183826 03/29/2010 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1
ONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: $706.58
CARMEL, INDIANA 46032 DEPT CH 10241
PALATINE IL 60055 -0241 CHECK NUMBER: 183826
CHECK DATE: 3129/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMB A DESCRIPTION
102 4239011 6021633 -01 544.34 SPECIAL DEPT SUPPLIES
=102 4239011 6766426 -01 162.24 SPECIAL DEPT SUPPLIES
WHSE DEA# RH0236667 Fed ID: 11- 3136595
a
S
his order as been processed by our NORTHEAS D.C.
41 WEAVER ROAD
DENVER, DA 17517
NORTHEAST D.C. State Lic 3:0046
�IA RK 317-423-8484
1 360 -1359 EA SAM SPLINT ORANGE /BLUE 36X4.25 24 24 6.76 162.24 1
HIS PRODUC7 IS BEING SHIPPED FROM OUR MIDWES DISTR BUTIO CENTER.
F YOU ARE ARTICIPATING IN A DISCOUNT PROG (E.G. POIN S, GIFTS OR O HER
PECIAL AWA S ("DISCOUNT")), WITH THIS PURCHASE YOU HAVE EARNED A CREDI TOWARD
GOODS OR SERVICES, RECEIVABLE OR REDEEMABLE N ACCO DANCE WITH DISCOUNT PROGRAM
RrTL- FS_.-- UP0:r_Dscr0UNT RECEIPT OP. REDEMPTICN, CU aPE- RECEI ING DR- WILL.R.
OTICE OF T HE DISCOUNT VALUE. FROM TIME TO TIME, MED ECARE, MEDICAID, TRI ARE OR
THER PAYER MAY REQUEST INFORMATION REGARDING SUCH VALUE, PND UPON ANY S CH
REQUEST, SU H VALUE MUST BE DISCLOSED AS A DI COUNT GAINSq THE PURCHASE THAT
ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RETAIN THESE RECORDS.
MERCHANDI E TOTAL 162.24
INVOI (E TOTAL 162 -24
PLEASE PAY WITHIN THIRTY(3 DAYS OF RECEIPT OF THIS INVOICE. 162.24
LEASE NOTE NEW REMIT TO ADDRESS
lease remi payments only to the following a dress:
ENRY SCHEI INC.
EPT CH 102 1
ALATINE, I 60055 -00241
BI INV .E_ CUSTOMER P0#
ITEM STATUS KEY REM KEY
1308571 6766426-01 MARK' 13 ftacknrdcrcd:llem will follow SK SchoUI Kit
I7- Discontinued: hcm no lnngur availahic NC M,Chargc
HIP T NV DATE F 1- Special Schein Free Goods
Ni Manufamtumr will ship hcm directly to you
1817102 3/1 1 P Prescription Drug; Return Authorization Required
R Refrigerated hcm; Mav be shiplxd separately
INVOICE TOTAL PAGE# S Special Schein Pricing
U Temporarily unavailahle; please reorder
162 .24 1 OF 1 r I -ahlchem
"4e make every effor to maintain prices far the duration of a Payment by CHECK or by the HENRY SCHEIN CREDIT CARD,
catalog. however, we reserve the right fo retake price adjustments in VISA, MASTERCARD, DISCOVER and AMERICAN EXPRESS
response to manufacturers' price changes
Guaranteed Satisfaction:
If you have tried a product and it is detective or does not perorm Bell Your O rde,, To Y ou Oper. AQ,:ou
satisfactorily, vse v.Jll provide a credit, refund, or exchange; it's your Available to licensed practitioners in the J.S. All invoices arc-
Choice. Sit�tply call our c ustomer service department wi hln 30 days
o° receipt of the merchandise to arrange for the return, Fora payable vrithin 3 da °ys.
warranty rer,air cr it you were sent sc iething you did riot order,
simply ,all;
Rx Products Controlled Substances:
Matra Medical 1 -800 -845 -3550
Regulations require us to 1in the sale of Rx and controlled
substances only to registered. licensed healthcare professionals.
If you are a ne%Al customer or have recently moved, please furnish
us with a copy of your updated state reg €straticrt. For controlled
substances, furnish a copy of your DDA certificate, verifying your
shipping address. Class 11 drugs can be ordered only by mail,
International Orders:
Plea No te-
We prOUdly serve healthcare profcss'onals and governments
Opened handpieces and equipment may not be. returned for throughout the v.o; d, To place orders or for inquiries on export
credit, b,jt will be repaired or replaced in accordaice with
manufacturer warranties. Before opening handpieces or terms and conditions, please contact our International Department:
equipment, we suggest that you check the shipping container 1-800-845
and .packing list to verify that you have received exactly :what Prescription Drug Returns Instructions
y Computer Software is not returnable.
Other restrictions may also apply.
A Return Authorization is Required for all Prescription Drugs. Simply call
our: ustomer Service Department 'd- LOO -845 -3550.
LP300
WHSE DEA# RH0236667 Fcd ID: 11-3136595
6
his order aas been processed by our NORTHEAS D. C.
41 WEAVER ROAD
DENVER, 3 A 17517
NORTHEAST D.C. State Lic#: 3:0046
RK 317-57L-2663
1 499 -0411 PU EA YANKAUER W /VENT TUBING 40 40 C 2.20 88.00 2
ASE GOOD I EM, MAY BE SHIPPED SEPARATELY.
