HomeMy WebLinkAbout331183 10/17/18 `%��_,qbf. CITY OF CARMEL, INDIANA VENDOR: 357526
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® 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