191229 10/27/2010 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1
0 ONE CIVIC SQUARE HENRY SCHEIN INC
CARMEL, INDIANA 46032 DEPT CH 10241 CHECK AMOUNT: $1,888.08
PALATINE IL 60055 -0241
CHECK NUMBER: 191229
CHECK DATE: 10/27/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 4239011 6183413 -01 1,636.08 SPECIAL DEPT SUPPLIES
102 4239011 6189777 252.00 SPECIAL DEPT SUPPLIES
HSI ORDER4 ORDER DATE
85215596 10/08/10
WHSE DEA# RH0162494 Fed ID: 11-3136595
MIN. 0
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 4ARK 317-57L-2663
1 107 -0530 100 /BX PURPLE NITRILE PF GLOVE LARGE 30 30 C 8 -50 255.00 3
ASE GOOD I EM, MAY BE SHIPPED SEPARATELY,
2 836 -1555 48 /CA LIFESHIE MICROBO EXT ST &2 CL ADAP 6 6 140.18 841.08 10
3 879 -8581 30 /PK MEDI -TRACE SNAP FOAM ELEC 530ECG 120 120 C 4.50 540.00 9
ASE GOOD I EM, MAY BE SHIPPED SEPARATELY.
F YOU ARE ARTICIPATING IN A DISCOUNT PROGRAM (E.G. POIN S, GIFTS OR 0 HER
PECIAL AWA DS "DISCOUNT WITH THIS PURCHASE YOU HAVE EARNED A CREDIT TOWARD
GOODS OR S ERVICES, RECEIVABLE OR REDEEMABLE N ACCO ZDANCE WITH DISCOUNT PROGRAM
RULES. UPOq DISCOUNT RECEIPT OR REDEMPTION, yOU ARE RECEI ING DR 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, SUM VALUE MUST BE DISCLOSED AS A DISCOUNT AGAINSI THE PURCHASE THAT
ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN T14- RECORDS.
MERCHANDI E TOTAL 1636.08
INVOI E TOTAL 1636.08
PLEASE PAY WITHIN THIRTY(3 DAYS OF RE I EIPT OF THIS INVOICE. 1636.08
SHIP TO or ITEM STATUS KEY REM KEY
1308571 1817102 6183413 -01 1636.08 13- Haek ru de,": hem will lnuow Sx Scheelxll
RDER ORDER DATE INVOICE T E Dtscommued; item no longer available NC- No Chug
P- Special Schein Free Goads
M Manulacturer will ship Item directly to you
8 52 15 S 96 10/08/10 10/08/10 11 F- Prescription Drug: Return Authorization Required
R Re4igerated Item; May be shipped separately
Special Schein Pricing
U Ternpemnly unavailable please reorder'
MARK 1 OF 2 T Taxable Item Continued on Next page
LP300
HSI ORDER ORDER DATE
85216280 10/08/10
WHSEDEA# RH0162494 Fed ID: 11-3136595
"33 jam'
y rw,u
T his order has been processed by our MIDWEST M.C.
5315 WES 74TH 3TREET
INDIANAP LIS,IN 46268
MIDWEST D.C. State Lic4: 23 00304
v1A 317 -57 -2663
1 648 -9088 12RL /BX MEDIRIP BANDAGE 2 12 12 21.00 252.00 2
F YOU ARE ARTICIPATING IN A DISCOUNT PROG (E.G. POIN S, GIFTS OR O HER
PECIAL AWA DS "DISCOUNT WITH THIS PURCH SE YOU HAVE EARNED A CREDI 11 TOWARD
GOODS OR S RVICES, RECEIVABLE OR REDEEMABLE N ACCO DANCE WITH DISCOUNT PROGRAM
RULES. UPO4 DISCOUNT RECEIPT OR REDEMPTION, OU ARE RECEI ING OR WILL RECEIVE
1 7 0TICE 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, D UPON ANY S CH
EQUEST, SU H VALUE MUST BE DISCLOSED AS A DI COUNT kGAINS1 THE PURCHASE THAT
E ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN TH SE RECORDS,
MERCHANDI E TOTAL 252.00
INVOI E TOTAL 252.00
PLEASE PAY WITHIN T (3 DAYS OF RECEIPT OF THIS NVOICE. 252.00
LEASE NOTE NEW REMIT TO ADDRESS
P lease remi payments only to the following address:
H ENRY SCHEIN INC.
EPT CH 10211
ALATINE, 2 60055 -0241
L I INVOICE INVOICE# AL
ITEM STATUS KEY REM KEY
1308571 1308572 6189777 -01 252.00 It- backordered: Item will follow SK School Kit
H I 04134 ORDER ATE INV D Disconllnucd: hem no longer available NC -No Charge
P Special Schein Free Goods
Q8 1� 10 10 2 M Manufacturer will ,ship Item directly to you
8521628 10/ P Prescription Drug_ Return Authorization Required
R Refrigerated Item: May he shipped separately
CUSTOMER PQj4 PAGE 5 Special Schein Pricing
U Tempermily unavailahlc: please reorder
1 FK 1 OF 1 T- T- ableltnm
LVOUU
rna ke every Of o l', to; rnain t&:,: 1 pril—es 'of tiff duration: of a Payment by CHECK or by the HENRY SCHEIN CREDIT CARD.
catalog, hovievp!, Ae reserve t'he r1uht 10 make price adju Wtn eat
VISA, MASTERCARD, DISCOVER and AMERICAN EXPRESS
response to manufacturers' price diances
Guaranteed Satisfaction:
or
If ,au have teed a r,)roduct,ard it isdefecfive
Bill Your Or der To, ou,- 01,oen Accouni
ivil: -roviric a credit, refund, or exchange: it's your
Avai:ablo to fioensed [11ractit.oners.n flhi, U.S. A" rtvoic are
choice. Sj[jjp! Ca :j Qor CUS service deparlmeni days
a; ail idth:n 30 days,
at rec jw�t of the me.f.-hands c, `o arrange fUr the return. For a
01 a rranly n zpaif or it vol sent' son•hing yoj d i, o t or
dc.
si':lply call,
I Rx Products Controlled Substances:
Matrx Medical 1-800-845-3550
J
Regula!ions cloiro us to lint the sale of Rx and" controlled
substances on:lylo registered, Jcensed healthcare protessionals.
are a nee custorner iLs-1
have rece� tiv moved, please furl
US Wifil, a C00V Of Your LIA.'aled stalp. registration. For controlled
your
shipping address, Class 11 druus can be orderod onIv bw mail.
International Orders:
Please Note:
''e proudly serve healthcare �rafessjofials and govemments
Op handpieces and equipmew may rwl be r4JLarried fc
i throughoui the ,vorld. o Place orders or for Pqur es orn expo--q
credit bU' bo repa'i or replaced in accard'ance w:�h
terms and" conditions, oleasecomactcur I? 1i 'ernalional Depatrnent:
manufacturer Before opaning trandpiecosor
eq�' roc s gg t thatyou c heck the shipping corlainer
at you ave receh. exactly vihat
and Pack'r.Q list to Ver:y L
you air(jeredOpened Computer Software is not returnable. Prescription Drug Returns Instructions
Other restrictions may also apply,
A Return Authorization is Required for all Prescription ;?rugs, Simply call
Our Gus�-Grner Servicp Department d 1-8010-B45-3550,
VOUCHER NO. WARRANT NO.
ALLOWED 20
Hcnry Schein
IN SUM OF
Dept Ch 10241
Palatine, IL 60055
$1,888.08
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# l Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
1120 6183413 -01 102 390.11 $1,636.08 1 hereby certify that the attached invoice(s), or
1120 6189777 102 390.11 $252.00 bill(s) is (are) true and correct and that the
4 .1 'J� mow, materials or services itemized thereon for
h
c which charge is made were ordered and
received except
OCT 5 20110
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))
6183413 -01 $1,636.08
6189777 $252.00
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