2 107 -0530 100 /BX PURPLE NITRILE PF GLOVE LARGE 50 50 C 8.75 437.50 7
ASE GOOD I EM, MAY BE SHIPPED SEPARATELY-
3 499 -0611 60 /BX ELECTRODE PEDIATRIC 2 2 9.42 18.84 8
F_YOU ARE ARTICIPATING IN A DISCOUNT PROGRAM (E.G. POIN S, GIFTS OR 0 HER
PECIAL AWA DS "DISCOUNT WITH THIS PURCHASE YOU HAVE ARNED A CREDI TOWARD
GOODS OR S RVICES, RECEIVABLE OR REDEEMABLE IN ACCO DANCE WITH DISCOUNT PROGRAM
RULES. TJPO4 DISCOUNT RECEIPT OR REDEMPTION, OU ARE RECEI ING OR WILL R CEIVE
OTICE OF T E DISCOUNT VALUE. FROM TIME TO TIME, MEDICARE, MEDICAID, TRT (ARE OR
THER PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, PND UPON ANY SITCH
R EQUEST, SU H VALUE MUST BE DISCLOSED AS A DI COUNT kGAINSI THE PURCHASET THAT
E ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN TH SE RECORDS.
MERCHANDI,E TOTAL 544.34
INVOI E TOTAL 544.34
PLEASE PAY WITHIN THIRTY(3 DAYS OF RE EIPT OF THIS NVOICE. 544.34
13ILL TO CUS TOMER P ITEM STATUS KEY REM KFY
1308571 6021633-01 MARK H uackordcmd: Item will tollow SK School Ki(
D Discontinued: hum no longer available NC No Charge
S HIP
T INV I E DATE F E XE P- Special Sehcin Free {;cods
M Manufaciurur will ship Item directly to you
181710
3/15/10 8 P- Prescription Drug; Remin Authorization Required
R Reinger:uc6 Item: May he shipped scparatcly
INVOICE TOTAL PA E
Special Schein Pricing
I Temporarily unavailable: please wordur
544.34 1 OF 2 r- Tasahlehem Continued on Next Page..........
FA H ENRY CHEIN
Med SHIP TO:
MAtrx I
tl le V V I Carmel Fire Department MI
135 Duryea Road, Melville, NY 11747 sno W 136 St
Station 46 Michael Kaufmann
Carmel,IN 46032 -8806
01, 00001, 308571, 0602163311 ,001000000054434037,5100 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 544.34
I:NVOICEN INVOICE DATE
6021633 -01 3/15/10
CUSTOMER PO# SHIP TO
MARK 1817102
Please detach hem and mail the abate with your payment
WHSE DEA# RH0236667 Fed 11): I1- 3136595
aHlW. l.;h':tllrvf�- i32��. �Z.aT w# 3-� 3 11�i' �9 ..A
LEASE NOTE NEW REMIT TO ADDRESS
Please remi payments only to the following a dress:
HENRY SCHE14 INC.
EPT CH 10211
ALATINE, I 60055 -0241
13 ILL TO T NVOTC F# CUSTO PQ# ITEM STATUS KEY REM KEY
1308571 6021633 01 MARK B 6zckordered', Item will follow SK School Kit
U Discontinued: hem no longer available INC No Charge
HIP T INVOICE DATE F BOXES P -Special Schein free Goods
M Manufacturer will ship Item directly io you
I' Prescription Drug: Return Authorization Required
18171 2 3 15 10
It Retrigerawd Item: May he shipped separately
INVOICE TOTAL P AG E# Special Schein 1'ricing
U Temporarily unavailable: please reorder
544.34 2 OF 2 T Taxable Item
HEN Y CHEIN
Matrx Medical ERM OF p r
P ayment `rw rr fi.
We r o hake every efto i to rnairtain pricos for the duration of a payment by CHECK or by the HENRY SCHEIN CREDIT CARD,
catalog, ho.h, we reserve the right to make price adjustments in VISA, MASTERCARD, DISCOVER and AM EXPRESS
response to manufacturers' price changes
C O V E
Guaranteed Satisfaction: vrs� E
or
If ycu have fried a product and it is defective or does not perform B ill Your Order To Y our O pen rat
satisfactf.:rily, ,A.ill provide a credit, refund, or exchange; it's your Available to licensed practitioners in the U.S. All involves are
choice. Simply call Our customer service department within 30 days payable within n days.
of receipt of the merchandise to arrange for the return. For a
warranty repair or if you were sent something you did not order,
simply call: lax Products Controlled Substances:
Matra Medical 1- 300 -845 -3550
Regulations require us to limit the sale of Rx and controlled
substances only to registered, licensed healthcare professionals.
If you are a nevv customer or have recently moved, please furnish
us with a copy of your updated state registration. For controlled
substances, furnish a copy of your DEA ceri ficate, verifying your
shipping address. Class II drugs can be ordered only by mail.
International Orders:
Please Note.
Opened handpieces and equipment may not be returned for We proudly serve healthcare professionals and govemr-nents
credit, but'vill be repaired or replaced in accordance with throughout the world. To place orders or for inquiries on export
manufacturer ^:arranties. Before opening ha�;dpieces or terms and conditions, please contact our International Department:
equipment, e suggest that you check the shipping container 1-800-845-3550 800 845 3550
and packing list to verity that you have received exactly what P rescription Drug Returns Instructions:
you ordered.Opened Computer Software is not returnable.
Other restrictions may also apply.
A Return Authorization is Required for all Prescription Drugs. Simply call
our Customer Service Department 1 -800- 845 3550.
LP300
Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
e
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))
6766426 -01 $162.24
6021633 -01 $544.34
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
Clerk- Treasurer
VOUCHER PJO, WARRANT N
ALLOWED 20
Henry Schein
IN SUM OF
Dept Ch 10241
Palatine, IL 60055
$706.58
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# 1 Dept. INVOICE NO. ACCT# /TITLE AMOUNT
Board Members
1120 6766426 -01 102 390.11 $162.24 1 hereby certify that the attached invoice(s), or
1120 6021633 -01 102 390.11 $544.34
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
MAR 2 6 9010
r
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund