK BLUE SENSOR SP ELECTRODES 50 50 12.10 605.00 3:
I
LEASE REFEZ TO BACK OF PAPERWORK FOR DISCLOS RES/TE S OF SALE
MERCHANDI E TOTAL 906 00
Invoice Date + 30 days 906.00
Please remi payments only to the following a dress:
enry Schei , Inc.
Dept CH 10211
Palatine, I 60055-0241
ILL TO '" SHIP TO - INVOICE# INVOICE C ITEM STATUS KEY REMKEY
-•
B-Backordered;Itemm er available will follow SK-School Kit
1308571 1817102 19581212 9 0 6.00 D-Discontinued;Iteno longer NC-No Charge
- F-Special offer
ORDER# ORDER DATE INVOICE DATE # OF B XE i -
M-Manufacturer will ship Item directly to you
P-Prescription Drug;Return Authorization Required -
30045091 05/11/15 5/12/15 3 R-Refrigerated Item;May be shipped separately
T MER P pA E $ -Special Schein Pricing
T-Taxable Item
0 51115 JON 1 OF 1 U-Temporarily unavailable;please reorder
'-Item has MSDS
purchase(s)are sublect to a bundled discount or rebate.Any such discounts must be T Equipment:
calculated pursuant to the terms of the applicable purchase offer,promotion,or discount Opened and used equipment may not be returned for credit.Before opening
program.Participation in a promotional discount program is only permissible in accordance equipment,we suggest that you check the shipping container and packing list to
with discount program rules_By participation in such program,you agree that,to your ensure that you are getting exactly what you ordered.Equipment must be returned
knowledge,your practice complies with the discount program requirements. in the original unopenedpackaging,unmarked and properly packaged.Speical order
equipment is not returnable.Alf equipment returns are subject to a restocking tee.
DELIVERYTERMS: Equipment is backed by the manufacturer's repair or replacement warranty.Please
Unless otherwise agreed,freight terms are FOB Shipper's Dock C'Ex Works"outside read and return all warranty information required immediately upon taking delivery of
North America).Title passes at the time the shipment is loaded at the shipper's dock. your new equipment.Open or defective equipment is subject to the manufacturer's
Continental U.S.: warranty.
All orders will be subject to a handling charge.This charge includes freight,exceptfor Prescription Dnp Returns:
additional carrier charges related to special delivery services and hazardous material Please note fiat,in order to comply with Federal and State Pedigree requirements,
shipments.Special orders are subject to additional freight charges. Henry Schein's policy on the return of Rx Drugs is as follows:
Alaska.Hawaii&Pacific Protectorates: Rx Drugs which Henry Schein has purchased from wholesalers are riot returnable.
Standard shipping methods provide direct,reduced cost,expedited air delivery These items will be identified in your invoice with the rode PIH.
service to all accounts in Alaska and Hawaii.Customers in the Pacific Protectorates Rx Drugs which are purchased by Henry Schein directly from the manufacturer may
are offered direct surface transport,or postal services for reliable delivery. be returned providing that the following key elements are met:
No additional surcharges apply,except when special services are requested.
Low-level hazardous items(dangerous goods in accepted quantities and Consumer 1)Only returns due to error in order or delivei i will be allowed.
Commodity iD 8000)are now available via UPS 2nd-day air. 2)Returns of Rx Drugs will only be.accepted i�HSI is notified within 14 calendar days
of receipt of the shipment and valid return authorization is issued by HSI.
Guam.Puerto Rico.U.S.Trust Territories&Virgin Islands: 3)The Prescription Drug Marketing Act requires any customer returning Rx Drugs
• Ail orders will be subject to a handling charge.This charge includes freight through to complete and return a Prescription Drug Return Authorization form.Federal law
the United States Postal Service(USPS). requires that the healthcare entity returning Rx Drugs document that the product
• Special delivery orders and hazardous material shipments can be shipped via United was kept under proper storage and handling conditions while in their possession
Parcel Services(UPS)for an additional charge.No minimum order amount or weight and during the return of the product.To get a copy of the town and proper return
applies.Speak to your International Representative for details. authorization,please contact Customer Service.
