HomeMy WebLinkAbout186851 06/23/2010 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1
ONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: $1,932.01
CARMEL, INDIANA 46032 DEPT CH 10241
PALATINE IL 60055 -0241 CHECK NUMBER: 186851
CHECK DATE: 6123/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 4239011 2732236 -01 107.41 SPECIAL DEPT SUPPLIES
102 4239011 2732250 -01 1,468.65 SPECIAL DEPT SUPPLIES
102 4239011 2732250 -02 266.00 SPECIAL DEPT SUPPLIES
102 4239011 7791560 -01 89.95 SPECIAL DEPT SUPPLIES
l t•u�it�c�
Please detach here and mail the above with your payment
HSI ORDER. ORDER DATE
80806363 04/29/10
WHSE DEA# RH0236667 Fed ID: 11- 3136595
w .2. a M �,::P
a P t
his order ias been processed by our NORTHEAS D.C.
41 WEAVEZ ROAD
DENVER, A 175 7
NORTHEAST D.C. State Lic 3:0046
1 499 -3996 EA BAG GREEN F /CYLINDER 02 POCKET 1 1 89.95 89.95 1
F YOU ARE ARTICIPATING IN A DISCOUNT PROG (E.G. POINI S, GIFTS OR O HER
PECIAL AWA DS "DISCOUNT WITH THIS PURCH SE YOU HAVE EARNED A CREDIII TOWARD
GOODS OR SERVICES, RECEIVABLE OR REDEEMABLE N ACCO DANCE WITH DISCOUNT PROGRAM
RULES. UPO4 DISCOUNT RECEIPT OR REDEMPTION, 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, ;ND UPON ANY S CH
R EQUEST, SU H VALUE MUST BE DISCLOSED AS A DI COUNT kGAINSrI THE PURCHASE THAT
E ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN THESE RECORDS.
MERCHANDI E TOTAL 89.95
INVOI E TOTAL 89.95
PLEASE PAY WITHIN THIRTY(3 DAYS OF RECEIPT OF THIS NVOICE. 89.95
LEASE NOTE NEW REMIT TO ADDRESS
lease remi payments only to the following a dress:
ENRY SCHEI4 INC.
EPT CH 10211
ALATINE, I 60055 -0241
BIL INVOIC TOTAL ITEM STATUS KEY REM KEY
1308571 1308572 7791560 -01 89.95 n- I3ackordered: Item will follow. SK School Kit
D Discontinued: Item no longer available NC -No Charge
HSI ORQER# ORDER DATE INVOICE ATE ff OF BOXES P Special Schein Free Goods
Al Manufacturer will ship Item directly to you
80806363 04/29/10 6/07/10 1 1'- Prescription Drug: Remm Authorization Required
R Refrigerated Item: May he shipped .separately
Special Schein Pricing
U Temporarily unavailable: please reorder
MARK 1 OF 1 T- Taxable hem
Ra me t Terms:
v make every effort to ma ntain prices for the duration of a Payment by CHECK or by the HENRY SCHEIN CREDIT CARD,
catalog, however, we reser%e 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 detective or does not perform fif Your Otcier To Your Open Account
satisfactorily, vve wili provide a credi±, refund, or exchange; its your Available to licensed practitioners in the U.S. All invoices are
choice. Simoly call our custcmer service department within 30 days payauie within 30 dots..
of receipt cf the merchandise to arrange for the return. Fora
warranty repair or if you,:sere sent something you did not order
simply call: Rx Products Controlled Substances:
iatrx Medical 1- 800.845 -3550
Regulations require us to limil 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 Faith a copy of your updated state registration. For controlled
substances, furnish a copy of your DBA cedificae, verifying your
shipping address. Class if drugs ran be ordered only by mail.
International Carders.
Please tote.
We proudly serve healthcare professionals and governments
Opened handpieces and equipment may not i e returned for throughout the world. To place orders or for inquiries on export
credit, but will be repaired or replaced in accordance with terms and conditions, please contact -our International Department:
manufacturer',varranties. Before opening hand pieces or 1 845 3550
equipment, we suggest that you check the shipping container
and packing list to verify that you have received exactly -,,Lrhat Prescription Drug Returns Instructions
you ordered.Cpened Computer Software is not returnable.
Other restrictions may also apply.
