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Home My WebLink About184312 04/14/2010 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1 ONE CIVIC SQUARE HENRY SCHEIN INC CARMEL, INDIANA 46032 DEPT CH 10241 CHECK AMOUNT: $1,248.64 *;rod w PALATINE IL 60055 -0241 CHECK NUMBER: 184312 CHECK DATE: 4/1412010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 102 4239011 4901132 -02 227.12 SPECIAL DEPT SUPPLIES 102 4239011 5860133 -01 425.00 SPECIAL DEPT SUPPLIES 102 4239011 5863576 -01 472.20 SPECIAL DEPT SUPPLIES 102 4239011 9320244 -01 124.32 SPECIAL DEPT SUPPLIES WHSE DEA# RH0236667 Fed ID: 11-3136595 a M IN W J s-� ro J� Q his order has been processed by our NORTHEAS D.C. 41 WEAVE ROAD DENVER, A 1751.7 NORTHEAST D.C. State Lic 3:0046 1 107 -0530 100 /BX PURPLE NITRILE PF GLOVE LARGE 10 10 C 8.50 85.00 1 ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. 2 107 -0501 100 /BX PURPLE NITRILE PF GLOVE SMALL 10 10 C 8.50 85.00 2 ASE GOOD I EM, MAY BE SHIPPED SEPARATELY, 3 107 -0502 100 /BX PURPLE NITRILE PF GLOVE MEDIUM 10 10 C 8.50 85.00 3 ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. l 4 107 -0540 90 /BX PURPLE NITRILE PF GLOVE X -LARGE 20 20 C 8.50 170.00 5 ASE GOOD ITEM, MAY BE SHIPPED SEPARATELY. F YOU ARE DARTTCTPATING IN A DISCOUNT PROG (E.G. POIN S, GIFTS OR OTHER PECIAL AWARDS "DISCOUNT WITH THIS PURC SE YOU HAVE EARNED A CREDI TOWARD GOODS OR S RVICES, RECEIVABLE OR REDEEMABLE N ACCO DANCE WITH DISCOUNT PROGRAM RULES. UPO DISCOUNT RECEIPT OR REDEMPTION, IOU ARE RECEI INS OR WILL R CEIVE OTICE OF T iE DISCOUNT VALUE. FROM TIME TO TI 1E, MED CARE, MEDICAID, TRI ARE OR THER PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, PND UPON ANY S CH R EQUEST, SU H VALUE MUST BE DISCLOSED AS A DI COUNT kGAINS1 THE PURCHASES THAT E ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RETAIN THESE RECORDS. MERCHANDI E TOTAL 425.00 �31LL TO INVOICE# CUSTOMER PQ# ITEM STATUS KEY REM KEY 13 5860133-01 MARK B llackordered: Item will lAunw SK School Kit 1) I )i, hem no lo"Cer available NC No Charee HIP TO INVOICE DATE OF 13 XE F Special Schein 1 Goudy M Manufacturer will Ship Item directly to y eu 18171 3/26/10 5 p- Prescription 17rug: Return Authrii o ttion Required R Rctrigcrawd Item: May be shipped separately S Special Schein Pricing H Temporarily unavailable: please reorler 425.00 1 OF 2 T Taxable hem Continued on Next Page HENRY SCHEIM SHIP TO: Mmtrx Medical 16 q Sta tion Carmel Fire Department MI 135 Duryea Road, Melville, NY 11747 1(`s/-, Sta w 136 St 46 Michael Kaufmann Carmel,IN 46032 -8806 01 00001308571, 05860133110010000000425000326107 BILL To_ Carmel Fire Dept MI 2 Civic Sq Carmel, IN 46032 -7543 Carmel Fire Dept MI 2 Civic SCI HILL TO INVOICE TOTAL Carmel, IN 46032 -7543 1308571 425.00 Il^NOICE1t INVOICE DATE 5860133 -01 3/26/10 CUSTOMER POk SHIP TO MARK 1817102 plcaa detach here and mail [he above with your Payment WHSE DEA# RHO236667 Fed ID: 11-3136595 rr 3i,;,: k a, 'a c�'.� f' age p <,en In F1 9 ffi t 0 C W Y N x 5 i+ v... 'S P r n 0 E 6t t'.s 'a�.�Am Z; .,a.d, ar" -r� C '_,�s a. INVOT E TOTAL 425.00 PLEASE PAY WITHIN THIRTY(30) DAYS OF RECEIPT OF THIS 'NVOICE. 