Outside U.S.(50 states): 4)In addition,Pedigree regulations require that the healthcare entity returning
If your order is being shipped outside the U.S.(50 states),please refer to the Rx Drugs certifies
international Terms&Conditions at henryschein.com.Unless otherwise agreed, that the product being returned is the same exact product purchased from HSI.
freight terms are FOB Shipper's Dock("Ex Works"outside North America). 5)Henry Schein will not issue credit for any returned Rx Drugs which have been
lltle passes at the time the shipment is loaded at the shipper's dock. tampered with,are out of date or where the labeling has been altered in any way.
Customer is responsible for compliance with any applicable import requirements. CHOOSE YOUR PAYMENT METHOD
RX PRODUCTS & CONTROLLED SUBSTANCES: 2%Cash Back or Maximum Rewards all urchaseswith_the Hen Schein
Regulations require usty limitthe-sale of-Fbcand-controlled-substances only to-registered,-__-, [? __ _ry
licensed healthcare professionals.If you area new customer or have recently moved, Credit Card.To apply now,cal[:1.066.398.9296 or online
please furnish us with a copy of your updated state DEA registration.For controlled www.henrysclneifr.coin/crediteard Reduce the cost and administration of paying
substances,furnish a cop±/of your DEA registration verifying your shipping address. Henry Schein-Pay electronically(ACH Debit)or set up AutoPay.
Please note that all orders for r,ontrolled substances are subject to a due diligence review Please call Customer Service for details.
process.Schedule II controlled substances can be ordered electronically or by mail. For your convenience,we provide several payment alternatives.Orders billed to your
For information on our Controlled Substance Ordering S stem pleasevisit account may be it b ACH Debit,Check by
Phone,or Check.if you prefer,
uwnn.henr Schein(.om/e222;ifyou refer to continue using Federal 222 Forms to order , Wryour V
Y } P you mai uselour Henry Schein Credit Card,American Express,Visa,MasterCard or
Schedule II controlled substances,please mail the form in.
. Discover Card when placing your order.All sales are subject to oirr normal terms and
Henry Schein,Inc.• Suite 300.5315 West 7401 Street • Indianapolis,IN 46268 conditions.All sales are subject to credit approval.Invoices are payable within agreed
REGULATORY REQUIREMENT: terms of sale.
Local regulator.,requirements may a .by to use or installation of certain products. Open Accounts Receivable:
g q Yp��l P P
Be sure to understand and comply wltti any such requirements prior to purchase,use, All unpaid accounts receivable past due are subject to a 1.5%finance charge.
or installation of products.
To arrange for a product return,simply call Customer Service as noted below:
Henry Schein Medical 3408 Program Henry Schein Medical(EMS
Customer Service: 1.800.472.4346 Barn-9prn,et. Customer Service: 1.877.344.3402 8:30ani-5:30prn,el. Customer Service: 1.800.845.3550 8:3Wni-5:30pin,et
Place an Order. 1.800.772.4346 Barn-9pnn,et. Place an Order. 1.877.344.3402 8:30am-5:30prn,et. Place an Order. 1.800.845.3550 8:30am-5:30pm,et
Fax an Order. 1.800.329.9109 2.4 Hours. Fax an Order. 1.888.685.2253 24 flours. Fax an Order. 1.800.533.4793 24 Hours.
Internet: www.henryschein.com/medical E-Commerce Support: 1.800.711.6032 Bam-Spm,et. Internet: www.henryschein.com/ems
E-Mail: custsery@henryschein.com Internet: www.henryschein.com/34116 E-Mail: scott.bruner0henryschein.com
E-Mail:_ customer.support@henrVsrhein.com
Please see:littp-.//wvnv.Henryschein.com/US-EN/Medical/LegalTerms.ASPX for Conditions&Exceptions.
LP300
bPJIgR# ORDER DATEDUE:DATE
29938874 05/07/15 06/14/15
D&B#:01-243-0880
WHSE DEA# PG0229321 Fed ID:11-3136595
his order has been processed by our GIV D.C.
