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185283 05/11/2010 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1 ONE CIVIC SQUARE HENRY SCHEIN INC INDIANA 46032 CHECK AMOUNT: $4,653.76 CARMEL DEPT CH 10241 PALATINE IL 60055 -0241 CHECK NUMBER: 185283 CHECK DATE: 5/11/2010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 102 4239011 2433905 -01 114.00 SPECIAL DEPT SUPPLIES 102 4239011 4823147 -01 2,865.89 SPECIAL DEPT SUPPLIES 102 4467006 4823147 -01 732.00 EMS EQUIP 102 4239011 4835163 -01 158.00 SPECIAL DEPT SUPPLIES 102 4467006 5448140 -01 139.87 EMS EQUIP 102 4239011 54483850 -01 644.00 SPECIAL DEPT SUPPLIES HSI ORDER# ORDER DATE 80502431 04/19/10 WHSE bEA# RH0236667 Fed ID: 11- 3136595 a s his order ias been processed by our NORTHEAS D.C. 41 WFAVEZ ROAD DENVER, A 175 L 7 NORTHEAST D.C. State Lic 3:004e RK. 1 253 -7520 5 /BG DIAPHR RIM LTMN ASMB SMALL 2 2 28.50 57.00 1 HIS PRODUCP IS BEING SHIPPED FROM OUR MIDWES DISTR BUTIO CENTER. 2 777 -8239 5 /PK DIAPHR RIM LTMN ASMB LARGE 2 2 28.50 57.00 1 HIS PRODUC IS BEING SHIPPED FROM OUR MIDWES DISTREBUTION CENTER. c YOU ARE LRTIC A DISCOUNT PROGR (E.G. POIN S, GIFTS OR 0 HER PECIAL AWA DS "DISCOUNT WITH THIS PURCHASE YOU HAVE EARNED A CREDI TOWARD GOODS OR S RVICES, RECEIVABLE OR REDEEMABLE N ACCO DANCE WITH DISCOUNT PROGRAM RULES. UPO4 DISCOUNT RECEIPT OR REDEMPTION, IOU ARE RECEI ING OR WILL R CEIVE OTICE OF TIE DISCOUNT VALUE. FROM TIME TO TI E, MED CARE, MEDICAID, TRI ARE OR THER PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, TND UPON ANY S CH R EQUEST, SU H VALUE MUST BE DISCLOSED AS A DI COUNT kGAINSI THE PURCHASE THAT ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN TH SE RECORDS, MERCHANDI E TOTAL 114.00 INVOI E TOTAL 114.00 PLEASE PAY WITHIN THIRTY(3)1 DAYS OF RECEIPT OF THIS NVOICE. 114.00 BI L' To SHIP TO INVOICE# INVOIC EBOXE ITEM STATUS KEY REM KEY 1308571 1308572 2433905 -01 n- liackordcred: 11cm wiil fullnw SK- School R4 D ❑itil,cnunued.Item no longer uvarlahle NC Nu Charge HSI R D IHV A P- Speaal Schcin 1-ree Coodz M Manu (;Lmer will ship lien) dimcily to you 80502431 0 4 /19 10 4/19/10 1 Itescripdon thug: Return Authonzation Required R Refrigerated hero_ Agay he st ippad ,�paraidy CUSTOMER g Special Schcin Pricing U 't unavailahlo; Please reorder MARK 1 OF 2 T- Tesahlc licm Continued on Next Page HST ORDER# ORDER DATE 80774223 04/28/10 1VHSE DEA# RP10236667 Feel IDI 1- 3136595 as �.r ��xE. E- his order ias been processed by our NORTHSAS' D.C. 41 WEAVER ROAD DENVER, A 17S L7 NORTHEAST D.C. State Lic .3:0046 1 120 -3713 EA STETH LITTMANN CARDI03 27" k 1 139.82 139.87 1 HIS PRODUC IS BEING SHIPPED FROM OUR MIDWES DISTR BUTIO CENTER. F YOU ARE DARTICIPATING IN A DISCOUNT PROGRAM (E.G. POIN S,.GIFTS OR 0 HER PECIAL 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. UPOq DISCOUNT RECEIPT OR REDEMPTION, 'OU ARE RECEI ING OR WILL A CEIVE NOTICE OF: IE DISCOUNT' VALUE. TIME TO TI.7E, MED r TJE. FR FROM CARE, MEDICAID, TnI P.R° 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 DISCOUNT AGAINS THE PURCHASET THAT E ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN THESE RECORDS. MERCHANDI E TOTAL 139.87 INVOI E TOTAL 139.87 PLEASE PAY WITHIN THIRTY(3 DAYS OF RECEIPT OF THIS NVOTCE. 