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HomeMy WebLinkAbout331183 10/17/18 `%��_,qbf. CITY OF CARMEL, INDIANA VENDOR: 357526 v.. ® ONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: $*******536.90* 9 /=a CARMEL, INDIANA 46032 DEPT CH 10241 CHECK NUMBER: 331183 .y�«oN�, PALATINE IL 60055-0241 CHECK DATE: 10/17/18 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 102 4239011 57803004 536.90 SPECIAL DEPT SUPPLIES VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201 (Rev.1995) Vendor# 357526 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER HENRY SCHEIN INC IN SUM OF$ 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, 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 57803004 42-390.11 $536.90 1 hereby certify that the attached invoice(s),or 10/11/18 57803004 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 Friday,October 12, 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 MIhNRY SCHEIN" £ (3)on ur MEDICAL EMS E w INVOICE Ship/Sold-To:1308572 Carmel Fire Dept Head Quarters 2 Civic Sq Carmel,IN 46032-7543 Bill-To: 130571 010000130857157803004110000000000536900928183 Carmel Fire Dept 2 Civic Sq Carmel,IN 46032-7543 CARMEL FIRE DEPT 2 CIVIC SQ CARMEL, IN 460327543 Invoice# Invoice Date Due Date Invoice Total 57803004 09/28/18 10/28/18 $536.90 Purchase Order# Payment Terms ---__-..___ _ 09282018 Invoice Date+30 days Customer DEA# Customer State Reg# Federal ID#: D&B#: 11-3136595 01-243-0880 FOR., 1 700-3325 EA Flowsafe II EZ CPAP w/Med Mask 10 10 53.69 536.90 1 IN YOUR ORDER 68415415 HAS BEEN SPLIT INTO MULTIPLE SHIPMENTS.CERTAIN ITEMS WILL BE SHIPPED SEPARATELY.YOU WILL BE BILLED FOR THESE ITEMS WHEN THEYARE SHIPPED. ---------------------------------------- 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/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 57803004 09/28/18 $536.90 C -case Good Item SK-School Kit D -Discontinued;Item no longer available T -Taxable Item F -Special offer U -Temporarily unavailable;please reorder Order# Order Date #of Boxes PO# M -Item will ship directly from manufacturer W-Warranty Item 68415415 09/28/18 1 09282018 NC-No Charge WH,MN,M2,DN-DSCSA CODES P -Prescription Drug;Return Authorization Required$ -Special Schein Pricing *-Item has SDS Distribution Names/Address IN:5315 6Y74th St Indanapdis.IN 46266 DDI#:RHO162494 State Reg#:48C011 ioA Chem.ReQ#:M--74HNY Please remit vavments to,Henry Schein,Inc.Dept CH 10241 Palatine,IL 60055-0241 US Page 1 of 1