181576 01/20/2010 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1
ONE CIVIC SQUARE HENRY SCHEIN INC
1 If a c, CHECK AMOUNT: $1,441.15
CARMEL, INDIANA 46032 DEPT CH 10241
1.4 i PALATINE IL 60055 -0241 CHECK NUMBER: 181576
CHECK DATE: 1/20/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 4239011 -96.62 14263238
102 4239011 87.40 822929102
102 4239011 461.30 859638102
102 4239011 221.60 9243001
102 4239011 -21.70 UNAPPLIED CASH
102 4467006 789.17 765787801
Page 1 of 7
Snyder, Denise W
From: Smith, Dina [Dina.Smith @henryschein.com]
Sent: Monday, January 04, 2010 3:20 PM
To: Snyder, Denise W
Subject: HENRY SCHEIN #1308571
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Be(owyou widfind a spreadsheet that shows at the credit memos and unappC:ed cash on the account. 'Underneath
that I did a print screen shot of the credit memos. P contact me after your. Thank you!
Credit Reference Original Remaining
JDE# 1308571 Date Due Date Memo Invoice Amount. Amount Comi
Credit Memo 11/10/06 12513595 2124927 1.61- 1.61- Sales T;
11/10/06 12513597 2112945 1.58- 1.58- Sales
11/10/06 12513600 4441667 .50- .50- Sales T�
11/10/06 12513609 6254494 2.09- 2.09- Sales T;
08/18/09 14263238 3274544 96.62- 96.62-
(12/0 6 1 .70 -1 21.70_ Reference chec!
1/5/2010
tri HENRY SCHEIN® SHIP TO:
ata
E! f Carmel Fire Dept Head Quarters
a ��Ws1 P
2 Civic Sq
135 DURYEA ROAD
Carmel IN 460322584
MELVILLE, NY 11747
CREDIT MEMO BILL TO:
Carmel Fire Dept
2 Civic Sq
Carmel IN 460327543
Carmel Fire Dept
2 Civic Sq
ACCOUNT TOTAL CREDIT
Carmel, IN 46032 -7543
1308571 96.62
CREDIT MEMO# CREDIT MEMO DATE
14263238 08/18/09
PAGE CREDIT. APPLIED TO
1 of 1 Account
k' LINE 4
e P' 1Ni N ''...,;q a s 4 t ''''''''''''2'5''''' fr 1. y r s V dm�� i yd,.. P m. fi^ S ii
ITE ,'UNIT "b,. i „r DE R IPTIONrgSTRENGTH, mj 1' QUANTITYY REFERENCE I UNIT E)(TENSION:i
NO l t q� ',1 A t 2- 1 SC h F,i s. r< a
w���.CODE...:� .�i?SIZE {�.i�ea� "..,..,,Yiiiw�JdGa�»: ,lN,�t' �r CREDITED s� ��G�pRIC ,,_'u
1 4170688 50 /Ca Ultrasite Ext Set Std Bor 1\ i` 21274544 96.62 96.62
07/15/09 Order 6547898 1.001 MARK,
Credit amount, 96.62
Sub Net, Total 96.62
T 11Cr t., 96.62
6
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ACCOUNT TOTAL CREDIT
1308571 96.62
CREDIT MEMO# CREDIT MEMO DATE
14263238 08/18/09
1
PAGE CREDIT APPLIED TO
1 of 1 Account J
-WHSE DEA# Fed 11).11-3136595
This order as been processed by our SOUTHEAST D.C.
8691 JESSE B SMITH CT
JACKSONV =LLE, FL 32219
MARK HUIETT 317- 571 -2663
TOTAL ORDER FOR THIS LOCATION 1945.62
1 826 -9995 EA OXYGEN MASK NON REBREATH INFANT 20 20 4.37 87.40 1
THIS PRODUCI'.IS BEING SHIPPED FROM OUR SOUTHEAST DISTRIBUTION CENTER.
IF YOU ARE •ARTICIPATING IN A DISCOUNT PROGRAM (E.G., POINTS, GIFTS OR OTTER
1 'u SPECIAL AWA DS DI-SCOUNT 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 RECEIIING OR WILL RECEIVE
NOTICE OF T E DISCOUNT VALUE. FROM TIME TO TIDE, MEDICARE, MEDICAID, TRICARE OR
DTHER PAYER MAY REQUEST INFORMATION REGARDING SUCH. VALUE, PND UPON ANY SUCH
REQUEST, SU H VALUE MUST BE DISCLOSED AS A DISCOUNT AGAINST THE PURCHASES THAT
EARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE^ -AIN TH -SE RECORDS.