139.87 LEASE NOTE NEW REMIT TO ADDRESS P lease remi payments only to the following a dress: H ENRY SCHEI INC. D EPT CH 10211 ALATINE, I 60055 -0241 TO SHIP TO, INWICE# TUVOICE TOTAL ITEM STATUS KEY REM KEY 1308571 1308572 5448140 -01 1'39.87 B lbckordcred� Item will follow SK School Kit D 1) isumtinued; Item nu IongeravaiIaNe NC No Charge' H I RDER ORDER DATE TNV ICE QATE F BOXES 1' Speci Schein Free Goods M Mnnufociurc. will ship Item diraclly to you 80774223 04/28/10 4/28/10 1 P- llxseri ptinn Drug: Retum Authorization Requimd R Rd6&cruted hem: May be shipped sepurately CUS TOMER PO# PA Special Schein Pricing U Tempnmdly unavailahlc: please reorder MARK 1 OF 1 T- Ta.xahle Ilan Pa 'Terms, We nvake every effort to maintain prices for the duration of a Payment by CHECK or by the HENRY SCHEIN CREDIT CARD, catalog, too we reserve the right to make price adjustments in VISA, MASTERCARD, DISCOVER and AMERICAN EXPRESS response to manufactrirers� price changes Guaranteed Satisfaction: =V If you have tried a product and it is defective or does not perform B ill Your t�$�t o ur Accou satisfacturrly, rye ed11 p Quid a credit, refund, or exchange; it s your Availadlc to licensed prac. k onr}r7 in the J.S. All invoices are choice. Simply call our customer service department vvithir; 30 clays payable v- °vithin 30 days. of receipt of the merchandise to arrange for the return, i=c€ a vtiarranty repair or if you were sent some ding you did not order, simply call: Rx Products Controlled Substances: Matrx 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 P re a neVV customer or have recently moved, please furnish us with a copy of your updated state registration. For controlled substances, furnis a copy of your DEA certificate verifying your shipping address. Class 11 drugs can be ordered only by mail, International Orders: Opened handpieces and equipment may not be returned for We proudly serve healthcare professionals and governments credit but will be repaired or rep laced in accordance with throughout the world, To place orders or for inquiries on export marutacturer tih Before opening handpieces or terrns and conditions, please contact our International Department: equipment, we suggest that you check the shipping container 1-800-845-K550 and packing list to verify that you have received exactly what Prescription Drug Returns Instructions: you o €dered.Opened Computer Software is not returnable. Other restrictions may also apply. A Return Authorization is 4- required for all Prescription Drugs. Simply calf our Customer Service Department a 1 -800- 845 -355©. LP300 HSI ORDER ORDER DATE 80698527 04/26/10 WISE DE-A# 8 1-1 02 3 6 6 67 I'al 11): 11- 3136595 �.a.... e�"a,(a?'r`„� :`s"� �uY agar v�„p w a 4��. 