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185045 04/28/2010 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1 ONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: $157.40 CARMEL, INDIANA 46032 DEPT CH 10241 `a PALATINE IL 60055 -0241 CHECK NUMBER: 185045 CHECK DATE: 4/28/2010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 102 4239011 5863576 -02 157.40 SPECIAL DEPT SUPPLIES Please detach hero and mail the ahove with your paymnm WHSE DEA# RH0162494 Fed ID: 11- 3136595 so r r.�,._, £mx a`11h. a�� W his order ias been processed by our MIDWEST E.C. 5315 WES 74TH 3TREET INDIANAP LIS,IN 46268 MIDWEST D.C. State Lic 23 00304 1 565 -4216 100 /BX NITRILE PF GLOVE BLACK XX -LRG 20 20 C 7.87 157.40 2 HIS PRODUC17 IS BEING SHIPPED FROM OUR MIDWES DISTR BUT10 CENTER. ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. F YOU ARE ARTICIPATING IN A DISCOUNT PROGRAM (E.G. POTN71S, GIFTS OR O HER PECIAL AWARDS "DISCOUNT WITH THIS PURL SE YOU HAVE EARNED A CREDI TOWARD GOODS OR S RVICES, RECEIVABLE OR REDEEMABLE N ACCO DANCE WITH DISCOUNT PROGRAM RULES. UPOI DISCOUNT RECEIPT OR REDEMPTION, IOU ARE RECEI INC OR WILL R CEIVE OTICE OF T 4E DISCOUNT VALUE. FROM TIME TO TI 1E, MEDICARE, MEDICAID, TRI ARE OR THER PAYER MAY REQUEST INFORMATION REGARDING SUCH VALUE, PND UPON ANY S JCH EQUEST, SU H VALUE MUST BE DISCLOSED AS A DI COUNT RGAINSI THE PURCHASE THAT E ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN THESE RECORDS. MERCHANDI E TOTAL 157.40 INVOI E TOTAL 157.40 PLEASE PAY WITHIN THIRTY(3 DAYS OF RECEIPT OF THIS NVOICE. 157.40 LEASE NOTE NEW REMIT TO ADDRESS P lease remi payments only to the following address: ENRY SCHEIN INC. D EPT CH 10211 P ALATINE, I 60055 -0241 131111, To IYVQICE# CUSTO PQ# ITEM STATUS KEY REM KEY 1308571 5863576 -02: MARK 11- Itackordemd: Item will tollow SK School Kit I) Discontinued: Item no Longer available Charge SHI TO INVOTC13 DATE ff OF E30XES Special Schein Free Goods M Manufacturer will ship Item directly to you 1308572 4/12/10 2 P- Prescription Drug: Return Authorization Required R Refrigerated Item: May be shipj)Qd separately INVOICE TOTAL PAQr# Special Schein Pricing U Temporarily unavailaNe: please reorder 157.40 1 OF 1 T- Taxable Item e t 'pert We make every effort to maintain prices for the duration of a Payment by CHECK or by the HENRY SCH IN CREDIT CARD, catalog, however, we reserve the right to make price adjustments in VISA, MASTERCARD, DISCOVER and AMERICAN EXPRESS response to manufacturers' price changes Guaranteed Satisfaction: or If you have tried a product and it is defective or does not perform Setif Your Order T Your Opcn A c c o u nt satisfactorily, we will provide a credit, refund, or exchange; ifs your Available to licensed practitioners in the US, A31 invoices are choice. Simply call our customer service department ��i.hin 30 lows payable within 30 days, 1 o receipt of the merchandise to arrange for the return. For a warranty repair or if you were sent something you di, not order simply call: Rx Products Controlled Substances: Matra Medical 1 -800- 845 -3550 Reaulations 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 li drugs can be ordered only by mail. International Orders: please N ote. Opened We proudly serve healthcare professionals and governments C l d handpieces and equipment may no! be returned for throughout the r ©rid, To place orders or for inquiries on export credit. but be repaired or replaced in accordance with terms and conditions, please contact our international I�epartrnert: manufacturer warranties. Before opening handpieces or equipment, we suggest that you check the shipping container 1-800-845-35-50 r and packing list to verify that you have received exactly what Prescription [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 Depart,~! ent 1 -800- 845 -3550. wal�m, LP300 VOUCHER NO. WARRANT NO. ALLOWED 20 Henry Schein IN SUM OF Dept Ch 10241 Palatine, IL 60055 $157.40 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO, ACCT /TITLE AMOUNT Board Members 1120 5863576 -02 102 390.11 $157.40 1 hereby certify that the attached invoice(s), or 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 PR- -2 �7C Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund Prescribed by State Board of Accounts C 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 -02 $157.40 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