A Return: Authorization is Required for all Prescription Drugs. Simply tail
our Customer Service Department ',d 800 345 -3350.
e
LP300
HSI ORDER# ORDER DATE
81857027 06/04/10
WHSEDEA# RH0236667 Fed ID: 11- 3136595
T his order has been processed by our NORTHEAS D.C.
41 WEAVER ROAD
DENVER, 3 A 175 L7
NORTHEAST D.C. State Lic 3:0046
1 220 -1398 3 /ST BODY STRAP SET DISP YELLO W 20 20 4.75 95.00 1
2 220 -1398 3 /ST BODY STRAP SET DISP YELLO W 18 18 4.75 85.50
3 220 -1398 3 /ST BODY STRAP SET DISP YELLO W 18 18 4.75 85.50
F YOU ARE ARTICIPATING IN A DISCOUNT PROG (E.G. POIN S, GIFTS OR OTHER
PECIAL AWA DS "DISCOUNT WITH THIS PURC SE YOU HAVE EARNED A CREDI TOWARD
GOODS OR SERVICES, RECEIVABLE OR REDEEMABLE N ACCO DANCE WITH DISCOUNT PROGRAM
RULES. UPOq DISCOUNT RECEIPT OR REDEMPTION, IOU ARE RECEI ING OR WILL RECEIVE
OTICE OF T E DISCOUNT VALUE. FROM TIME TO TI E, MED CARE, MEDICAID, TRI ARE OR
THER PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, PND UPON ANY S CH
REQUEST, SU H VALUE MUST BE DISCLOSED AS A DI COUNT GAINS THE PURCHASES THAT
EARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN THESE RECORDS.
MERCHANDI E TOTAL 266.00
INVOKE TOTAL 266.00
PLEASE PAY WITHIN THIRTY(3 DAYS OF RECEIPT OF THIS NVOICE. 266.00
BILL INVOICE INVOICE TA ITEM STATUS KEY REM KEY
1308571 1817102 2732250 -02 266.00 11- llackordcrcvl: Unt will rt,lh— SK schuolKit
I ORDrR# ORDER DATE INVOICE DATE OF BOXES IJ Discoatiaued; item no longer availahle NC No Charge
p Special Schein I?ee Goods
6 11 N1- Manufacturer willship Item directly In y
81857027 06/
04/10 10 1 1'- prescription Drug: Return Authorizmion Required
R Refrigcratud Item: May no shipped separ:nely
CUS IQMBR PAGE Special Schcin Pricing
U Tempururily unavailable; please reorder
5 0 LK 1 OF 2 T- Taxable firm Continued on Next Page
HSI ORDER# ORDER. ➢ATE
81857488 06/04/10
WHSF6DEA# RH0236667 Fed ID: 11- 3136595
T his order as been processed by our NORTHEAS D.C.
41 WEAVEK ROAD
DENVER, A 175L7
NORTHEAST D.C. State Lic 3:0046
1 113 -6962 1000 /3T IBUPROFEN TABLETS 200MG 1 1 19.01 19.01 1
2 114 -5435 100 /BT ACETAMINOPHEN CAPLETS 500MG 4 4 1.85 7.40 1
3 555 -4218 PU EA JELCO IV CATHETER 14GX1" 100 100 0.81 81.00 2
HIS PRODUCT IS BEING SHIPPED FROM OUR MIDWES DISTRIBUTIOE CENTER.
F YCU ARE AP_TICI_PAT -ING 1N A 'DISCOUNT PROD (E.G Pot c 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. UPO DISCOUNT RECEIPT OR REDEMPTION, OU ARE RECEI ING OR WILL R CEIVE
OTICE OF T E DISCOUNT VALUE. FROM TIME TO TIME, MED CARE, MEDICAID, TRI ARE OR
THER PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, PND UPON ANY S CH
R EQUEST, SU H VALLUE "MUST BE DISCLOSED AS A DISCOUNT GAINSl THE PURCHASE THAT
E ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN TH SE RECORDS.