1 x tee., "�a^ra�" �a'��I""r,�r` e k$+ T his order ias been processed by our NORTHEAS D.C. 41 WEAVER ROAD DENVER, A 175L7 NORTHEAST D.C. State Lic 3:0046 1 499 -07.76 5 /PK OXYGEN GASKET METAL 51 32 3.95 126.4.0 1 ARTIAL SHI MENT WILL SHIP AND INVOICE WHEN AVAILABLE. 2 499 -0776 5 /PK OXYGEN GASKET METAL 9 8 3.95 31.60 2 HIS PRODUCT IS BEING SHIPPED FROM OUR WEST COAST DI TRIBU ION CENTER. ARTIAL SHI MENT BACK ORDERED TO FOLLOW. F'"OU'ARE PARTICIPATING IN K DISCOUNT PROGRAM (E.G. POIN S, GIFTS OR O'HER PECIAL AWARDS "DISCOUNT WITH THIS PURCHASE YOU HAVE EARNED A CREDI TOWARD GOODS OR S RVICES, RECEIVABLE OR REDEEMABLE N ACCO DANCE WITH DISCOUNT PROGRAM RULES. UPON DISCOUNT RECEIPT OR REDEMPTION, OU ARE RECEI ING OR WILL R CEIVE OTICE OF THE DISCOUNT VALUE. FROM TIME TO TI E, MEDICARE, MEDICAID, TRI ARE OR THER PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, PND UPON ANY S CH EQUEST, SU H VALUE MUST BE.DISCLOSED AS A DI COUNT GAINSI THE PURCHASES THAT ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN THESE RECORDS. MERCHANDI E TOTAL 158.00 INVOI E TOTAL 158.00 PLEASE PAY WITHIN THIRTY(30) DAYS OF RECEIPT OF THIS NVOICE. 158.00 BILL To SHI T' INV OjCP4 TNV0 ICE TOTAL ITEM STATUS KEY REM KEY k06571 1308572 4835163 -01 158.00 It nackorducd; tom will follow sr<- Schnnlxh I') Disconlinucd: Item no Ionger available ,1'C Nn Charge RDER ORDER D E INV E F. B E F Special Schein F'cc GOOds M Manulaclurcr will .ship Item directly to you 27 04/26/10 4/26/10 2 1 llrescnption Drug: Return Aulherizatinn Required R Rehigeralcd Ilcm: May he shipped separately CUSTOME P PAGE Special Schein I)icing. U Temporuily unavailable; please reorder MARK 1 OF 2 T Taxai le ucm Continued on Next. Page HSI ORDER# ORDER DATE 80774038 04/28/10 WHSE DEA# RH0236667 Fed ID; 11-3136595 R E "�s': A s a' Fag. m rcr` ._JA s'� :ce T his order has been processed by our NORTHEAS D. C. 41 WEAVER ROAD DENVER, A 175 7 NORTHEAST D.C. State Lic 3:0046 1 602 -8100 EA COLLAR AD STIFNECK SELECT UNV 100 100 C 5.75 575.00 2 HIS PRODUC r IS BEING SHIPPED FROM OUR MIDWES DISTR BUTTO CENTER. ASE GOOD 117EM, MAY BE SHIPPED SEPARATELY. 2 220 -1652 EA COLLAR XTRIC STIFNECK CER PEDIAT 12 12 5.75 69.00 3 HIS PRODUC IS BEING SHIPPED FROM OUR MIDWES F DISTR BUTION CENTER. YOU ARE DARTICIPATING IN A LISCOUNT PROF (E.G. POIN S, GIFTS OR OTHER PECIAL AWA DS "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. UPO4 DISCOUNT RECEIPT OR REDEMPTION, IOU ARE RECEI ING OR WILL RECEIVE OTICE OF T E DISCOUNT VALUE. FROM TIME TO TIME, MEDICARE, 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 \GAINSrI THE PURCHASE THAT E ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN TH SE REC ORDS. MERCHANDI E TOTAL 644.00 INVOICE TOTAL 644.00 PLEASE PAY WITHIN THIRTY(310) DAYS OF RECEIPT OF THIS INVOICE. 