425.00 LEASE NOTE NEW REMIT TO ADDRESS Please remi payments only to the following a dress: HENRY SCHEI INC. DEPT CH 10211 ALATINE, I 60055 -0241 B ILL TO INVO TCEff CUSTO P ITEM STATUS KEY REM K -Y 1308571 5860133-01 MARK B I3ackordened: Imm will follow SK school Kit 5t y hem I n o Iona et acailablc NC Nu Charge SHIP T F B E 1 Special M Mtmu(acmror will ship Item directly m you 1817102 3/26/10 5 p I'rescr puun Drug: Return nuthurir..niun Requited R ReGigerared lmm: May he shipped separaiely INVOICE TOTAL PAGE# Special Schein Pricing U Temporarily unavadahlc; please ivordcr 425.00 2 OF 2 T TaxaWhcm NA HENRY SCHEIN" IERMS 01-4 matrx medical 0emakr every effohNmaintain prices for the duration da Payment by CHECK or by the HENRY SCHEIN CREDIT CARD, catalog, however, we reserve the fight to make price adjustments |n VISA, IWASTERCARD, DISCOVER and AMERICAN EXPRESS response to manufacturers' price changes Guaranteed SBtisfaction� or If you have tried apmduoL and i1isdefendvaor does nutperform yai�da�uri|y.wewi||pmvidoun�eUii.r�uod'orexohongej!'oyour oho�e. S�oy Cal' our cu�omer km �h 8 days Available to licensed prac1itioners in the U—S, All invoices are payatolevnlh.n 30 days. ot receipt of1he merchandise (n arrange for the return, For warramly repair orUyoo were sent something you did not order, oimplyxo||: R&pyodUcts Controlled Substances: Matrx Medical 1~800-845'3550 Regulations require us N|inobthe sale ofRx and controlled substances only W registered, licensed healthcare professionals. |fyou are anow customer or have recently moved, please iumish uu with 000pynf your updated state mgistn3ivn For controlled substances, fu.miohaonpyof your DEAoeUificate. verifying your shipping address. C|aoeU drugs can be ordered only bymail, International Orders: ��Alc dh serje, healthcare pmleusiVmda and governments O dh di� d i |mo not pene on p oeoan equpman y �hmughuui(hevodd. Tn place nrdemor for inquiries ooexport CreuJ, butwi|| be epaivedo/ replaced in accordance wi|h ionnsand oondiUona. �|ea»eoon�ao�our|n�amadonu| DepaMment manuta nb Before opening hand handpeces or 1'OOO'8�5'355O equipment, w� suggest thal you check the shipping container U packinq list to verify that you have received exactly what Prescription Drug Returns Instructions: you ord dQ d Computer Gnftwuveiencdreturnabka. Other restrictions may also apply, A Return Authorization is Required for all Prescription Dr as. �imp|Yc�| uurCuo(om*r Service Deparmen� �r4-1`800'845'3550. WHSE DF-Aff IZHO236667 1 11): 11-3136595 Na "M REN R 'F 1, I 11ARK 317-57 L-2663 .1 499-3262 FA ULTRA BREATHSAVER "D" BAG RED 1 1 227,12 227.12 PRODUCT IS 3EING SHIPPED TO YOU DIRECTLY FROM THE MA4UFACTTRER- IF YOU ARE DAPTICIPATING IN A DISCOUNT PROGRAM (E.G. POINT OR 0 HER 3PECIAL AWAZ DS "DISCOUNT WITH THIS PURCHASE YOU HAVE EARNED A CREDIr TOWARD GOODS OR S3RVTCES, RECEIVABLE OR REDEEMABLE :N ACCOZDANCE WITH DISCOUNT PROGRAM RULES. UPO4 DISCOUNT RECEIPT OR REDEMPTION, -OU ARE RECEIWNG OR WILL R110EIVE �TOTICE OF TIE DISCOUNT VALUE. FROM TIME TO TI E, MEDECARE, MEDICAID, TRI"ARE OR OTHER PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, PND UPON ANY S JC14 I REQUEST, SU- VALUE MUST 13E DISCLOSED AS A DI S COUNT G AINS THE PURCHASE: THAT EARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RF TH RECORDS. MERCHANDI,E TOTAL 227.12 INVOI E TOTAL 227.12 PLEASE PAY WITHIN THTRTY(3') DAYS OF RECEIPT OF THIS NVOTCE. 