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Home My WebLink About191676 11/10/2010 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1 s` �t ONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: $1,749.96 CARMEL, INDIANA 46032 DEPT CH 10241 PALATINE IL 60055 -0241 CHECK NUMBER: 191676 CHECK DATE: 11/10/2010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 102 4239011 8547992 1,032.96 SPECIAL DEPT SUPPLIES 102 4467006 8548061 717.00 EMS EQUIP r HSI ORDER# ORDER DATE 85685410 10/26/10 WHSE DEA# RH0162494 Fed ID: 1 1-3136595 This order has been processed by our MIDWEST D.C. 5315 WES 74TH 3TREET INDIANAP LIS,IN 46268 MIDWEST D.C. State Lic 23 00304 1 857 -3847 EA NASAL AIRWAY LF 26FR 20 20 2.35 47.00 3 2 857 -3190 EA NASAL AIRWAY LF 28FR 20 20 2.35 47.00 3 3 857 -9955 EA NASAL AIRWAY LF 30FR 20 20 2.35 47.00 3 4 857 -6066 EA NASAL AIRWAY LF 32FR 20 20 2.35 47.00 4 HIS PRODUC IS BEING SHIPPED FROM OUR NORTHEAST DIS RIBUT ON CENTER. 5 857 -4186 EA NASAL AIRWAY LF 34FR 20 20 2.35 47.00 3 6 250 -9611 EA ACCU -CHEK CONTROL COMFORT HI /LO 12 12 8.33 99.96 3 7 507 -8362 X 100 /BX NACL PREFILL SYRINGE 10ML ST 3 3 41.00 123.00 3 PEDIGR E ITEM. DC:6380701 010 8 602 -8100 EA COLLAR STIFNECK SELECT ADULT 100 100 C 5.75 575.00 2 ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. OUR ORDER 35685410 HAS BEEN SPLIT INTO MULTI LE SHI MENTS. CERTAIN ITEMS WILL E SHIPPED 3EPARATELY. YOU WILL BE BILLED FOR THESE TEMS ivHEN THEY ARE HIPPED. B ILL TO SHIP TO INVOTCE# INVOICE TOTAL ITEM STATUS KEY REM KEY 1308571 1817102 8547992 -01 1032.96 t3- llackordcrcd: hem will follow sx- sehool xil D Discontinued: Item no longer available NC No Charge H RDER E DATE 4 OF 13OXES F- Special Schein Free Goods M Manulaclurer will ship hem directly to you 8 5 6 8 5 410 10/26/10 10/26/10 4 P 11re.udprioa Drug: Rmrn Aullb -i 0— Re MER P PA R Refrigcraled hem: May be chipped separately Special Schein Pricing U Tcm or poraril unavailable: please reder MARK 1 OF 2 T- Taxable hem Continued on Next Page LP300 HENRY SCHEN 1 \I` SHIP TO /SOLD TO: Matrx Medical IA Y Y OIC Carmel Fire Department MI 135 Duryea Road, Melville, NY 11747 540 W 136 St Station 46 Michael Kaufmann Carmel,IN 46032 -8806 010000130857108547992110010000001032961026103 BILL TO: Carmel Fire Dept MI 2 Civic Sq Carmel, IN 46032 754.3 Carmel Fire Dept MI 2 Civic Sq HILL TO I SHIP TO INVOICE TOTAL Carmel, IN 46032 -7543 1308571 1817102 1032.96 INVOICE# INVOICE DATE 8547992 -01 10/26/10 CUSTOMER PO MT Tzx P.Icam. detach hew and.mail thcabuvewith_vour payment HSI ORDER# ORDER DATE 85685410 10/26/10 WHSEDEA# RHO162494 Fed ID: 11 10 R F YOU ARE ARTICIPATING IN A DISCOUNT PROG (E.G. POTN S, GIFTS OR O PECIAL AWA DS "DISCOUNT WITH THIS PURCH SE YOU HAVE EARNED A CREDI TOWARD GOODS OR S RVICES, RECEIVABLE OR REDEEMABLE IN ACCO DANCE WITH DISCOUNT PROGRAM RULES. UPON DISCOUNT RECEIPT OR REDEMPTION, (CU ARE RECEI ING OR WILL R CEIVE OTICE OF T E DISCOUNT VALUE. FROM TIME TO TIM, 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 DI COUNT GAINSI THE PURCHASE THAT ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN THi.SE RECORDS. N HENRY 3CHEIN, INC. HAS PURCHASED THE SPE IFIC UNIT OF THE PRESCRIPT ON DRUG DIRECTLY F OM THE MANUFACTURER. MERCHANDI E TOTAL 1032.96 INVOI E TOTAL 1032.96 PLEASE PAY WITHIN THIRTY(3 DAYS OF RECEIPT OF THIS NVOICE. 