MERCHANDI I E TOTAL 107.41
INVOI E TOTAL 107.41
PLEASE PAY WITHIN THIRTY(30) DAYS OF RECEIPT OF THIS NVOICE. 107.41
BI P I NVOIC T
ITEM STATUS KEY RE1v1 KEY
1308571 1308572 2732236 -01 107.41 13- Backordered: seem will follow sx- school xir
1 Pe
7 Discontinued: Item no longer available p7C No Charge
DE R ER DATE I I E DATE E E I' S �51it1 Schein Free Goods
M Manufacturer will ship Item directly to you
81857488 06/ 0 4/10 6 04 /10 2 Prescription Drug; Relurn Authorization Required
R Refrigerated Item: May he shipped separately
Special Schein Pricing
MARK 1 �F 2 U Temporarily unavailahle. please reorder
T- Taxahle Item Continued on Next Page
HSI ORDER# ORDER DATE
81857027 06/04/10
WHSE DEA# RH0236667 Fed ID: 11- 3136595
T his order ias been processed by our NORTHEAS D.C.
41 WEAVER ROAD
DENVER, A 175 7
NORTHEAST D.C. State Lic 3:0046
1 555 -8241 PU EA JELCO IV CATHETER 16X11/4 100 100 0.81 81.00 9
HIS PPODUCf IS BEING SHIPPED FROM OUR MIDWES DISTRIBUTTOE CENTER.
2 420 -4674 EA NASAL ATOMIZATION DEVICE W /SYR 100 100 2.89 289.00 9
HIS PRODUC IS BEING SHIPPED FROM OUR MTDWES DISTR BUTIO CENTER.
3 107 -0530 100 /BX PURPLE NITRILE PF GLOVE LARGE 60 60 C 8.46 507.60 6
ASE GOOD I EM, MAY BE SHIPPED SEPARATELY.
4 220 -1398 3 /ST BODY STRAP SET DISP YELLO W 100 44 4.75 209.00 8
P ARTIAL SHI )MENT BACK ORDERED TO FOLL W. 5
5 360 -1359 EA SAM SPLINT ORANGE /BLUE 36X4.25 25 25 6.65 166.25 7
6 496 -2369 100 12X LANCET SURGILANCE ORANGE 21G 2 2 9.80 19.60 7
7 890 -6868 3 /PK LIFEPAK 12 PAPER EKG 1.8 18 10.90 196 -20 7
F YOU ARE ARTICTPATING IN A DISCOUNT PROGRAM (E.G. POTN S, GIFTS OR 0 HER
PECIAL AW DS "DISCOUNT WITH THIS PURCHASE YOU HAVE EARNED A CREDI TOWARD
GOODS OR SERVICES, RECEIVABLE OR REDEEMABLE IN ACCORDANCE WITH DISCOUNT PROGRAM
RULES, UPO4 DISCOUNT RECEIPT OR REDEMPTION, OU ARE RECEI ING OR WILL R CEIVE.
OT ICE OF T I IE DISCOUNT VALUE. FROM TIME TO TIME, MED CARE, MEDICATD,.TRI ARE OR
RIL TO i NVOICEg INVOIC tPT ITEM STATUS KEY REM KEY
1308571 1817102 2732250 -01 1468.65 13- 13ackordered: hem will follow s<
school Ki
D Discontinued_ Item no longer available NC No Charge
HSI R R ORDER DATE INVOICE DATE OF J30XES Special Schein Pine Goods
PO rvu mufacturer will ship Item directly to you
81857027 06/04/10 6 0 4 1 0 9 P- Prescription Drug: Return Authomation Required
R Refrigerated Item: May be shipped separmely
R Special Schein Pricing
j�jt 1 C1)' 2 U Temporarily tmavailaNe: pleas reorder
T Taxable la:m Continued on Next Page
H ENRY SCHEIN
SHIP To:
Mzitrx Medical Carmel Fire Department MI
135 Duryea Road, Melville, NY 11747 INVOI 540 W 136 St
Station 46 Michael Kaufmann
Carmel,IN 46032 -8806
010000130857102732250110010000001468650604100 BILL To:
Carmel Fire Dept MI
2 Civic Sq
Carmel, IN 46032 -7543
Carmel Fire Dept MI
2 Civic Sq BILL TO SHIP TO INVOICE TOTAL
Carmel, IN 46032 -7543 1308571 1817102 1468.65
INVOICE INVOICE DATE
2732250 -01 6/04/10
CUSTOMER PO4 MAP.K
Plcase detach here and mail the ahove with your payment
HS I ORDERM ORDER DATE
1857027 06/04/10
WHSE DEA# RH0236667 Fed ID: 1 1- 31 36595
W-1 s ai®.�.a c: a x
THER PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, PND UPON ANY SUCH
R EQUEST, SU H VALUE MUST BE DISCLOSED AS A ]DISCOUNT kGAINSl THE PURCHASES THAT
E ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN TH SE RECORDS.