227.12 PLEASE NOTE NEW REMIT TO ADDRESS Please remi- payments only to the following aidress: HENRY SCHRIq INC. DEbT CH 102 1 PALATINE, T 60055-0241 n IL RE M KEY BL TO INV -Eff CUSTOMER LEO# Rk QTr ITEM STATUS KEY MARK 1� ha�kurda,d� Item �111 loll— 1308571 4901132 2 [)iscon6nued: Gem i longer available TO INVOWE DATE OF BOXES P-ia] ScfiCill FNe. Ivi mamiracturer will Ship hum directly In you 1308572 3/31/10 P- PW-%Cr1j)ki0fl Drug: Return Auilwrtzali— Acquired R Re[IigauWd Item; May be shipped WPaIaICIY INVOICE TOTAL PAGF# Special Schein Pricing U Tenipurj6[y unavailablu; please jeoider 227.12 1 OF 1 T T-able Rem LP300 P=ayment r in We make every efforl to maintain prices for the duration of a Payment by CHECK or by the HENRY SC EIN CREDIT CARD, catalog, however, we reserve the right to make price adjustments in VISA, MASTERCARD, VISCOVER a €3 AMERICAN EXPRESS response to manufacturers' price changes Guaranteed Satisfaction: If you have tried a product and it is detective or does not perform s ark t ,�t' o 'c �ar Ope t satisfactorily, we v.fl provide a credit refund, or exchange, it's your i, choice. Simply call oar customer service department within 30 days Available ,o licensed practitioners in the US. Ail invoices are of receipt of the merchandise to arrange for the return. Fora payable tivithin 30 days. warranty repair or it yon: ware sent something you did not order simply call: Rx products Controlled Substances: Matra Medical 1- 800 -845 -3550 Regulations require us to limit the sale of Rx and controlled substances only to registered, licensed healthcare professionals. If you are a new 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 certificate, verifying your shipping address. Class Il drugs can be ordered only by mail. International Orders: Please N ote: Opened handpieces and equipment may not be returned for We proudly serve healthcare professionals and governments credit, but will be repaired or replaced in accordance with throughout the world, To place orders or for inquiries on export manufacturer �.ananties. Before opening handpieces or terms and conditions, please contact our International Department: equipment, we suggest that you check the shipping container 1- 800 845 -3550 and packing list to verify that you have received exactly what Prescription Drug Returns Instructions: you ordered.Cpened Computer Software is not returnable. Other restrictions may also apply. A Return Authorisation is Required for all Prescription [?rugs. Simply calf our Customer Service Department 6§ 1 800 845 35150, a -l" ME M' nei f WHSE DEA# RH0236667 Fed ID: I1- 3136595 PA W' q "a e m .s.. s .s a q a n _'R b e ,z« 1 5"1 T his order ias been processed by our NORTHEAST D.C. 41 WEAVEZ ROAD DENVER, DA 175L7 NORTHEAST D.C. State Lic#: 3:0046 17- 571 -266 MARK 1 267 -0721 160 /PK SANI -CLOTH GERM LARGE 6 "X6.75 24 24 C 5.18 124.32 2 HIS PRODUC IS BEING SHIPPED FROM OUR MIDWES DISTR BUTIO CENTER. ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. F YOU ARE ARTICIPATING IN A DISCOUNT PROG (E.G. POIN S, GIFTS OR O HER PECIAL AWA DS "DISCOUNT WITH THIS PURCHASE YOU HAVE EARNED A CREDI TOWARD GCODS OR 5 ERVICES, RECEIVABLE OR REDEEMABLE .N ACCn7nANCE WTTH DISCOUNT PROGRAM RULES. UPOq DISCOUNT RECEIPT OR REDEMPTION, 'IOU ARE RECEI ING OR WILL R CEIVE OTICE OF T IF DISCOUNT VALUE. FROM TIME TO TIME, MET) CARE, MEDICAID, TRI ARE OR THER PAYER MAY REQUEST INFORMATION REGARDING SUCH VALUE, PND UPON ANY S CH R EQUEST, S0 -H VALUE MUST BE DISCLOSED AS A DISCOUNT AGATNSI THE PURCHASES THAT E ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN THESE RECORDS. MERCHANDI E TOTAL 124.32 INVOI E TOTAL 124.32 PLEASE PAY WITHIN THIRTY(3 DAYS OF RECEIPT OF THIS NVOICE. 124.32 BILL TO INVOICE INVOICE# CUS R PO4 ITEM STATUS KEY REM KEY 13085 9320244-01 MARK B Rackordamd; hem win tutluw till School Ki I) Discominued: [rem no hmger available NC No Charge SHIP, To N z F H xe F- Special Schein Free Goeds M Manufacturer will ship Itrm dimclly to you 13 3/31/1 3 F Prescription Drug: Remrn Authorization Required R Refrigerated nem: May be shipped sgarately Special Schein Pricing U Temporarily unavailable: please rcoider 124.32 1 OF 2 T- Taxable ltcm Continued on Next Page WHSEDEA# RH0236667 Fed ID: I1- 3136595 his order has been processed by our NORTHEAS D.C. 41 WEAVER ROAD DENVER, DA 17517 NORTHEAST D.C. State Lic 3:0046 :1 565 -1031 100 /BX NITRILE PF GLOVE BLACK LARGE 20 20 C 7.87 157.40 2 ASE GOOD =M, MAY BE SHIPPED SEPARATELY. 2 565 -4216 100 13X NITRILE PF GLOVE BLACK XX -LRG 20 B 0.00 0.00 ITEM BACK O DERED, WILL FOLLOW SHORTLY 3 565 -0811 100 /BX NITRILE PF GLOVE BLACK X -LARGE 20 20 C 7.87 157.40 4 ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. 4 565 -7365 100 /BX NITRILE PF GLOVE BLACK MEDIUM 20 20 C 7.87 157.40 6 ASE GOOD ITEM, MAY BE SHIPPED SEPARATELY. F YOU ARE ARTICIPATING IN A DISCOUNT PROG (E.G. POIN S, GIFTS OR OTHER PECIAL AWA DS "DISCOUNT WITH THIS PURL SE YOU HAVE ARNED A CREDIT TOWARD GOODS OR SERVICES, RECEIVABLE OR REDEEMABLE N ACCORDANCE WITH DISCOUNT PROGRAM RULES. UFO DISCOUNT RECEIPT OR REDEMPTION, OU ARE RECEI ING OR WILL RECEIVE OTICE OF THE DISCOUNT VALUE. FROM TIME TO TIME, MEDICARE, 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 AGAINS THE PURCHASET THAT EARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RB AIN THEESE RECORDS. MERCHANDI E TOTAL 472.20 BILL TO 114VOICIEt! T ME ITEM STATUS KEY REM KEY 13081571 5863576 -01 MARK It- I3acxeidered: lie. will rouow SK- 5eheol Kir D N.seoatmued: Item no linger available NC NU Charge SHIP TO INVOICE DATE: QF B XE P- Special Schein 1 roe Gnnds TO h4anuracmrer will chip Item diremly to you 1308572 3/26/10 6 l' Prescription Drug: Return Authorization Required R Rerrigeraied Item: wy be shipped separately INVOICE TOTAL PAGE11 Special Schein l'ricine U l emporarily unav i:ah]c: picasu reorder 472.20 1 OF 2 T Ta.xablcltem Continued on Next Page.......... H ENRY SCHE N SHIP TO: Mi�trx Medical INVOICE Carmel Fire Dept Head Quarters MI 135 Duryea Road, Melville, NY 11747 2 Civic Sq Carmel,IN 46032 -2584 010000 1308571, 05863576110010000000472200326105 BILL TO: Carmel Fire Dept MI 2 Civic Sq Carmel, IN 46032 -7543 Carmel Fire Dept MI 2 Civic .SCI BILL TO INVOICE TOTAL Carmel, IN 46032 -7543 1308571 472.20 INVOICE# L INVOICE DATE 5863576 -01 3/26/10 CUSTOMER POq SHIP TO MARK 13085 Pleaw detach here and mail the shove wilh your payment WHSE DEA# RH0236667 Fed ID: 11 3136595 WMA r�za �z Mary `1 m. i 6 INVOICE TOTAL 472.20 PLEASE PAY WITHIN THIRTY(3 DAYS OF RECEIPT OF THIS NVOICE. 