HomeMy WebLinkAbout190298 09/29/2010 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1
ONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: $693.30
CARMEL, INDIANA 46032 DEPT CH 10241
off �o PALATINE IL 60055 -0241 CHECK NUMBER: 190298
CHECK DATE: 9/29/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 4239011 2791534 -01 85.50 SPECIAL DEPT SUPPLIES
102 4239011 3301252 -01 462.00 SPECIAL DEPT SUPPLIES
102 4239011 6282134 -01 145.80 SPECIAL DEPT SUPPLIES
HSI ORDERH ORDER DATE
84357590 09/08/10
WHSE DEA# RHO162494 Fed ID: 11- 3136595
a .m?:: ...�t 7462268 FUME �u his order as been processed by our MIDWEST .C.
5315 WES 74TH INDIANAP LIS,IN
MIDWEST D.C. State Lic 23 00304
17 -571 -266
1 360 -1359 EA SAM SPLINT ORANGE /BLUE 36X4.25 20 20 6.75 135.00 1
2 857 -0650 EA BERMAN AIRWAY 50MM SZ 0 36 36 0.30 10.80 1
F YOU ARE ARTICIPATING IN A DISCOUNT PROG (E.G. POIN S, GIFTS OR 0 HER
PECIAL AV:A DS "DISCCUNT")), WITH THIS PURCH SE YOU HAVE ARMED A CREDI TOWARD
GOODS OR S RVICES, RECEIVABLE OR REDEEMABLE N ACCO DANCE WITH DISCOUNT PROGRAM
RULES. UPO DISCOUNT RECEIPT OR REDEMPTION, IOU ARE RECEI ING OR WILL R CEIVE
OTICE OF T iE DISCOUNT VALUE. FROM TIME TO TI 1E, MED LCARE, MEDICAID, TRI 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 3 3COUNT %GATNSq THE PURCHASES THAT
E ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN TH RECORDS.
MERCHANDI E TOTAL 145.80
INVOI E TOTAL 145.60
PLEASE PAY WITHIN THIRTY(3 DAYS OF RECEIPT OF THIS NVOICE. 145.80
BI LL TO SHIP TO I NVOICE ITEM STATUS KEY REM KEY
1308571 1817102 6282134 -01 145.80 li- Backordered: hem will follow SK SchoolKit
HSI P ER RDE DATE NV A F xE D Discontinued: Item no lonecr ge.
F- Special 1''rc-r. Good availahlL` NC No Char
MI Manufac urer will ship Item directly to you
84357590 09/08/10 9/08/10 1 P- PrescriprionDntg :ReturaAuthoriratia¢Required
R Refrigerated hem: May he shipped separately
S Special Schein Pricing
U Tempunn unavailable: ph rcordeY
MARK 1 OF 2 'r- Taaahle hom Continued on Next Page
HSI ORDER# ORDER DATE
8410871 09/07/10
3
WHSEDEA# RHO162494 Fed ID: 11 -3136595
Y
his order ias been processed by our MIDWEST D.C.
5315 WES 74TH TREET
INDIANAP LIS,IN 46268
MIDWEST D.C. State Lic 23 00304
1 507 -0791 PU EA IV EMS SET W /ULTRA SITE 8 15DROPS 300 300 C 1.54 462.00 6
ASE GOOD I FEM, MAY BE SHIPPED SEPARATELY.
F YOU ARE DARTICIPATING IN A DISCOUNT PROG (E.G. POIN S, GIFTS OR O HER
PECIAL.AWA DS "DISCOUNT WITH THIS PURCHASE YOU HAVE EARNED A CREDI TOWARD
GOODS OR S RVICES, RECEIVABLE OR REDEEMABLE IN ACCORDANCE WITH DISCOUNT PROGRAM
RULES. UPOd DISCOUNT RECEIPT OR REDEMPTION, OU ARE RECEI ING OR WILL k CEIVE
OTICE OF THE DISCOUNT VALUE. FROM TIME TO TILE, MEDICARE, MEDICAID, TRI ARE OR
THER PAYER MAY REQUEST INFORMATION REGARDING SUCH V ),LUE, PND UPON ANY S JCH
REQUEST, SU H VALUE MUST BE DISCLOSED AS A DI COUNT 2LGAINSl THE PURCHASE THAT
EARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN TH SE RECORDS.
MERCHANDIIIE TOTAL 462.00
INVOI E TOTAL 462.00
PLEASE PAY WITHIN THIRTY(3 DAYS OF RECEIPT OF THIS NVOICE. 462.00
LEASE NOTE NEW REMIT TO ADDRESS
lease remi payments only to the following a dress:
ENRY.SCHEI INC.
