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192099 11/23/2010 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1 ONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: $724.66 CARMEL, INDIANA 46032 DEPT CH 10241 PALATINE IL 60055 -0241 CHECK NUMBER: 192099 CHECK DATE: 11/2312010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 102 4239011 2919225 -01 301.85 SPECIAL DEPT SUPPLIES 102 4239011 3209322 -01 313.67 SPECIAL DEPT SUPPLIES 102 4239011 8548020 -01 109.14 SPECIAL DEPT SUPPLIES HSI ORDER4 ORDER DATE. 85685410 10/26/10 WHSE DEA# RHO162494 Fed ID: 11 3136595 OWN 8`.:��k T his order as been processed by our MIDWEST D.C. 5315 WES 74TH TREET INDIANAP LIS,IN 46268 MIDWEST D.C. State Lic 23 00304 1 499 -1647 PU 100 /BX SYRINGE /NEEDLE 21GX1 -1/2 1OCC 2 2 54.57 109.14 1 OUR ORDER 35685410 HAS BEEN SPLIT INTO MULTI LE SHI MENTS. CERTAIN ITEM WILL E SHIPPED EPARATELY. YOU WILL BE BILLED FOR THESE ITEMS WHEN THEY ARE HIPPED. F YOU ARE ARTICIPATING IN A DISCOUNT PROG (E.G- POIN S, GIFTS OR or HER PECIAL AWA ZDS "DISCOUNT, WITH THIS .PURCHASE YOU HAVE EIARNED A CREDI TOWARD GOODS OR S RVICES, RECEIVABLE OR REDEEMABLE IN ACCO DANCE WITH DISCOUNT PROGRAM RULES- UPOZ DISCOUNT RECEIPT OR REDEMPTION, YOU ARE RECEI ING OR WILL RECEIVE OTICE OF T E DISCOUNT VALUE. FROM TIME TO TIME, MEDICARE, MEDICAID, TRI ARE OR THER PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, AND UPON ANY S CH R EQUEST, SU H VALUE MUST BE DISCLOSED AS A DI COUNT GAINSI THE PURCHASE THAT E ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN THESE RECORDS. 14 N HENRY CHEIN, INC. HAS PURCHASED THE SPE IFIC U4IT OF THE PRESCRIPT ON DRUG DIRECTLY F OM THE MANUFACTURER. MERCHANDISE TOTAL 109.14 INVOI E TOTAL 109.14 PLEASE PAY WITHIN THIRTY(30) DAYS OF RECEIPT OF THIS NVOICE. 109.14 s INVOIC TO TAL ITEM STATUS KEY REM KEY 1308571 1817102 8548020 -01 109.14 B nucl:ordered:Itemwiutollow SIC School Kit H I RDER OF-DER ATE NV I A xR5 D Diseununued: Item no longer available NC: No Charge P Special Schein Free Goods M Mamdacturer will ship Item diev:tly to you 8 5 6 B 5410 10/26/10 11/04/10 1 P Prescripiion Drug: Return Authorization Required CUSTO 2 R Refrigerated Item: May be shipped separately —Special Schein Pricing U 'pemporarily unavailable: please reorder MARK 1 OF 2 T Taxable Item Continued on Next Page LP300 Matrx Medical SHIP TO /SOLD TO: 135 Duryea Road, Melville, NY 11747 INVOICE 540mW1136rStDepartment MI Station 46 Michael Kaufmann Carmel,IN 46032 -8806 0100001 30857108548020110010000000109141104102 BILL TO: Carmel Fire Dept MI 2 Civic Sq Carmel, IN 46032 -754.3 Carmel Fire Dept MI 2 Civic Sq 6I LL TO SHIP TO I INVOICE TOTAL Carmel, IN 46032 -7543 1306571 1817102 109.14 INVOICE INVOICE DATE 8548020 -01 11/04/10 CUSTOMER P0 MARK Please deluch.here.and.mail the ahow with your payment. HST ORnPR# ORDER DATE 85685410 10/26/10 WHSE DEA# RHO 162494 Fed ID: 11-3136595 S... M,- LEASE NOTE NEW REMIT TO ADDRESS lease remi payments only to the following a dress: ENRY SCHEIF INC. EPT CH 102 1 ALATINE, I 60055 -0241 BTLL TO SiliP TO TNVQTCE# INVOICE TOTAL ITEM STATUS KEY REM KEY 1308571 1817102 8548020 -01 109.14 H- llackordend item will follow SK School Kit H I R INVOICE BOXES 