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180830 12/30/2009 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1 i O NE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: $1,658.22 CAR MEL, INDIANA 46032 DEPT CH 10241 tf PALATINE IL 60055 -0241 CHECK NUMBER: 180830 CHECK DATE: 12/30/2009 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION .102 4239011 8229291 -01 1,858.22 SPECIAL DEPT SUPPLIES HENRY C EIN' SHIP TO: Carmel Fire Department MI I I V OI C Station Kaufmann 135 Cluryea Road, Melville, NY 11747 Carmel, IN 46032-8806 `0100001 308571, 08229291 ,10010D00001858221208 ©96 BILL TO: Carmel Fire Dept MI 2 Civic Sq Carmel, IN 46032 -7543 Carmel Fire Dept MI 2 Civic Sq BILL TO INVOICE TOTAL Carmel, IN 46032 -7543 1308571 1858.22 INVOICE# INVOICE DATE 8229291 -01 12/08/09 CUSTOMER PO$ SHIP TO 0 MARK 12 -08 -09 1817102 j WHSE DEA# Fed ID: 1 1- 3 13659 5 R.' ^f is §Dz sa. :6. x ,C m. ='flk 1 ca ,z ViipEo B a w p. y. _.z ^e P ..':T his order has been processed by our NORTHEAST D.C. 41 WEAVER ROAD DENVER, ?A 175L7 RK HUIETT 317- 571 -2663 OTAL ORDER FOR THIS LOCATION 1945.62 1 120 -8808 EA COMBITUBE ROLL -UP KIT 41FR 10 10 41.50 415.00 11 2 499 -9696 EA THE BAG II ADULT 12 12 9.55 114.80 13 HIS PRODUCT IS BEING SHIPPED FROM OUR MIDWEST DISTRIBUTION CENTER. '3 493 -3779 EA BAG II INFANT 12 12 9.55 114.60 13 THIS PRODUCT IS BEING SHIPPED FROM OUR MIDWEST DISTRIBUTION CENTER, 4 499 -3778 EA THE BAG II PEDI 12 12 9.55 114.60 12 THIS PRODUCT IS BEING SHIPPED FROM OUR MIDWES': DISTRIBUTION CENTER. 5 826 -9995 EA OXYGEN MASK NON REBREATH INFANT 20 B 0.00 0.00 ITEM BACK ORDERED, WILL FOLLOW SHORTLY 6 499 -0380 PU EA FS 02 MASK H CONC W /RESER CHILD 2 20 1.29 25.80 11 7 890 -6868 3 /PK LIFEPAK 12 PAPER EKG 18 18 10.79 194.22 11 8 107 -0530 100 /BX .PURPLE NITRILE PF GLOVE LARGE 50 50 C 8.50 425.00 5 VASE GOOD ITEM, MAY BE SHIPPED SEPARATELY. BILL TO INVOICES CUSTOMER P05 ITEM STATUS KEY REM KEY v 1308571 8229291-01 MARK 12-08-09 8 Backordered: Item will follow SK School Kit I? Disconunuud: Item no longer available NC No Charge SHIP TO INVOICE 'DATE 5 OF BOXES F Special Schein Flee Goods M Manutaclurer will ship hem directly t you 1817102 12/08/09 14 P Prescription Drug: Return Authorization Required 12- Retngurated hem: May be shipped separately TNVOIOE TOTAL PAGES Special Schein Pricing U Temporarily unavailable: please reorder 1858.22 1 OF 2 T- 'taxable Item Continued on Next, Page WHSE DEM Fed ID: 11-3136595 ONO:MEN c 9� ftE itit 7-17-11-7;n: {d 9 1107 -0540 90 /BX PURPLE NITRILE PF GLOVE X -LARGE 50 50 C 8.50 425.00 10 CASE GOOD ITEM, MAY BE SHIPPED SEPARATELY. 10 496 -2369 100 /BX LANCET SURGILANCE ORANGE 21G 3 3 9.80 29.40 11 IF YOU ARE •ARTICIPATING IN A DISCOUNT PROGRAM (E.G., POINTS, GIFTS OR 0 HER SPECIAL AWA•DS "DISCOUNT WITH THIS PURCHASE YOU HAVE EARNED A CREDI TOWARD GOODS OR S RVICES, RECEIVABLE OR REDEEMABLE IN ACCORDANCE WITH DISCOUNT PROGRAM RULES. UPO DISCOUNT RECEIPT OR REDEMPTION, YOU ARE RECEIvING OR WILL R'CEIVE NOTICE OF T E DISCOUNT VALUE. FROM TIME TO TIME, MEDICARE, MEDICAID, TRIIARE OR OTHER PAYER MAY REQUEST INFORMATION REGARDING SUCH VALUE, AND UPON ANY SICH REQUEST, SU H VALUE MUST BE DISCLOSED AS A DISCOUNT AGAINST THE PURCHASE. THAT EARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RETAIN TH3SE RECORDS. MERCHANDI' TOTAL 1858.22 INVOIIE TOTAL 1858.22 PLEASE PAY WITHIN THIRTY(3)) DAYS OF RECEIPT OF THIS NVOICE. 1858.22 PLEASE NOTE NEW REMIT TO ADDRESS Please remi: payments only to the following address: HENRY SCHEI.1 INC. DEPT CH 10211 PALATINE, IL 60055 -0241 BILL TO INVOICE# CUSTOMER PO# 1 ITEM STATUS KEY REM KEY 1308571 8229291 -01 MARK 12 -08 -09 11- 13acicordcred: Imm will follow SK SchoolKit SHIP TO INVOICE DATE OF BOXES 1) Uisen 11111m d: Item no longer available t,„ NC No Charge I'- Special Schein Free Goods M Manufacturer will .chip item directly In you 1817102 1 2/ 0 8/ 0 9 1 e- Preseiiption Drug: IG ern Authorialion Required R Refrigerated hem: May ho shipped sepal uely iNVOICE TOTAL PACE# Special Schein Pricing U Temporarily unavailable: please :corder 1858.22 2 OF 2 T- Taxable lien VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995) ALLOWED 20 ACCOUNTS PAYABLE VOUCHER Henry Schein 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 Palatine, IL 60055 whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc. $1,858.22 Payee Purchase Order No. ON ACCOUNT OF APPROPRIATION FOR Terms Carmel Fire Department Date Due Invoice Invoice Description Amount PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members Date Number (or note attached invoice(s) or bill(s)) 1120 8229291-01 102 390.11 $1,858.22 I hereby certify that the attached invoice(s), or 8229291 -01 $1,858.22 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 DEC 2 1 2000 1 3 Fire Chief Title Cost distribution ledger classification if I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and 1 have audited same in accordance claim paid motor vehicle highway fund with IC 5- 11- 10 -1.6 20 Clerk- Treasurer