1032.96 LEASE NOTE NEW REMIT TO ADDRESS P lease remi payments only to the following a dress: ENRY SCHE14 INC. D EPT CH 10211 ALATINE, I 60055 -0241 BILL TO SHIP TO IIJVQICE� TNVCTCE T018L ITEM STATUS KEY REM KEY 1308571 1817102 8547992 -01 1032.96 1] -l3 aexordered: Item will follow SK- School Kit D Di ommucd_ Item no longer available NC -No Charge H Z RDER ORDER f Special Schein free (foods M Manufacturer will ship Item diicetly to you 65685410 10 2 6 10 10/26/10 4 P Prcuription Drug: Retum Authorization Required R Reirigmated Item: May he shipped separately CUSTOM Poll Special Schein Pricing U Temporarily unavailable: please reorder MARK 2 OF 2 T Tu Ile Item LP300 HENRY SCHE'l N Medical TERMS OF S ALE 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' firers' price changes Guaranteed Satisfaction: visa n If you have tried a product and it is defective or does not perform or satisfactorily, we will provide a credit, refund, or exchange; its your IBM Your Order T o Your Open Account choice. Simply call our customer service department within 30 days Available to licensed practitioners in the U.S. All invoices are of receipt of the merchandise to arrange for the return. Fora payable within 30 days. warranty repair or if you were sent something you did riot order simply call: Rx Products Controlled Substances: Matt"x Medical 1- 8 Regulations require us to limit the sale of Fix and controlled substances only to registered, licensed healthcare professionals. If you a' re a new customer or have recently moved, please furnish us ,with copy of your updated state registration. For controlled substances, furnish a copy of your DEA certificate verifying your shipping address. Class 11 drugs can be ordered only by mail. International Orders: Please Note: Opened handpieces and equipment may not be returned for We proudly serve healthcare professionals and governments credit but will be repaired or replaced in accordance with the world. To place orders or for inquiries on export manufacturer warranties. Before opening handpieces or terms and conditions, please contact our International Department: 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.0pened Computer Software is not returnable. Other restrictions may also apply, A Return Authorizations Required for all Prescription Drugs. Simply Call our Customer Service Department 1 -800 -845 -3550. HSI ORDER# ORDER DATE 85685320 10/26/10 WHSE DEA# RHO 162494 Fed 111 1 1-3136595 his order has been processed by our MIDWEST D.C. 5315 WEST 74TH 3TREET INDIANAPOLIS, IN 46268 MIDWEST D.C. State Lie##: 23 00304 17 -571 -266 MARK 1 827 -2329 EA SUCTION UNIT W /DISP CANN 1 1 C 717.00 717.00 1 HIS PRODUCr IS BEING SHIPPED FROM OUR NORTHEAST DIS RIBUT ON CENTER. ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. F YOU ARE ARTICIPATING IN A DISCOUNT PROG (E.G. POIN S, GIFTS OR 0 HER SPECIAL AWA 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, IOU ARE RECEI TNG OR WILL RECEIVE OTICE OF TIE DISCOUNT VALUE. FROM TIME TO TI E, MEDICARE, MEDICAID, TRI ('ARE OR OTHER PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, P.ND UPON ANY S CH REQUEST, SU H VALUE MUST BE DISCLOSED AS A DI COUNT kGAINSI THE PURCHASE THAT EARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE FAIN TH SE RECORDS, MERCHANDISE TOTAL 717.00 INVOICE TOTAL 717.00 PLEASE PAY WITHIN THIRTY(3 DAYS OF RECEIPT OF THIS INVOICE. 