334063 01/04/19 CITY OF CARMEL, INDIANA VENDOR: 357526
ONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: $*******258.00*
s CARMEL, INDIANA 46032 DEPT CH.10241 CHECK NUMBER: 334063
PALATINE IL 60055-0241 CHECK DATE: 01/04/19
(tON GO'
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 4239011 60584576 258.00 SPECIAL DEPT SUPPLIES
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201 (Rev.1995)
ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
Vendor# 357526
HENRY SCHEIN INC IN SUM OF$ 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
$258.00
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
60584576 42-390.11 $258.00 1 hereby certify that the attached invoice(s),or 12/21/18 60584576 Misc.EMS Supplies $258.00
1120 102 Prior Year 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
Thursday,January 3,2019
David Haboush
Fire Chief
1-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
I tNW SCHEN R , on us-
MEDICAL < 1
INVOICE Ship/Sold-To:1308572
Carmel Fire Dept Head Quarters
2 Civic Sq
Carmel,IN 46032-7543
Bill-T : 1
010000130857160584576110000000000258001221181 Carmelo
Fire Dep71
2 Civic Sq
Carmel,IN 46032-7543
CARMEL FIRE DEPT
2 CIVIC SQ
CARMEL, IN 460327543
Invoice# Invoice Date Due Date Invoice Total
60584576 12/21/18 01/20/19 $258.00
Purchase Order# Payment Terms
-- 12212018 .-Invoice.Date+30 days ..-..-.-..
Customer DEA# Customer State Reg#
HSI Federal ID# HSI D&B#
11-3136595 01-243-0880
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1 507-0313 EA Introcan Safety Catheter 20gX1.25" 150 150 1.72 258.00 1 IN
MERCHANDISE TOTAL 258.00
INVOICE TOTAL 258.00
Please refer to back of paperwork for Terms of Sale and disclosures or go to
https://www.henryschein.com/us•en/medicaUlegaiterms.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 60584576 12/21/18 $258.00 C -Case Good Item SK-School Kit
D -Discontinued;Item no longer available T -Taxable Item
F -Special offer U -Temporarily unavailable;please reorder
Order# Order Date #of Boxes PO# M -Item will ship directly from manufacturer W-Warranty Item
71327602 12/21/18 1 12212018 NC-No Charge WH,MN,M2,DN•DSCSA CODES
P -Prescription Drug;Return Authorization Required$ -Special Schein Pricing "-Item has SDS
Distribution Names/Address
1"151,Y74th St..lndianVolis,IN 46268
BEA#;11062494 State Beg#:48991176A
Chem.Req#:006574HPN
Please_ remit pavments to,Henry Schein,Inc.Dept CH 10241 Palatine,IL 60055-0241 US Page 1 of 1
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