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Home My WebLink About187852 07/21/2010 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1 0 ONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: $1,877.30 CARMEL, INDIANA 46032 DEPT CH 10241 PALATINE IL 60055 -0241 CHECK NUMBER: 187852 CHECK DATE: 7121/2010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 102 4467006 3098369 381.00 EMS EQUIP 102 4239011 4495903 -01 211.08 SPECIAL DEPT SUPPLIES 102 4239011 5538073 -01 1,285.22 SPECIAL DEPT SUPPLIES c HSI QRQER# ORDER DATE 82462181 06/28/10 WHSE t)EA# RH0236667 Fed 1D: 11-3136595 rA 0101 1 his order has been processed by our NORTHEAS D.C. 41 WEAVEF ROAD DENVER, FA 175 7 NORTHEAST D.C. State Lic 3:0046 17- 428 -878 AARK 1 499 -1918 EA RING CUTTER 3 3 5.58 16.74 1 2 499 -0652 EA PENLIGHT METALITE 20 20 2.50 50.00 1 3 499 -9994 EA ULTRA SOFBOX PLUS ROYLBLU 1 1 144.34 144.34 1 F YOU ARE ARTICIPATING IN A DISCOUNT PROD (E.G. POINTS, 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. UPO DISCOUNT RECEIPT OR REDEMPTION, 'IOU ARE RECEI ING OR WILL RECEIVE OTICE OF TIE DISCOUNT VALUE. FROM TIME TO TI E, MEDICARE, MEDICAID, TRI ARE OR THER PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, PND UPON ANY SITCH REQUEST, SU H VALUE MUST BE DISCLOSED AS A DISCOUNT kGAINSq THE PURCHASE THAT EARNED SUCH VALUE, ACCORDINGLY, YOU SHOULD RE AIN THESE RECORDS. MERCHANDI E TOTAL 211.08 INVOI E TOTAL 211.08 PLEASE PAY WITHIN THIRTY(3 DAYS OF RECEIPT OF THIS NVOICE. 211.08 BILL I ITEM STATUS KEY REM KEY 1308571 1308572 4495903 -01 211.08 B- Backordered: hem will follow SK SchoolKil t) lliscontinued: hem no longer available NC No Charge HSI ORDER# DATE TIqVQJCE DATE It OF DOXES P Special Schein Pre: Goods M Manulaclurer will ship hem directly to you 82462181 0 6 2 8 10 6/28/10 1 l' Pre.. ription Drug: RClurn Authorization Required R Refrigerated Item: May he shipped separately CUSTO PC# PRGE# Speciai Schein pricing I U Temporat'ily unavailable; p]casc reorder MARK 1 OF 2 T Taxable hem Continued on Next Page HSI ORDER# ORDER DATE 82477885 06/28/10 WHSE DEA# RH0236667 Fed ID: 11-3136595 ..a ec o.w y' T his order has been processed by our NORTHEAS D.C. 41 WEAVER ROAD DENVER, PA. 175 7 NORTHEAST D.C. State Lic 3:0046 �1 120 -8808 EA COMBITUBE ROLL -UP KIT 41FR 8 8 C 42.75 342.00 2 HIS PRODUCI IS BEING SHIPPED FROM OUR MIDWES DISTR BUT10 CENTER. ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. 2 602 -8100 EA COLLAR AD STIFNECK SELECT UNV 100 100 C 5.75 575.00 4 HIS PRODucr IS BEING SHIPPED FROM OUR MIDWES DISTR BUTIO CENTER. ASE GOOD ITEM, MAY BE SHIPPED SEPARATELY. 3 891 -3037 PU 50 /CA IV PREP KIT Wj TEGADERM 6 6 C 61.37 368.22 10 HIS PRODUC r IS BEING SHIPPED FROM OUR MIDWES DISTR LBUT10k, CENTER, ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. F YOU ARE 3 ARTICIPATING IN A DISCOUNT PROGRAM (E.G. POIN S, GIFTS OR 0 HER PECIAL AWA DS "DISCOUNT WITH THIS PURC SE YOU HAVE EARNED A CREDI TOWARD GOODS OR S RVICES, RECEIVABLE OR REDEEMABLE N ACCORDANCE WITH DISCOUNT PROGRAM RULES. U204 DISCOUNT RECEIPT OR REDEMPTION, OU ARE RECEI 1NG OR WILL R CEIVE OTICE OF THE DISCOUNT VALUE. FROM TIME TO TIME, MEDICARE, MEDICAID, TRI ARF OR THER PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, PND UPON ANY SITCH EQUEST, SU H VALUE MUST BE DISCLOSED AS A DI COUNT RGAINSa THE PURCHASE THAT ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN THESE RECORDS. MERCHANDI E TOTAL 1285.22 BILL TO S HIP TO INVOICE INVOIC INVOICE TOTAL ITEM STATUS KEY REM KEY 1308571 1817102 5538073 -01 1285.22 B_ Backordered; hem will Rdlow SK- Scho HSI l� tliscnntinucd; Item no longer available NC -Nn Charge RDER ORDER b INVOICE DATE BO P- Special Schein Pre 6,i ods M Manuh,elurcr will .chip Ilan, direcdv w yo 82477885 06/28/10 6/28/10 10 p- pl'cAciiptim Wt g:Rel,r Aulhorizatinu Reyuir ;d T