644.00 BILL TO HIP T INV I E NV ICE T ITEM STATUS KEY REM KEY 1308571 1817102 5448385 -01 644.00 n- llackordenxt: i cm will Follow SK SchoolKit D Discontinued; Item no Longer available RC No Charge ]tD ER DATE TNVOTCF DATE OF BOXES I- SlNcial Schein Pree Goods M -Manufacturer will ship Item directly to y ou 80774038 04 2 8 10 4/28/10 3 P Prescription Drug: Return Authorization Required R Refrigerated hem: May be shipped separately s Special Schein Pricing MARK 1 OF 2 U -Temporarily unavailable: please reorder T Ta,ahlc Item Continued on Next Pa .-e HSI ORDER# ORDER DATE 80695032 04/26/10 WHSE DEA# RH0236667 Fed ID: 11- 3136595 93 ON v f r o T his order as been processed by our NORTHEAS D.C. 41 WEAVE ROAD DENVER, A 175 7 NORTHEAST D.C. State Lic 3:0046 RK 617-57--2663 1 677 -8965 EA OXYGEN CYLINDER W /TOGGLE SIZE D 13 13 C 45.75 594.75 17 HIS PRODUCP IS BEING SHIPPED FROM OUR MIDWES DISTRIBUTIO11 CENTER. ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. 2 677 -8965 EA OXYGEN CYLINDER W /TOGGLE SIZE D 3 3 C 45.75 137.25 3 ASE GOOD ITEM, MAY BE SHIPPED SEPARATELY. 3 891 -3037 PU 50 /CA T`I PREP KIT W/ TEGADERM, 8 8 C 61.75 ^94.00 25 HIS PRQDUC IS BEING SHIPPED FROM OUR MIDWES DISTR BUTIO CENTER, ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. 4 258 -9850 250ML /BT STERILE WATER F /IRRIG 250ML 144 144 C 1.23 177.12 31 HIS PRODucr IS BEING SHIPPED FROM OUR MIDWES DISTR BUTIO CENTER. PEDIGR E ITEM. ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. 5 102 -4985 100 /CA EXTENSION SET SMALL BORE 1 1 204.00 204.00 33 HIS PRQDUC P IS BEING SHIPPED FROM OUR MIDWES DISTR LBUTIO CENTER. 6 102 -4985 100 /CA EXTENSION SET SMALL BORE 3 3 204.00 612.00 4 7 555 -5396 UIE EA PROTECTIV ACUVNC SFT CATH 20X1.25 200 200 C 2.74 548.00 32 S PRQDUC IS BEING SHIPPED FROM OUR MIDWES DISTR BUTIQ CENTER. AILL TD SH IP 70 INVOICE# INVOT E TOTAL ITEM STATUS KEY REM KEY 1308571 1817102 4823147 -01 3597.89 Ii Backordered: llem ivm lohuw SK Sehnol K,1 Disx;oniinucd: Ilum nn nng Icrrvuilublc NC Nn Churgc HSI Q RDER# Q DER DATE F- Special Schein FreeC auds M Manul curer will shin hem directly W ynu 8 0 6 9 5 0 3 2 0 4/ 2 6/ 10 4/26/10 33 P l>rescripiion Drug; Reiurn Aulhodzation Required R Refrigerated Item; May he shipped separately Cu- qTnmER PC# PAGElf Special Schein Pricing MARK 1 OF 3 U Temporarily unpeahh a Cc please reorder r- Taxrrhle hem CDntlnued oa Next Pale HENRY SCHEIN SHIP TO: Matrx Carmel Fire Department MI I NVOICE 540 W 136 St 135 Duryea Road, Melville, NY 11747 Station 46 Michael Kaufmann Carmel,IN 46032 -8806 010000130857104823147 710010000003597890426],04 BILL TO: Carmel Fire Dept MI 2 Civic Sq Carmel, IN 46032 -7543 Carmel Fire Dept MI 2 Civic Sq HILL TO SHIP TO INVOICE TOTAL Carmel, IN 46032 -7543 1308571 1817102 3597.89 INVOTCEff INVOICE DATE 4823147 -01 4/26/10 CUSTOMER PO# MA Rx HSI ORDE32# ORDER DATE 80695032 F i4/26/10 NNIHSE DEA# RH0236667 Fed ID: I I- 3136595 R aw _q a a R ,f E a 0 r v :x rr .,:.s wee �e ASE GOOD T EM, MAY BE SHIPPED SEPARATELY. 