1) Discontinued Ilan no longer available NC No Charge V -Special Schein Free Goads M Manufacturer will ship Ilan dime ly to you 85685410 10 2 6 10 11/04/10 1 P Prescription Drug: Return Aulhorisati0n [required CUSTOMER PO PA E R Refrigerated hem: May he shipped suparately Special Schein Pricing U Temporarily unavailable: please reorder MARK 2 OF 2 T Taxableltcm LV3UU Marx Medical LR�-, OF mu�a �edum�»�a nu�bghowevo.war;vmn{ha right priceadjuutmmn%|n Payment by CHECK or by the HENRY SCHEIN CREDIT CA RD, VISA, MASTERCARD, DISCOVER and AUERICAN EXPRESS mspmnneto man uimdureo' price changes Guaranteed Satisfaction: or Uvou have thed8 product 8ndi|io detective nr does n0tperform ooiia[a�nri!y.wowi||pnwidoe credit, �fuod.o/exnhungej[ynu chcice S| our cus[0meraomiredo U thin 88days avable with:n 30 days. dOnt|hnmnruha odiue�anaogeiorthoneum. Fora :mnunhn0ai/orit you �ernoeo'oomothingyuu did not order, �imp|ycaU, Rx Products Controlled Substances: Mat[XMed|cal 1-800-845-3550 Rngoie||»/m requio Lis <uUm{? the sale of Rx and om!xd\od m��ces, r.)r:y';,o--g'ste K you are a new customer ur have moemU mnvad fu :s* International Orders: Please Note: VYo proudly serve health oare professionals and gov*mmon1x Opened hundpiouou and uquipme�mayoribereturned'or |hmuVhou\ the Tnp}anoorder- or for �:qu�nannnoxpnrt omdiLbu*w0bo/epx|'edurmp)euodinacoor an |h terms and onndkiono |ouu000�a�our|n|enmdnna|Depu�n*»� muoo�t��fwmimn eo, Beomo0onk�hand�e:o»or equipment, o ggn��a you check ffie ship i i "^ei'ved exactly �m��r��t�� U� Returns ��8y��K��^ you dO d Computer Go�verm is not returnable. Other restrictions may also apply. ARo|um&uthohzaUnnioRoquiroUfor all Freaoriphcn Drugs. 5|mp/ycall Our Cust-orner Service Department "S" 1-80-0-845---3�50. HSI ORDER# ORDER DATE 86064713 11/09/10 WHSE DEA# RHO162494 Fed ID: 11- 3136595 This order has been processed by our MIDWEST D.C. 5315 WES 747H TREET INDIANAP LIS,IN 46268 MIDWEST D.C. State Lic 23 00304 1 206 -8985 EA WALL HOLDER F/690 THERMOM 1 1 33.73 33.73 1 2 180 -7538 EA STETH LTMN CARDI03 2HD 27" 2 2 139.97 279.94 1 F YOU ARE DARTICIPATTNG IN A DISCOUNT PROGRAM (E -G, POIN S, GIFTS OR OTHER PECIAL AWA DS "DISCOUNT WITH THIS PURCHASE YOU HAVE EARNED A CREDI TOWARD GOODS OR S RVICES, RECEIVABLE OR REDEEMABLE IN ACCO DANCE WITH DISCOUNT PROGRAM RULES. UPO DISCOUNT RECEIPT OR REDEMPTION, YOU ARE RECES ING OR WILL RECEIVE OTICE OF TIE DISCOUNT VALUE, FROM TIME TO TI E, MED CARE, MEDICAID, TRI ARE OR THER PAYER MAY REQUEST INFORMATION REGARDING SUCH V UE, PND UPON ANY S CH REQUEST, SU H VALUE MUST BE DISCLOSED AS A DI COUNT GAINSq THE PURCHASE THAT EARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE 'AIN TH 3SE RECORDS. MERCHANDI E TOTAL 313.67 INVOI E TOTAL 313.67 PLEASE PAY WITHIN THIRTY(3 DAYS OF RECEIPT OF THIS :NVOICE. 