M R P R Refrigerated lwm; May he shipped scparalcty F Special tichcin Toeing U Temporarily unavailabic: plcaac reorder RK MA 1 OF 2 T- Taxahle Cleo, Continued on [Next Page PSI ORDER. ORDER DATE 82699329 07/07/10 WHSE DEA# RH0236667 Fed ID: 1 t- 3136595 y N O R 4q MR. o RK 17- 426 -878 CELL 17 -571 -266 1 387 -9164 EA ULTRA LOC BACKBOARD RED 3 3 127.00 361.00 P RODUCT IS 3EING SHIPPED TO YOU DIRECTLY FROM THE MAiUFACTILRER. F YOU ARE ARTICIPATING IN A DISCOUNT PROGPAJI (E.G. POTN71S, GIFTS OR or HER PECTAL AWA ZDS "DISCOUNT WITH THIS PURCH SE YOU HAVE EARNED A CRED3 TOWARD GOODS OR SERVICES, RECEIVABLE OR REDEEMABLE N ACCO DANCE WITH DISCOUNT PROGRAM RULES. UPO 4 DISCOUNT RECEIPT OR REDEMPTION, YOU ARE RECEI ING OR WILL RJ CEIVE OTICE OF T E DISCOUNT VALUE. FROM TIME TO TIME, MED CARE, MEDICAID, TRT ARE OR THER PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, ID UPON ANY S CH EOUEST, SU H VALUE MUST BE DISCLOSED AS A D1 COUNT GAINS THE PURCHASE THAT E ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN THESE RECORDS. MERCHANDI E TOTAL 381.00 INVOICE TOTAL 381.00 PLEASE PAY WITHIN THIRTY(3 DAYS OF RECEIPT OF THIS INVOICE. 381.00 LEASE NOTE NEW REMIT TO ADDRESS lease remi payments only to the following a dress: ENRY SCHEI INC. EPT CH 102 1 ALATINE, I 60055 -0241 B I TL TO SHIP TO 114VOICEa I NVOTCE TOTAL ITEM s KEY REM KEY 1308571 1308572 3098369 -01 381,00 13- Buckordered: Item will follow SK SchoolKil D Di.:onunuud: Item no loner available NC -No Charge HSI ORD MRR DATE INV I E DATE u OP BOXES 1' Special Schein Free Goudc 82699329 07/07 10 7/09/10 M- Manop r willtp emdircctlyutyou I I'reacn tion uon Druu Retain Ru[horizution Rc• q aired N Refrigerated Item; May be shipped,eparatcl} CUSTOMER P0# -AQE# -Special Schein Pricing U Temporarily umtvaituhle: please reorder MARK 1 OF 1 T Tuxable. We. rake every effort to maintain prices for the duration of a Payment by C HECK or by the HENRY SCHEIN CREDIT CARD, cataloo. however. we reserve the rignl to make vic& adjustments in LISA, MASTERCARD. DISCOVER and AMERICAN EXPRESS response to manufaciure rc rv' p� chances Guaranteed Satisfaction: visa h If you have tried a produ t and i`, is defectil e or does not perlo, m OCeI o u r r lS` L� t o c oLI' n a Sa istactorEl alrc vv; 1i provide a credii, refund, or exchange its your y Available it, licensed practitione in, the r All invoices are Cnol. e. 5irri.piy Cali our cusionmi sei rye depar ent within 3:; Gay's payable v:itttin 30 days. of receipt of the merchandise to arrange for the return. For a k,varranty repair or if you we're sent som «eihing you did not order, simply call:' Px Products Controlled Substances: Matrx Medical 1 -800- 845 -3550 F aguiations require us to ;unit the snip of lax and controlled substances only to registered licensed healthcare pro €essionais_ if you are a net'. c-tlstorrt «ar or have rece=ntly moved, please furnish us vJth a eopy of your updated state registration, For con rolled suhstances, Unish a copy of your DE-A certificate veritying your shipping address. Class it drugs can be ordered only by mail. International Orders: Please date: I,Ve prtradly serve healthcare pr:)fessionals and goy ernmerts Opened handpieces and equipment may not be retuned for throughout the viondl, To place orders or for incuiries on exocrt credit but vviili be repaired or replaced n accordance v�ith terms and conditions, please contact our lnternationat Department: manufacturer tvarea;fies. Before opening handpieces or i 830 -845 -35:,0 equipment, L4'A suggest that you cheo, the shipping container and passing list to verify that yog have re�sived exactly =,'hat Prescription Drug Returns Instructions: you ordered.0pened Computer Software is not returnable. Other restrictions may also apply. A Return Authorization is Required for all Prescription Drugs. Sirnphv call our Ct :stoner Service Depar ment V a ;:.a. �`w w-FV° x. as"r,a*-° a s.,..