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Home My WebLink About186851 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