717.00 SILL TO SHIP To INVOICE# INVOICE T ITEM STATUS KEY REM KEY 1308571 1308572 8548061 -01 717.00 m- HaAordmcl: bem mill fnuuw SK SehmnKn HSI OR DER# ORDER TNV I DATE Il Discunrinued: Rom no longer availahle NC No Charge P Special Schein Frcc Goods M Manuf:m nwr will ship Ilan ,l maly to you 85685320 10 2 6/ 10 10/26/10 1 P- Prescription Dru R,no n Amhon,aii m, Required N Rclrigcraled Ilan: May he shipped separutcly CUMMER ?0# A Special Schein Pricing U Temporarily unavailable: please reorder MARK 1 OF 2 T T:rxahlc [ICm Cc minued on Nexl Page LP300 HENRY SCHEIN Matrx Medical \I` SHIP TO /SOLD TO: Du INVOIC Y I�,J Carmel Fire Dept Head Quarters MI 135' Du ea Road, Melville, NY 11747 2 civic s Carmel,IN 46032 -2584 0100001308571085480611100 7,0000000717001026106 BILL TO: Carmel Fire Dept MI 2 Civic Sq Carmel, IN 46032 -7543 Carmel Fire Dept MI 2 Civic Sq HILL TO I SHIP TO INVOICE TOTAL Carmel, IN 46032 -7543 1308571 1308572 717.00 INVOICEO INVOICE DATE 8548061 -01 10/26/10 CUSTOMER PO MARK Please detach here and mail the aburr 1h your- puymenl HSI OPr)EP# ORDER DATE 85685320 10/26/10 WHSE DEA# RH0162494 Fcd ID. 11 LEASE NOTE NEW REMIT TO ADDRESS Please remi payments only to the following a dress: ENRY SCHEIq INC. EPT CH 10211 ALATINE, I 60055 -0241 BILL TO SHIP TO INVOICEff INVOICE TOTAL ITEM STATUS KEY REM KEY 1308571 1308572 8548061 -01 717.00 19- 1lackurdemd:uum will lellnw SK SchotrIKit H I D D INV I E DATE D- I )iseuntinued: Item nn Iongur available NC Nu Charge F Special Schein Fro (3unds M Manulaclurcr will ship Item directly to you 8 5 6 8 5 3 2 0 10/26/10 10/26/10 1 P Prescriplion Drug: Retum Authorization Required CUSTO P E R Ret ngeraled hem: May he .chipped separately Special Slhein Pficing U Temporally unavailable: please reorder MARK 2 OF 2 T- raaanle lem LP300 HENRY SCHEIN TER OF SALE J Fl rtment Ternt m: 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: It you have tried a product and it is defective or does not performn Or t. O pen Accou satisfactorily, we will provide a credit, refund, or exchange; it's your Available to licensed practitioners in the J.S. All invoices are choice. Simply call our customer service department within 30 days payable within 30 dayls, 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: Rx Products Controlled Substances: Natrx Medical 1- 800 -845 -3550 Regulations require us to limit the sale of Rx and controlled substances only to registered, licensed healthcare professionals. It you are a need customer or have recently moved, please furnish us with a copy of your updated state registration. For controlled substances, furnish a copy of your DEA certificate, verifying your shipping address. Class II drugs can be ordered only by mail. International Orders: Please Note: Cpe €,ed handpieces and equlpr ent may not be returned for We proudly serve healthcare professionais and governme� is throughout the world. To place orders or for inquiries on export credit, but ;11 be repaired or replaced it accordance with terms and conditions, please contact our International Department: manufacturer warranties. Fsefore open:.ina handpieces or 1- 800 -845 -3800 equipment, we suggest that you check the shipping container and packing fist 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 Prescription Drugs. Simply call our Customer Service Department 1- 800 845 -3550. VOUCHER NO, WARRANT NO. ALLOWED 20 Henry Schein IN SUM OF Dept Ch 10241 Palatine, IL 60055 $1,749.96 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members 1120 8548061 102- 670.06 $717.00 1 hereby certify that the attached invoice(s), or 1120 102- 390.11 bill(s) is (are) true and correct and that the 1120 8547992 102 390.11 $1,032.96 materials or services itemized thereon for which charge is made were ordered and received except Nev 8 26W r ,r� k 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)) 8548061 $717.00 8547992 $1,032.96 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