DEPT CH 10211
ALATINE, I 60055 -0241
RILL TO SKIP T INV OICER INVOTCE TOTAL ITEM STATUS KEY REM KEY
1308571 1817102 3301252 -01 462.00 H- Backnrdcrcd: Lcm will follow SK SchoolKil
H I RDER RD R DATE INVOICE DATE F BOXES D Discominucd: Lem no longer available NC No Charge
P Special Schein Fme Goods
M Manufacturer will ship Item directly to you
8 4 310 8 71 09/07/10 9 0 7 10 6 P Prescription Drug: Return Authorization Required
R Refrigerated hem: A1ap he.shipped .eparatcly
Special Schein [Incine
U -Temporarily unavailable: pioase reorder
MARK 1 OF 1 T Taxable Lem
W make even e for to maintain prices for the d rration of a Payment by CHECK or by the HENRY SCHEIN CREDIT CARD,
catalog, however, eve reserve the right to make price adjus'n,en ±sin VISA, MASTERCARD, ISCOVER and AMERICAN EXPRESS
response to manufacturers' price changes
Guaranteed Satisfaction: wsa
or
If you have tried a product anti it is defective or does not perform off Your Order To V our Open 4�ccavrit
satisfactorily, we rr1! pro'virfe a credit, refund, or exchange; its your Available to licensed practitioners in the ��.S. All invoices are
choice. Sim ,ply call our sustcmer service de arlment within 30 days
of receipt of the merchandise to arrange for the return. Fora payable within 35 days.
Y''a €rant, repair or if you enure sent something you did not order,
simply Dell: Rx Products Controlled Substances:
Matrx Medical 804 -845 -3554
Reaulations require us to 5nnit the sal: of Rx and controlled
su stancas only to reg €stored, licensed healthca,e prcfessianais.
if ,ou are a r ei, customer or have recently moved, please furnish
trs with a cope of 'your updated state registration. For controlled
su'astances, furnish a copy of your DEA cenificate verifying your.
shipping address. ;lass f drugs can be ordered only by mail.
International Orders:
Please N ote:
T 0a proUdiy serve heaithcare profess orals and r ;o'. =rnn eats
Opened handpieces and equipment may not be returned for fhruuahout the rvo €id. To place or lens or for inquiries on export
credit, nut hill be repaired Cf re,L°llaced in accordance with terms and conditions, please Contact our lnternational Deilanrnent:
manufacturer warranties. Before' opgming handpieces or
equinment, we suggest that you check the shipping container
and packing list to v'erif} that;tou have received exac :What Prescription Drug Returns I nstructions:
voiu ordered.opened Computer Software is not returnable.
Other restrictions may also apply.
A Return Authorization is Requi red for all Prescription Drugs. Simply call
DU- Customer Service Departrnen1 9 -570- 545 -355
N ,2
Z
LP300
HSI ORDER# ORDER ""TE
83737392 08/16/10
WHSE DEA# RHO162494 Fed ID: 1 1- 3 136595
t a
RK 317-57L-2663
1 499 -5558 24 /CA INSTANT COLD PACKS DISPOS 6 6 8.50 51.00 a
2 499 -5557 24 /CA INSTANT HEAT PACKS DISPOS 3 3 11.50 34.50
OUR ORDER 3737392 HAS BEEN SPLIT INTO MULTIPLE SHI MENTS. CERTAIN ITEM WILL
E SHIPPED EPARATELY. YOU WILL BE BILLED FOR THESE TEMS HEN THEY ARE HIPPED.
F YOU ARE ARTICIPATING IN A DISCOUNT PROG (E.G. POIN S, GIFTS OR OTHER
PECIAL AWA DS "DISCOUNT WITH THIS PURCH SE YOU HAVE EARNED A CREDI TOWARD
GOODS OR S RVICES, RECEIVABLE•OR REDEEMABLE N ACCO DANCE WITH DISCOUNT PROGRAM
RULES. UPC) DISCOUNT RECEIPT OR REDEMPTION, OU ARE RECEI ING OR WILL R CEIVE
OTICE OF T fE DISCOUNT VALUE. FROM TIME TO TT 1E, MED ECARE, MEDICAID, TRI ARE OR
THER PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, JAND UPON ANY STJCH
EQUEST, SUM VALUE MUST BE DISCLOSED AS A DI COUNT %GAINS7 THE PURCHASE THAT
ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN THESE RECORDS.
N HENRY 3CHEIN, INC. HAS PURCHASED THE SPE IFIC UNIT OF THE PRESCRIPT DRUG
DIRECTLY F OM THE MANUFACTURER.
MERCHANDI E TOTAL 85.50
INVOI E TOTAL 85.50
PLEASE PAY WITHIN THIRTY(3 DAYS OF RECEIPT OF THIS NVOICE. 85.50
ILL T o 114VOICE# INV I E TOTAL ITEM STATUS KEY REM KEY
1308571 1817102 2791S34-01 8 5 5 0 11 packordered: hem will louow SK School Kit
ItbER E DATE INVOICE D E 1) Di COmInnCd; [rem no longer available NC No Charge
I Special Schein free Good,
M NlanulactPrcr will Ship Item directly to YOU
83737392 0 8 16 10 9/16/10 P llwscnpu- Drug: Return A am uri -lion Required
k Refrigerated Item: May he shipped separately
CUSTOM P' E S Special Schein Pricing
U Temporarily tmavailahle: please reorder
MARK 1 OF 2 T- Taxable Item Continued on Next Page
VOUCHER NO. WARRANT NO.
ALLOWED 20
Henry Schein
IN SUM OF
Dept Ch 10241
Palatine, IL 60055
$693.30
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT
Board Members
1120 6282134 01 102 390.11 $145.80 1 hereby certify that the attached invoice(s) or
1120 3301252 -01 102 390.11 $462.00 bill(s) is (are) true and correct and that the
1120 2791534 -01 102- 390.11 $85.50
materials or services itemized thereon for
which charge is made were ordered and
received except
SFP 2. 7 2010
t
l
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))
6282134 -01 $145.80
3301252 -01 $462.00
2791534 -01 $85.50
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