472.20 LEASE NOTE NEW REMIT TO ADDRESS lease remi payments only to the following a dress: ENRY SCHEIq INC. EPT CH 10211 ALATINE, I 60055 -0241 TO MOIC> T MEP POt ITEM STATUS KEY REM KEY 13 5863 01 MARK 13- Backordcrcd: Item will follow SK SchoolKit l7 Diw mlinucd; Item no longer available NC 10 Charge SHIP TO E DATE F 13OXES Special Schein Free. Goods NJ ManalLcmrer wili chip hem dircetly to pnu 1308572 3/26/10 6 P Pmscriptiun Dnig: Rcm on rn Aathoriratl Required R Reirigerated hem: May he shipped separately INVOICE TOTAL Special Schein Pricing U Tumpnrarily unavailable: please reorder 472.20 2 OF 2 T- Ta.eahlchcm 91 H ENRY SCHEDN' '11-IRMS OF SALE blatrx Medical We make everi efbrt to mainta prices ior the duraUnnofs Payment by CHECK or by the HENRY SCHEIN CREOIT CARD, cotabg.howev [seeo reserve &nak p�eu�ue�euo|n r�pnnsa\nmaoufa�u�o'pmmchanges Guaranteed Satisfaction: or UynuhavethedaDmdud and itis defective o, does not peftnn B!U Your Order o Yotv Open Pc o�/�auLuriiy.wswiUpmvidoanredi|.reiuod.or exchange; iyxyou( Availa"De to licen�pd practitioners in the US, All invoic are C5 ice. Gim.r4 cal nurmstomer Service department wMin80dayx of,em*i�uf the me�handioe�xnonge� r�hwtum. Fora wenantyrepairorif you wero sent oomething you did no! order, a|mp�uyU� RxpyQducts &Contmolied Substances. M�8trx Medical 1-800^845-3550 Readationa require us to iimk the aale of Rx and controlled ou.otaneunnhto registered, licensed hea0cu 'if you are anmw customer ur have recently moved, please lumioh uaei|huonpyo|ymor Updated st aieegiutration, FnroontmUed substa furnish arimyof your DEA certificate, verifying your shipping address, Class |(dm can beo�eed only bymoii International Orders: VVapmud|y serve healthcare p fiaseiono\u and govarnments Dpenadhaodpieceu and eVUipmen|m&y not beTeiumedfor throughout the wor|d. To place orders o, to inquiries on. e«pO� credi1.bU�wi|\be repaired orrep|xcodina:nordaDcewith terms and conditions, please contact our |ntomabonalDepartment: o»xmiu:iurerwa/mumo 8�oreopan�g|/��piemea/ 1'800-846'3650 equip em vlie Suggest that you check the sh ipping n0pummg list tc, Prescription Drug Returns |Nst[Uc�OnS: yuuo�e�U�Qpene��umot*rSonwmreiu not roro,neow. Other restrictions may also apply. A Return Authorization iuRequimdfor all Prescription Omgs. Simply md| our Customer Service Department 9-1-800'845-3550� Bass V u Lpmm VOUCHER NO. WARRANT NO. ALLOWED 20 Henry Schein IN SUM OF Dept Ch 10241 Palatine, IL 60055 $1,248.64 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members 1120 5863576 -01 102 390.11 $472.20 1 hereby certify that the attached invoice(s), or 1120 9320244 -01 102 390,11 $124.32 bill(s) is (are) true and correct and that the 1120 4901132 -02 102 390.11 $227.12 materials or services itemized thereon for 1120 5860133 -01 102 390.11 $425.00 which charge is made were ordered and received except APR 12 2010 t /f' 1 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)) 5863576 -01 $472.20 9320244 -01 $124.32 4901132 -02 $227.12 5860133 -01 $425.00 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- 11- 10 -1.6 20 Clerk- Treasurer