MERCHANDISE TOTAL 87.40
INVOICE TOTAL 87.40
PLEASE PAY WITHIN THIRTY(3)) DAYS OF RECEIPT OF THIS NVTICE. 87.40
HILL rn INVOJCE# CUSTOMER poa If EM STATUS KEY REM KEY
1308571 8229291 -02 MARK 12 -08 -09 it Backordered: Item will follow SK School Kit
SHIP TO INVOICE DATE OF I3OXE.S 1) Discontinued Item no longer available NC No Charge
P Special Schein Free Goods
Manufacturer will +hip Item directly in you
1817102 12/22/09 1 p- Prescription Ding: Return Authorization HcGuired
R Refrigerated Item: May be shipped separately
INVOICE TOTAL PAGE# Special Schein Pricing
lJ Temporarily unavailable: please reorder
87.40 1 OF 2 T usable hem Continued on Next Page
L°
WHSE DEA# Fed ID: 11- 3136595
b
I
II te a m a o A la w,:. z^
This order Ras been processed by our NORTHEAST D.C.
41 WEAVER ROAD
DENVER, ?A 17517
1 499 -0650 EA BREATHSAVER ULTRA ROYBLUE 2 2 230.65 461.30 1
IF YOU ARE PARTICIPATING IN A DISCOUNT PROGRAM (E.G. POINIS, GIFTS OR 0 HER
SPECIAL AWARDS "DISCOUNT WITH THIS PURCHASE YOU HAVE mARNED A CREDI TOWARD
GOODS OR SERVICES, RECEIVABLE OR REDEEMABLE :N ACCORDANCE WITH DISCOUNT PROGRAM
RULES. UPON DISCOUNT RECEIPT OR REDEMPTION, IOU ARE RECEI ING OR WILL R :CEIVE
NOTICE OF THE DISCOUNT VALUE. FROM TIME TO TII'ME, MEDICARE, MEDICAID, TRIiARE OR
GTHF R PAYER'MAY- INFORMATION REGARDING SUCH VALUE, ?D UPGN ANY S.:CH
REQUEST, SUCH VALUE MUST BE DISCLOSED AS A DISCOUNT 'GAINST THE PURCHASES THAT
'EARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RETAIN TH SE RECORDS.
MERCHANDISE TOTAL 461.30
INVOICE TOTAL 461.30
PLEASE PAY WITHIN THIRTY(3)) DAYS OF RECEIPT OF THIS NVOICE. 461.30
PLEASE NOTE NEW REMIT TO ADDRESS
Please remit payments only to the following address:
4ENRY SCHEIN INC.
DEPT CH 10211
PALATINE, IL 60055 -0241
BILL TO INVOICE4 CUSTOMER PO#
ITEM STATUS KEY REM KEY
1308571 8 5 9 6 3 81= 0 2 MARK HUE I TT t3 Backordered: Item will follow SK School Kit
SHIP TO INVOICE DATE OF BOXES I) Discontinued: Item no longer available NC No Charge
I' Special Schein Free Goods
bl Manufacturer will .chip Item directly to you
1308572 12/31/09 2 1' Preemption Drug: Return Authorization Required
INVOICE TOTAr, PArE# k Refrigerated 11001: May he shipped separately
Special Schein Pricing
U Temporarily unavailable: please reorder
461.30 1 OF 1 T- Taxable Item
WHSE DEA# Fed ID: 11 3I36595
4. to ..r €g: .1.$W t f e 14 s+ v
his order as been. processed by. our NORTHEAST D.C.
41 WEAVER. ROAD
DENVER, ?A 17517
ARK 317 -423 -8784
1 132 -1802 10 /BX BLANKET WOV 806WOOL 66X84 OLIVGRN 2 2 C 100.00 200.00 3
HIS PRODUCT IS BEINGSHIPPED FROM OUR WEST COAST DISTRIBUTION CENTER.
ASE•GOOD I EM,, MAY BE SEPARATELY.
2 499 -7358 EA BLANKET -HEAVYWGHT FLEECE MAROON 3 3 7.20 21.60 1
HIS PRODUC IS BEING SHIPPED OUR MIDWEST DISTRIBUTION CENTER.
IF YOU ARE PARTICIPATING IN A DISCOUNT PROGRAM (E.G., POINTS, GIFTS•OR 0
.PECIAL AWARDS "DISCOUNT WITH THIS PURCHASE YOU HAVE EARNED A CREDIT TOWARD
GOODS OR SERVICES, RECEIVABLE OR REDEEMABLE 7N ACCORDANCE WITH: DISCOUNT PROGRAM
RULES. UPON DISCOUNT RECEIPT OR REDEMPTION, "OU ARE RECEI4ING OR WILL RECEIVE
OTICE OF T1E DISCOUNT VALUE. FROM TIME TO TIME, MEDICARE, MEDICAID, TRICARE OR
•THER PAYER MAY REQUEST INFORMATION REGARDING SUCH VALUE, AND UPON ANY SUCH
'EQUEST, SU_H VALUE MUST BE DISCLOSED AS A DISCOUNT AGAINST THE PURCHASES THAT
IARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RETAIN THESE RECORDS.