80 SUMMI VIEW LANE
BASTIAN VA t43 4
his is a b ckordered shipment for order:2993 874 or ginal invoice:19496 44
---------- --------------------------------- ------ ----- ------------- -------
---------- --------------------------------- ------ ----- ------------- -------
1 700-0017 EA LSU NIMH BATTERY 1 1 * 99.00 99.00 1
LEASE REFEZ TO BACK OF PAPERWORK FOR DISCLOSJRES/TEZMS OF SALE
MERCHANDI E TOTAL 99.00
Invoice Date + 30 days 99.00
Please remi payments only to the following a dress:
Henry Schei , Inc.
Dept CH 10211
Palatine, I 60055-0241
z HIP TO " o ITEM STATUS KEY REM KEY
B-Backordered;Item will follow SK-School Kit
1308571 1308572 19729577 9 .00 D-Discontinued;Item no longer available NC-No Charge
RDER ORDER DATE NVO E D E OF E F- l offs[
M-MManufacturer will ship Item directly to you
P-Prescription Drug;Return Authorization Required
29938874 05/07/15 5/15/15 1 R-Refrigerated Item;May be shipped separately
`C[JST MER--P A-E' $ -Special Schein Pricing
T-Taxable Item
TOM SMALL 1 OF 1 U-Temporarily unavailable;please reorder
•-Item has MSDS
purchase(s)are subject to a bundled discount or rebate.Arty such discounts must be Equipment:
calculated pursuant to the terms of the applicable purchase offer,promotion,or discount Opened and used equipment may not be returned for credit.Before opening
program.Participation In a promotional discount program is only permissible in accordance equipment,we suggest that you check the shipping container and packing list to
with discount program rules.By participation in such program,you agree that,to your ensure that you are getting exactly what you ordered.Equipment must be returned
knowledge,your practice complies withthe discount program requirements. in the original unopenedpackaging,unmarked and properly packaged.Speical order
equipment is not returnable.AI equipment returns are subject to a restocking fee.
DELIVERYTERMS: Equipment is backed by the manufacturer's repair or replacement warranty.Please
Unless otherwise agreed,freight terms are FOB Shipper's Dock(Ex Works"outside read and return all warranty information required immediately upon taking delivery of
North America).Title passes at the time the shipment is loaded at the shipper's dock. your new equipment.Open or defective equipment is subject to the manufacturer s
Continental U.S.: warranty.
All orders will be subject to a handling charge.This charge includes freight,except for Prescription drug Returns:
additional carrier charges related to special delivery services and hazardous material Please note titat,in order to comply with Federal and State Pedigree requirements,
shipments.Special orders are subject to additional freight charges. Henry Schein's poliry on the return of Rx Drugs is as follows:
Alaska.Hawaii&Pacific Protectorates: Rx Drugs which Henry Schein has purchased from wholesalers are riot returnable.
Standard shipping methods provide direct,reduced cost,expedited air delivery These items will be identified in your invoice with the rode WH.
service to all accounts in Alaska and Hawaii.Customers in the Pacific Protectorates Rx Drugs which are purchased bey Henry Schein directly from tie manufacturer may
are offered direct surface transport,or postal services for reliable delivery. be returned providing that the following key elements are met:
No additional surcharges apply,except when special services are requested.
Low-level hazardous items(dangerous goods in accepted quantities and Consumer 1)Only returns due to error in order ur delive�r will be allowed.
Commodity ID 8000)are now available via UPS 2nd-day air. 2)Returns of Rx Drugs will only be.accepted if HSI is notified within 14 calendar days
Guam Puerto Rico U.S.Trust Territories&Urr in Islands of receipt of the shipment and valid return authorization is issued by HSI.
• All orders will o.U.S.subjr st a handlingViLgicharge.shin charge includes treightthroirgh 3)Thr,Prescription Drug Marketing Act requires any customer returnrng Rx Drugs
the United States Postal Service(USPS). to complete and return a Prescription Drug Return Authorization form.Federal law
• Special red Slaty orders and hazardous mterial shipments can be shipped via United requires that the healthcare entity returning Rx Drugs document that the product
Parcel Services(UPS)for an additional charge. hi minimum order shipped
amount or United was kept under proper storage and handling conditions while in their possession
applies.Speak to your International Representative for details. and during the return of the product get copy of the.form and proper return
authorization,please contact Customerr Sen;ice,
Outside U.S.t50 statesl: 4)In addition,Pedigree regulations require that tie healthcare entity returning
If your order rs being shipped outside the U.S.(50 states),please refer to the Rx Drugs certifies
International Terms&Conditions at henryschein.com.Unless otherwise agreed, that the product being returned is the same exact product purchased from HSI.
freight terms are FOB Shipper's Dock("Ex Works"outside North America). 5)Henry Schein will not issue credit for any returned Rx Drugs which have been
Title passes at the time the shipment is loaded at the shipper's dock. tampered with,are out of date or where the labeling has been altered in anyway.