MERCHANDI E 'TOTAL 1468.65
INVOI E TOTAL 1468.65
PLEASE PAY WITHIN THIRTY(3 DAYS OF RECEIPT OF THIS NVOICE. 1468.65
LEASE NOTE NEW REMIT TO PIDDRESS
P lease remi payments only to the following a dress:
ENRY SCHEIq INC.
D EPT CH 10211
ALATINE, I 60055 -0241
RTLL TO SHILI TO INVOICE# TNVO TOTAL ITEM STATUS KEY REM K.EY
1308571 1817102 2732250 -01 1468.65 B liackordeed:hemwiurollow SK SchoolKit
I) Discontinued: Item no longer available NC- No Charge
H R ORDER E DATE F X I' Special Schein Frec Goods
M Manufacturer will shir I= directly to you
81857027 06/04/10 6/ 0 4/ 10 9 P Prescription Drug_ Return All lhOri %adOn Required
R Refrigerated Item; May be shipped separately
CUSTOMER Poll 2AGE4 Special Schein Rieing
U Temporarily unavailahle: plemsc reorder
MARK 2 OF 2 T Taxable Item
HENRY SCHE N `y
r
I A
r� �lme rl d g ns:
">le make every effor to maintain prices for the duration of a payrrrent by CH CK or by the HEN€�Y SCHEIN CREDIT CARD,
catalog, hoyveyer, vac €asen e ih2 €fight to nEaka price adjustments in VISA. MASTERCARD. DISCO and AMERICAN EXPRESS
response to manufacturers' price changes
Guaranteed Satisfaction: v�sn
or
If you have tried a product and it is detective cr does not pe r;orm mF' ouC rder a Your 0 c�
satisfactorily vvel v.3il provide a c €eaii, refund, or exchange; it s your Available to licensed! practitioners in the U.S. All invoices are
choice. Simply Cali our customer serViCe department within 30 days payabl ,vi hin 3u days.
of recalpt of the merchandise to arrange for the return. For a
Warranty repair or it you %h'ere sent something you did not order
simply coil: Rx Products Controlled Substances:
atrx 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 nevv Customer yr have. re ently moved, please furnish
us vJth a copy of your updated state registratio For cont €olled
substances, fUri,iSh a cop,' of your DEA certific ate, verifying your
shipping address. Glass II drugs can be ordered= only by rnail.
international drders:
Please Nolte
yi fa p ru:ldly Set'Je Ilealt'1Cc're pr?�f °�Si�na and �nb'? "nnl?CiS
Open d handpiecr and equipment mays not be returned for throughout the ,vodd. To place orders or'for inquiries on export
credit, but :Ail! be rewired or replaced in accordance with terms and conditions, please contact our International Department:
rnanutacturer ,Aaarranties. Before opening handpieces or 1- 800 -845 -3550
equipment, we suggest that you check the shipping container
and packing list to verity that you have received exactly :what Prescription Dr€�g Returns Instructions:
you ordered.opened Computer Software is next returnable.
other restrictions may also apply.
A Return Authorization is Required for all Prescription Drugs. Simply ca'l'l
our Customer S rvice Department 800 845 -3550.
s ems. n�se�s s m s,
LP300
VOUCHER NO. WARRANT NO.
ALLOWED 20
Henry Schein
IN SUM OF
Dept Ch 10241
Palatine, IL 60055
$1,932.01
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO, ACCT #/TITLE AMOUNT
Board Members
1120 2732250 -02 102-390.11 $266.00 1 hereby certify that the attached invoice(s), or
1120 7791560 -01 102 390.11 $89.95
bill(s) is (are) true and correct and that the
1120 2732250 -01 102- 390.11 $1,468.65
materials or services itemized thereon for
1120 2732236 -01 102- 390.11 $107.41
which charge is made were ordered and
received except
JUN 2 1 f'
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))
2732250 -02 $266.00
7791560 -01 $89.95
2732250 -01 $1,468.65
2732236 -01 $107.41
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