MERCHANDISE TOTAL 221.60
INVOICE TOTAL 221.60
PLEASE: PAY WITHIN THIRTY(30) DAYS o F- RECEIPT OF THIS,- NVOICE: 221.60
BILL TO INVOICEiI CUSTOMER PO# i
ITEM STATUS KEY REM KEY
1308571 9 2 4 3 0 01. MARK h Back Item will fothisv SK School Kit
SHIP TO TNVO7('E DATE OF BOXES D Discominued. Item no longer available, NC No Charge
]r Special Schein Free Goods
M Manutacturerwll ship hem directly to you
1308572 1/06/10 3 P- Prescription Drug: Return Authorization Required
INVOICE TOTAL PAGE# R Refrigerated Item: May be shipped separately
Special Schein Pndng
U Temporarily unavailable, please reorder
221.60 1 OF 2 I Taxable Item Continued on Next Page
WHSE DEA# Fed ID: 11-3136595
'1 It `ai 1ikt a 6w...ar.� �,a a a �r .a 'I W W.r:.::.e2t Ur, Ir.:. 2 !ft
This order as been processed by our NORTHEAS' D.C.
41 WEAVER ROAD
DENVER, PA •17517
'NARK 317 -42: -8784
1 499 -0661 EA 02 CYLINDER BAG GREEN D SIZE 1 1 72.17 72.17 2
2 827 -2329 EA SUCTION UNIT W /DISP CANN 1 1 C 717.00 717.00 1
2ASE 000D;IIEM,.MAY BE SHIPPED SEPARATELY.
YOUR ORDER '4298418 HAS BEEN SPLIT INTO MULTI?LE SHI ?MENTS. CERTAIN ITEMS WILL
3E' SHIPPED'.EPARATELY: "YOU WILL 'BE' BILLED FOR THESE `ITEMS: inHEN THEY ARE $HIPPED.
IF YOU ARE •ARTICIPATING IN A DISCOUNT PROGRAM (E.G., POINTS, GIFTS OR OTHER
SPECIAL AWA'DS "DISCOUNT')), WITH THIS PURCHASE YOU HAVE EARNED A CREDI TOWARD
GOODS OR S RVICES, RECEIVABLE OR REDEEMABLE :N ACCORDANCE WITH DISCOUNT PROGRAM
RULES. UPO DISCOUNT RECEIPT OR REDEMPTION, "fOU ARE RECEIlING OR WILL RECEIVE
NOTICE OF T E DISCOUNT VALUE. FROM TIME TO TIME, MEDICARE, MEDICAID, TRICARE OR
OTHER PAYER MAY REQUEST INFORMATION REGARDING SUCH VALUE, PND UPON ANY SUCH
REQUEST, SU H VALUE MUST BE DISCLOSED AS A DISCOUNT AGAINST THE PURCHASES THAT
EARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE ^-AIN THESE RECORDS.
MERCHANDISE TOTAL 789.17
INVOICE TOTAL 789.17
PLEASE PAY WITHIN THTRTY(30) DAYS OF RECEIPT OF THIS NVOICE. 789.17
RILL TO INVOICE# CUSTOMER PO# ITEM STATUS KEY REM KEY
130857.1. ,7657878 -01 •NARK B llackordercd:Itemwillfollow SK School Ka
D Discontinued, Item no longer available NC No Charge
5HIP TO INVOICE DATE OF BORES I Special Schein Iroc Clouds
M Manufacturer will ship Icon directly to you
1308572 1/06/10 2 r- I'rescnption Drug: Return Authorization Required
i NVOICE TOTAL PAGEN R- Refugerated Item: May be shipped separately
S Special Schein Pricing
U Temporarily unavailable: please reorder
789.17 1 OF 2 r- Taxable Item Continued on Next Page
LP30u
VOUCHER NO. WARRANT NO.
ALLOWED 20
Henry Schein
IN SUM OF
Dept Ch 10241
Palatine, IL 60055
$1,441.15
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT
Board Members
1120 7657878 01 102 670.06 $789.17 I hereby certify that the attached invoice(s), or
1120 8229291 102 $87.40 bill(s) is (are) true and correct and that the
1120 92430 01 102 390.11 $221.60
materials or services itemized thereon for
1120 JNAPPLIED CASE 102 390.11 ($21.70)
1120 8596381 102 $461.30 which charge is made were ordered and
1120 14263238 102 390.11 ($96.62) received except
JAN l "9 ZuiU
st`7
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
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.
Payee
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
7657878 -01 $789.17
8229291 -02 $87.40
92430 -01 $221.60
JNAPPLIED CASE- ($21.70)
8596381 -02 $461.30
14263238 ($96.62)
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 -1 1- 10 -1.6
20
Clerk- Treasurer