Customer is responsible for compliance with any applicable import requirements. CHOOSE YOUR PAYMENT METHOD
— --RX-P-RODUCT-S-&-CONTROLLED-SUBSTANCES:- — 2.16 Cash Back or-Maximum Rewards-onall-purchaseswith the-Henrir-Schein--
Regulations require usto limit the sale of R,t and controlled substances only to registered, Credit Card.To apply now,call:1.866.398.9296 or online
licensed healthcare professionals.If you area new customer tr have recFor coy moved, www.henryselieiii.com/creditcard Reduce the cost and administration of in
please furnish us with a copy of your updated state DEA registration.For controlled ry Pay 9
substances,furnish a copy of your DEA registration verifying your shipping address. Henry Schein-Pay electronically(ACH Debit)or set up AutoPay.
Please note that all orders for controlled substances are subjectto a due diligence review Please call Customer Service for details.
process.Schedule II controlled substances can be ordered electronically or by mail. For your convenience,we provide several payment alternatives.Orders billed to your
For information on our Controlled Substance Ordering System please visit account may be paid by ACH Debit,Check by Phone,or Check.If you prefer.
ww4w.henryschein.com1e222;if you prefer to continue using Federal 222 Forms to order you may usejyour Henry Schein Credit Card,American Express,Visa,MasterCard or
Schedule II controlled substances,please mail the form to: Discover Card when placing your order.All sales are subject to our normal terms and
Henry Schein,Inc.• Suite 300,5315 West 74th Street • Indianapolis,IN 46268 c:onditions.All sales are subject to credit approval.Irrvoices are payable within agreed
REGULATORY REQUIREMENT: terms of sale.
Local regulatory requirements may apply to use or installation of certain products. Open Accounts Receivable:
Be sure to understand and comply with any such requirements prior to purchase,use, All unpaid accounts receivable past due are subject to a 1.5%finance charge.
or installation of products.
To arrange for a product return,simply call Customer Service as noted below:
Henry Schein Medical 340B Program Henry Schein Medical/EMS
Customer Service: 1.800.472.4346 8am-9pm,et. Customer Service: 1.877.344.3402 8:30ani-5:30prn,el. Customer Service: 1.800.845.3550 8:30am--5:30pin,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: 1.800.845.3550 8:30am-5:30pm,et
Fax an Order. 1.800.329.910924 Hours. Fax an Order. 1.888.885.2253 24 Hours. Fax an Order. 1.800.533.4793 24 Hours.
Internet: www_henMehein.com/medical E-Commerce Support: 1.600.711.6032 Sam-8prn,et. Internet: www.henryschein.corn/ems
E-Mail: custserv^henryschein.com Internet: twrw.henryschein.com/34011 E-Mail: scott.brunerghenryschein.com
E-Mail: customer.support@henryseliein.com
Please see:lrttp://www.Henryschein.com/US-EN/Medical/LegalTerms.ASPX for Conditions&Exceptions.
LP300
VOUCHER NO. WARRANT NO.
ALLOWED 20
Henry Schein
IN SUM OF $
Dept Ch 10241
Palatine, IL 60055
$1,030.10
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1120 19581212 102-390.11 $906.00 1 hereby certify that the attached invoice(s), or
1120 19523645 102-390.11 $25.10
bill(s) is (are)true and correct and that the
1120 19729577 j 102-390.11 j $99.00 materials or services itemized thereon for
which charge is made were ordered and
received except
JUN ® 1 2015
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
IIAn 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))
19581212 $906.00
i
19523645 $25.10
19729577 $99.00
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