8 555 -1166 U EA PROTECTIV ACUVNC SFT CATH 18X1.25 200 200 2.74 546.00 33 HIS PROT)UCr IS BEING SHIPPED FROM OUR MIDWES DISTRLBUTIOIN CENTER. 9 654 -5076 U 50 /BX PROTECTIV ACUVANCE SAFETY 22GX1" 1 1 137.00 137 ..00 33 HIS PRODUCE IS BEING SHIPPED FROM OUR MIDWES DISTREBUTIO1 CENTER. 10 654 -1395 U 50 /BX PROTECTIV ACUVANCE SAFETY 24GX5/8 1 1 145.77 145.77 33 HIS PRODUCE IS BEING SHIPPED FROM OUR MIDWES DISTR BUTIO CENTER, F YOU ARE ARTICIPATING IN A DISCOUNT PROG (E.G. POINTS, GIFTS OR O PECIAL AWA DS "DISCOUNT WITH THIS PURL SE YOU HAVE EARNED A CREDI TOWARD GOODS OF. S _RTTIC"S, RECaT` ✓A °LE OR RED2. N ACCO .DA ,CE [''ITH 'OT_SCCUNT PRO0RJ'VM RULES. UPO DISCOUNT RECEIPT OR REDEMPTION, I OU ARE RECEI ING OR WILL RECEIVE OTICE OF T E DISCOUNT VALUE. FROM TIME TO TI E, MEDICARE, MEDICAID, TRI ARE OR THER PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, TND UPON ANY S CH R EQUEST, SU H VALUE MUST BE DISCLOSED AS A DI COUNT I %GAINS THE PURCHASEI THAT E ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN THESE RECORDS. N HENRY 3CHEIN, INC. HAS PURCHASED THE SPE IFIC U= OF THE PRESCRIPT ON DRUG DIRECTLY F OM THE MANUFACTURER. MERCHANDI E TOTAL 3597.89 INVOI E TOTAL 3597.89 PLEASE PAY -WITHIN THIRTY-(.3 1 DAYS OF RECEIPT OF THIS NVOTCE._ 3597.89 L INVOICIE4 INVOI ITEM STATUS KEY REM KEY 1 1308571 1817102 4823147 -01 3597.89 It nnclamolcred: hero N'dl follow SK- School Kit f)- Discontinued: It em nn longeravailahlc NC- N,7mrge I INVOICE ATE F B P Special Schein Prce Gnnds M ;17anafac1Ltrer will shin Item directly to you 80695032 04/26/10 4/26/10 33 P- Prescnphon thug: Return Anmonreiiun RCyuired R Retrieermed ](,in: May be shipped sepaz icly Spcalal Schein Pricing MARK 2 OF 3 U 'Temporarily unavailuhlc: please reorder T- Taxahl, licm Continued on Next Pale.......... VOUCHER NO. WARRANT NO. ALLOWED 20 Henry Schein IN SUM OF Dept Ch 10241 Palatine, IL 60055 $4,653.76 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO. ACCT #ITITLE AMOUNT Board Members 1120 5448140 -01 102- 670.06 $139.87 1 hereby certify that the attached invoice(s) or 1120 4823147 -01 102- 670.06 $732.00 bill(s) is (are) true and correct and that the 1120 5448385 -01 102- 390.11 $644.00 materials or services itemized thereon for 1120 4835163 -01 102 390.11 $158.00 1120 4823147 -01 102 390.11 $2,865.89 which charge is made were ordered and 1120 2433905 -01 102 390.11 $114.00 received except MAY 1 0 le J �7 Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund Prescribed by State Board of Accounts City Form No. 2G1 (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)) 5448140 -01 $139.87 4823147 -01 $732.00 5448385 -01 $644.00 4835163 -01 $158.00 4823147 -01 $2,865.89 2433905 -01 $114.00 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