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Home My WebLink About189365 08/31/2010 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1 0 ONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: $1,209.00 '.o CARMEL, INDIANA 46032 DEPT CH 10241 c;.od,i�o PALATINE IL 60055 -0241 CHECK NUMBER: 189365 CHECK DATE: 8/31/2010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 102 4239011 2791533 -01 1,209.00 SPECIAL DEPT SUPPLIES HSI ORDER# ORDER DATE 83737392 08/16/10 WHSE DEA# RHO162494 Fed ID: 1 1 :a o ek his order ias been processed by our MIDWEST C. 5315 WES 74TH 3TREET INDIANAPOLIS, IN 46268 MIDWEST D.C. State Lic 23 00304 ARK, 317 -57 -2663 1 890 0044 6RLS /BX CURITY CLEAR ADH TAPE 2 "X10YD 30 16 6.55 104,80 19 ARTIAL SHI MENT WILL SHIP AND INVOICE WHEN AVAILA LE. LEASE NOTE 8903950 IS NOW 8900044 2 107 -0530 100 /BX PURPLE NITRILE PF GLOVE LARGE 60 60 C 8.25 495.00 6 ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. 3 107 -0502 100 /BX PURPLE NITRILE PF GLOVE MEDIUM 40 40 C 8.25 330.00 10 ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. 4 153 -2007 20 /RL BIOHAZARD BAG 14.5X19 RED 3GAL 30 30 C 1.99 59.70 13 ASE GOOD =M, MAY BE SHIPPED SEPARATELY. 5 507 -8362 U 100 /BX NACL PREFTLL SYRINGE 10ML ST 3 3 41.00 123.00 19 N PEDIGREE ITEM. DC:6380701 010 6 499 -.5224 EA NASAL CANNULA W /CURVD TIP ADULT 200 200 C 0.33 66.00 17 ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. 7 111 -3358 100 /CA RAZOR STERILE SHAVE PREP 2 SIDED 1 1 C 30.50 30.50 18 ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. R TNV 1�! AL ITEM STATUS KEY REM KEY 1308571 1817102 2791533-01 1209.00 13- nackordemd: hem will follow s 00lxb I) Di. ;ammucd. Item no longer available NC No Charge HSI 6RDFR# ORDER DATE INVOICE, DATS 0 OF BOXES F Special Schein Free Goods M- Manufacturer will ship Item directly to you 83737392 0 8 16 10 8/16/10 1 P Prescription Drug: Return Authorization Required R RerrigeratMl Item; May he shipped separately CUSTOMER PO# S Special Schein Pricing U 7empomtily unavailable: pleas- reorder ARK 1 OF 2 T- Taxable Item Continued on Next. Page HENRY SCHEIN Matrx Med i cal SHIP TO /SOLD TO: I A Carmel Fire Department MI 135 Duryea Road, Melville, NY 11747 INVOICE 540 W 136 St INVOI Station 46 Michael Kaufmann Carmel,IN 46032 -8806 01000013085710279 1533110010000001209000816100 BILL TO: Carmel Fire Dept MI 2 Civic Sq Carmel, IN 46032 -7543 Carmel Fire Dept MI 2 Civic .SCI BILL TO SHIP TO INVOICE TOTAL Carmel, IN 46032 -7543 1308571 1817102 1209.00 INVOICE INVOICE DATE 2791533 -01 1 8/16/10 CUSTOMER PO# MARK Please detach here and mail thu above with your payment HSI ORDER# ORDER DATE 83737392 08/16/10 WHSE.DEA# RH0162494 Fed ID: 11- 3136595 OUR ORDER 3737392 HAS BEEN SPLIT INTO MULTI DLE SHI MENTS. CERTAIN ITEM WILL E SHIPPED EPARATELY. YOU WILL BE BILLED FOR THESE TEMS HEN THEY ARE HIPPED. F YOU ARE PARTICIPATING IN A DISCOUNT PROGRAM (E.G. POINI S, GIFTS OR 0 HER PECIAL AW DS "DISCOUNT WITH THIS PURCHASE YOU HAVE EARNED A CREDI 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, PND UPON ANY S CH EQUEST, SU H VALUE MUST BE DISCLOSED AS A DT 3COUNT kGAINSI THE PURCHASE THAT EARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN THESE RECORDS. N HENRY 3CHETN, INC. HAS PURCHASED THE SPE IFIC U4IT OF THE PRESCRIPT ON DRUG DIRECTLY F OM THE MANUFACTURER. MERCHANDI E TOTAL 1209.00 INVOI E TOTAL 1209.00 PLEASE PAY WITHIN THIRTY(3 DAYS OF RECEIPT OF THIS NVOICE. 1209.00 LEASE NOTE NEW REMIT TO ADDRESS Please remi payments only to the following a dress: HENRY SCHE14 INC. DEPT CH 1021 ALATINE, I 60055 -0241 ITEM STATUS KEY REM KEY SILL T I E L 1308571 1817102 2791533 -01 1209.00 11- Backordered: Item will follow SK School Kit D Discontinued: item no longer available NC No Charge EST O RDER# ORDER DATE INVOICE DATE DF 130 Special Schein 1 Goods M Manufacturer will ship Item directly to you 83 73 73 92 08/16/10 8 16 10 19 P Prescription Drug: Return Amhorization Required R Refrigerated liem: May be shipped separately special Schein Pric7ng U Temporarily unavailable: please reorder MARK 2 OF 2 T TaxahleItem 1 E HENRY SCHEIN TERMS OF N ALE Matrx Medical TF .w W Payment Terms: We make every effort to maintain prices for the duration of a Payment by CHECK or by the HENRY SCHEIN 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 It you have tried a product and it is detective or does not perform Bill Your Order To Your Open Account satisfactorily, we vdl[ provide a credit, refund, or exchange; its your Available to licensed practitioners in the U.S. All invoices are choice. Simply call our customer service department within 30 days payable within 30 days. of receipt of the merchandise to arrange for the return. For a warranty repair or if you were sent something you did not order simply call, lax 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 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 Dr certificate, verifying your shipping address. Class li drugs can be ordered only by mail. International Orders: Please Note: We proudly serve healthcare professionals and governments Opened handpieces and equipment may not be returned for throughout the world. i a 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 warranties. Before opening handpieces or 1 800 845 3550 equipment, we suggest that you check the shipping container 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 Proscription Drugs. Simply call our Customer Service Department 91 -8D0- 845 -3550. o� LP300 VOUCHER NO, WARRANT NO. ALLOWED 20 Henry Schein IN SUM OF Dept Ch 10241 Palatine, IL 60056 f $1,209.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# I Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members 1120 2791533 -01 102 390.11 $1,209.00 I 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 AUG 3 0 2010 8 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)) 2791533 -01 $1,209.00 1 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