�dvos a. LP300 HENRY SCHEIT Matrx M ed SHIP TO: I o N V I Carmel Fire Department MI 135 Duryea Road, Melville, NY 11747 540 W 136 St Station 46 Michael Kaufmann Carmel,IN 46032 -8806 010000130857105538073110010000001285220628101 BILL TO: Carmel Fire Dept MI 2 Civic Sq Carmel, IN 46032 -7543 Carmel Fire Dept MI 2 Civic Sq BILL TO I SHIP TO INVOICE TOTAL Carmel, IN 46032 -7543 1308571 1817102 1 1285.22 INVOICE# I INVOICE DATE 5538073 -01 6/28/10 CUSTOMER PO MARK P ease &LaCh here and mall the above with your paymenf HSI ORDER# ORDER DATE 82477885 06/28/10 WHSE DEA# RH0236667 Fed ID: 11-3136595 INVOI E TOTAL 1285.22 PLEASE PAY WITHIN THIRTY(310) DAYS OF RECEIPT OF THIS INVOTCE. 1285.22 7 LEASE NOTE NEW REMIT TO ADDRESS P lease remi payments only to the following a dress: ENRY SCHE14 INC. D EPT CH 10211 P ALATINE, I 60055 -0241 ILL To I E TOTAL, ITEM STATUS KEY REM KEY 1308571 1817102 5538073 -01 1285.22 11- l3ackordcr0: lie. wib(nunw SK SchoolKit H I ORDER# ORDER DATE INV I E A P Discontinued: Item no longer available INC Ida Churgc F Sp'cia] Schein Free 6e(U, M Manulaemrer will chip Item directly to you 82477885 06/28/10 6/28/10 10 F- 1 Return AwhormininnRequired R- Rclrigerated liem: May be shipped acparamly CUSTO P Special Schein Pricing U- Temporarily unavailable: plea.w reorder MARK 2 OF 2 T- Taxable Item 1 i HENRY SCHEIN T E RMS E We mane every effort to maintain prices for the duration of a Payment by CHECK or by the HENRY SCHEIN CREDIT CARD, catalog, hmy, we reserve the right to make price adjustments in VISA MASTERCARD. DISCOVER and AMERICAN EXPRESS response to manufacturers` price changes Guaranteed Satisfaction..: If you have tried a product and it is defective or does not perform B ill Your Order To Yo O pen c unt satisfactorily!, we will provide a credit, refund, or exchange; its your Available to licensed practitioners in the US, All invoices are choice, Simply call our customer service department within 30 days payable within 30 days, of receipt of the merchandise :o arrange for the return. For a warrarty repair or if you vvere sent something you did riot order simply call: Rx Products Controlled Substances: atrx Medical 1- 800 -845 -3550 Regulations require us to lir; it the sale of Rx and controlled substances only to registered, licenses! ;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 f.3EA certificate, verifying your shipping address, Class ll drugs can be ordered only by mail, International Orders: Please Note: Opened handpieces and equip €nent may not be. returned for We proudly serve healthcare professionals and governments credit, b !t tilii be repaired or replaced in accordance with throughout the ,world. To place orders or for inquiries on export terms and conditions, please comae: our international Department manufacturer �harranties. Betora opening handpieces or 1-800-8415-31550 equipment, vvc suggest that you check the shipping container and packing list to verily 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 ail t.'rescriptian Drags. Simply call our Customer Service Department 4 1- 800 -845- 3550. I I LP300 VOUCHER NO. WARRANT NO. ALLOWED 20 Henry Schein IN SUM OF Dept Ch 10241 Palatine, IL 60055 $1,877.30 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members 1120 3098369 102- 670.06 $381.00 1 hereby certify that the attached invoice(s), or 1120 5538073 -01 102- 390.11 $1,285.22 bill(s) is (are) true and correct and that the 1120 4495903 -01 102 390.11 $211.08 materials or services itemized thereon for which charge is made were ordered and received except JUL 1 20 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)) 3098369 $381.00 5538073 -01 $1,285.22 4495903 -01 $211.08 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