HomeMy WebLinkAbout331522 10/25/18 4�f C�qM
c. .•� CITY OF CARMEL, INDIANA VENDOR: 357526
• ONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: $*******442.10*
as CARMEL, INDIANA 46032 DEPT CH 10241 CHECK NUMBER: 331522
PALATINE IL 60055-0241 CHECK DATE: 10/25/18
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 4239011 58118759 442.10 SPECIAL DEPT SUPPLIES
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201 (Rev.1995)
Vendor# 357526 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
HENRY SCHEIN INC IN SUM OF$ 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
$442.10
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
58118759 42-390.11 $442.10 1 hereby certify that the attached invoice(s),or 10/22/18 58118759 Replacement Supplies $442.10
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, October 22,2018
David Haboush
Fire Chief
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
HENRY SCHEIN0MEDICAL I EMS
Ship/Sold-To:1308572
2'Crim el Fire Dept Head Quarters
INVOICE
Carmel,IN 46032-7543
Bill-To:130571
010000130857158118759110000000000442101009189 Carmel Fire
et
2 Civic Sq
Carmel,IN 46032-7543
CARMEL FIRE DEPT
2 CIVIC SQ
CARMEL, IN 460327543
Invoice# Invoice Date Due Date Invoice Total
58118759 10/09/18 11/08/18 $442.10
Purchase Order# Payment Terms
_.- - - - --09242018 - _Invoice-Date+30 da s
Customer DEA# Customer State Reg#
Federal ID#: D&B#:
11-3136595 01-243-0880
IN n'g
ME
< Ic.. M'. £ 3
E�����,rb".�....,
This is a backordered shipment for order.-68191903 original invoice:57591810
1 499-1860 EA Ultra Soft Box Plus Red 2 2 221.05 442.10 1 VA
MERCHANDISE TOTAL $442.10
INVOICE TOTAL $442.10
Please refer to back of paperwork for Terms of Sale and disclosures or go to
hftps://www.henryscheirLeom/us-en/medicalfiegaiterms.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 58118759 10/09/18 $442.10 C -Case Good Item SK-School Kit
D -Discontinued;Item no longer available T -Taxable Item
F -Special offer U -Temporarily unavailable;please reorder
Order# Order Date #Of Boxes PO# M -Item will ship directly from manufacturer W -Warranty Item
68191903 09/24/18 2 09242018 NC-No Charge WH,MN,M2,DN-DSCSA CODES
P -Prescription Drug;Return Authorization Required$ -Special Schein Pricing "-Item has SDS
Distribution Names/Address
IVA(GIVI:89 Summit Uim Lane Baslia£F:VA 24314
DEA§:PGUM321 State Reg@.02150DYM
Chem.Reg#,006522GEY
Please remit payments to,Henry Schein,Inc.Dept CH 10241 Palatine,IL 60055-0241 US Page 1 of 1