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Home My WebLink About330144 09/19/18 �c�.p�aM t� CITY OF CARMEL, INDIANA VENDOR: 357526 ONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: $*****1,174.22* r �'� CARMEL, INDIANA 46032 DEPT CH 10241 CHECK NUMBER: 330144 "� �� CHECK DATE: 09/19/18 �'�iorl�. PALATINE IL 60055.0241 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 102 4239011 57002385 637.32 SPECIAL DEPT SUPPLIES 102 4239011 57181902 536.90 SPECIAL DEPT SUPPLIES VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995) ALLOWED 20 ACCOUNTS PAYABLE VOUCHER Vendor# 357526 HENRY SCHEIN INC IN SUM OF$ CITY OF CARMEL DEPT CH 10241 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. PALATINE, IL 60055-0241 Payee $536.90 Purchase Order# ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Terms Date Due PO# ACCT# DATE INVOICE# DESCRIPTION DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT 57181902 42-390.11 $536.90 I hereby certify that the attached invoice(s),or 9/18/18 57181902 EMS Supplies $536.90 1120 102 1120 102 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 Tuesday,September 18,2018 David Haboush Fire Chief 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 Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer IMENkYS04EINO anus, MEDICAL I EMS • Ship/Sold-To:1308572 INVOICE Carmel Fire Dept Head Quarters z Civic sq Carmel,IN 46032-7543 571 010000130857157181902110000000000536900911183 CCarmelFieDept 2 Civic Sq Carmel,IN 46032-7543 CARMEL FIRE DEPT 2 CIVIC SQ CARMEL, IN 460327543 Invoice# Invoice Date Due Date Invoice Total 57181902 09/11/18 10/11/18 $536.90 Purchase Order# Payment Terms - -. 09112018 Invoice Date-+30--days------- Customer 0-da s------- Customer DEA# Customer State Reg# Federal ID#: D&B#: 11-3136595 01-243-0880 .kE h 3 J ex ti p 1t77 �.. III yF ;x F ,r.ism .€ I r < r`Ggqq BOOM �<j.€ .7? Y�'sllalLFhR < xFial3'fi 1 700-3325 EA Flowsafe II EZ CPAP w/Med Mask 10 10 53.69 536.90 1 TX THIS PRODUCT IS BEING SHIPPED FROM OUR SOUTHWEST DISTRIBUTION CENTER. ESTIMATED DELIVERY DATE:09114118 MERCHANDISE TOTAL 536.90 INVOICE TOTAL 536.90 Please refer to back of paperwork for Terms of Sale and disclosures or go to https://www.henryschein.com/us-en/medicalAegalterms.aspx.Such terms are incorporated herein by reference Thank you for your order! CODE STATUS KEY Ship To# Bill To# Invoice# Invoice DateIrivoice Total B -Backordered;Item will fallow R -Refrigerated Item;May be shipped separately 1308572 1308571 57181902 09/11/18 $536.90 C -Case Good Item sK-School Kit D -Discontinued;Item no longer available T -Taxable Item F -Special offer U -Temporarily unavailable;please reorder Order# Order Date #of Boxes PO# M -Item will ship directly from manufacturer W-Warranty Item 67737900 09/11/18 1 09112018 NC-No Charge WH,MN,M2,DN-DSCSA CODES P -Prescription Drug;Return Authorization Required$ -Special Schein Pricing '-Item has SDS Distribution Names/Address TX 1001 Nolen Dr.0400Grapevine.TX 76051 OEA#:RHOM92 State Reg#:0030M Chem.Reg#:OD6515HNY Please remit pavments to,Henry Schein,Inc.Dept CH 10241 Palatine,IL 60055-0241 US Page 1 of 1 VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201 (Rev.1995) Vendor# 357526 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER HENRY SCHEIN INC IN SUM OF$ CITY OF CARMEL DEPT CH 10241 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. PALATINE, I L 60055-0241 Payee $637.32 Purchase Order# ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Terms Date Due PO# ACCT# DATE INVOICE# DESCRIPTION DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT 57002385 42-390.11 $637.32 1 hereby certify that the attached invoice(s),or 9/14/18 57002385 $637.32 1120 102 1120 102 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 Monday, September 17,2018 David Haboush Fire Chief 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— Cost 20Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer EN CHE 1 v us„ MEDICAL � . Ship/Sold-To:1308572 INVOICE Cannel Fire Dept Head Quarters 2 Civic Sq Cannel,IN 46032-7543 Bill-To:130571 010000130857157002385110000000000637320906185 Carmel Fire et 2 Civic Sq Cannel,IN 46032-7543 CARMEL FIRE DEPT 2 CIVIC SQ CARMEL, IN 460327543 Invoice# Invoice Date Due Date Invoice Total 57002385 09/06/18 10/06/18 $637.32 Purchase Order# Payment Terms _ ------- _ _09052018 __Invoice..Date_t_30--da s-__ Customer DEA# Customer State Reg# Federal ID#: D&B#: 11-3136595 01-243-0880 "4•x�a•�. ,�.W.. .x..,�?......��.. �.�M 1 499-3940 EA Spur Resuscitator W/Mask Resv Adult 12 12 C 10.11 121.32 1 IN CASE GOOD ITEM,MAYBE SHIPPED SEPARATELY. 2 507-0313 EA Introcan Safety Catheter 20gX1.25" 300 300 1.72 516.00 3 IN MERCHANDISE TOTAL 637.32 INVOICE TOTAL 637.32 Please refer to back of paperwork for Terms of Sale and disclosures or go to https://www.henryschein.com/us-en/medicalAegaiterms.aspx.Such terms are incorporated herein by reference Thank you for your order! CODE STATUS KEY Ship To# Bill To# Invoice# Invoice Date Invoice Total B -Backordered;Item will follow R -Refrigerated Item;May be shipped separately 1308572 1308571 57002385 09/06/18 $637.32 C -Case Good Item SK-School Kit D -Discontinued;Item no longer available T -Taxable Item F -Special offer U -Temporarily unavailable;please reorder Order# Order Date #Of Boxes PO# M -Item will ship directly from manufacturer W-Warranty Item 67558943 09/05/18 3 09052018 NC-No Charge WH,MN,M2,DN-DSCSA CODES P -Prescription Drug;Return Authorization Required$ -Special Schein Pricing *-Item has SDS Distribution Names/Address Itt53156N741h SL Indianapd's,IN 46268 BEA$:RHO162494 SlateReg9:48001176A Chem Regi.C6G574HNY Please remit uavments to,Henry Schein,Inc.Dent CH 10241 Palatine,IL 60055-0241 US Page 1 of 1