313.67 LEASE NOTE NEW REMIT TO ADDRESS Please remi payments only to the following a dress: ENRY SCHEII INC. DEPT CH 10211 ALATINE, I 60055 -0241 BILL E TNV I E TOTAL:: ITEM STATUS KEY REM KEY 1308571 1308572 3209322 -01 313.67 ii Backordered: hern sill folio% SK Scheel xir H R ORDER ATE INVOICE D Discaniinued; Item no longer available NC No Charge F Special Schein Free Goods M ManUfaeRirer will chip Item directly to yn❑ 86 064 713 11/09/10 11/09/10 1 P Prescription Dru Ruwm Amneriza, inn Required CUSTO E' R Refrigerated hem: May he shipped uparately Special Schein Pricing U Temporarily unavailable_ please reorder MA 1 OF 1 T Taxahlelmm L RK a u Payrnert Ter�rts: We make every ellollto; maintain pril '-,jr the duratu', iota Payment by CHECK or by the HENRY SCHEIN CREDIT CARD, catalo 1� re, ,)Q hq��4E,� ce serve t -e kht to make Sri adiistments. :it VISA, MASTERCARD, DISCOVER and AMERICAN EXPRESS response to manufar-1;Urers' price chanties Guaranteed Satisfaction: or If you have tr.ed aprodu-ck and it is defective or does not penorm Bill Y Ac S satisfactorily, we will provide a credit, refund, or exchange: its your tN Available to licensed practitione I in e U.S. A" invoicos are chone. ShOv call oJr cuslorrier service depar[mer;'wibin 30 dai s D of r -d of the fner-haitdiseo arrangefor the return. Fora pavable withm. 30 days, or .varraniv repair or it yo.Jere sent soniothirigvo did not d w Sin call: Rx Products Controlled Substances: Matrx Medical 1-800-845-3550 Regulation p :e r re us to lim f 'he sale of Rx and' conlrolked substances n!%'v licensed healthcare pmfessicnals, if you are anew customer o, have re-cenitly moved, please furnish us vv fth a copy of your updated state registration. For controlled SUbstances, furnish a Copy of your DEA certificate, verifying yor�r shipping address. Class 11 drugs can. be ordered only b- t�tail, International Orders: Please Note: We proudly serve healthcare professionals and governments Opened handpie�es and equi.pment n Oy ric ot be returned for V'Vld. t 0 :,or iVq,:;r10S 0 k�trajughout thn, P lace orders or f export credit but will be repaire or replao-ad in accordance,.-vilh terms and .0ndt':ons, please contact o€ r International Department: rnanufactw r Brkrc- or ening handpeces or J J eQ.Uipment, we, sugg that check the sNp 00,nlainer H: and packmg lid tovenfy that you have received exactly what ug Reuc yoti ordered.Opened Computer Software is not returnable, Prescription Dr turns Instr tions: Other restrictions may also apply. A l�eljm Authorization is Rewired f o; r all Pre-scrVion :)rugs, S:nlply call our I US t uMe r S Depar 'ment 1-80-' 0-84 -3,55 D HSI ORDER ORDER DATE 85987589 11/05/10 WHSE DEA# RH0162494 Fed 1D: 11-3136595 4 T his order has been processed by our MIDWEST D.C. 5315 WES 74TH 3TREET INDIANAP LIS,IN 46268 MIDWEST D.C. State Lic 23 00304 1 203 -3856 EA SURETEMP PLUS THERM ORAL 4' CORD 1 1 225.00 225.00 1 2 741 -8045 EA PROBE RECTAL F /SURETEMP PLUS 1 1 69.00 69 -00 1 3 840 -2661 250 /BX PROBE COVER SURETEMP 1 1 7.85 7.85 1 UE TO MANUFACTURER NO RETURN POLICY THIS ITEI IS NOT NABLE OUR ORDER 5987589 HAS BEEN SPLIT INTO MULTI LE SHIPMENTS. CERTAIN ITEM WILL E SHIPPED EPARATELY, YOU WILL BE BILLED FOR THESE ITEMS HEN THEY ARE HIPPED. F YOU ARE PARTICIPATING IN A DISCOUNT PROG (E.G. POIN S, GIFTS OR OTHER PECIAL AWA ZDS "DISCOUNT WITH THIS PURCUMSE YOU HAVE EARNED A CREDI TOWARD GOODS OR SERVICES, RECEIVABLE OR REDEEMABLE N ACCORDANCE WITH DISCOUNT PROGRAM RULES. UPO4 DISCOUNT RECEIPT OR REDEMPTION, OU ARE RECEI ING OR WILL R CEIVE OTICE OF TIE DISCOUNT VALUE. FROM TIME TO TI E, MEDICARE, MEDICAID, TRI ARE OR THER PAYER MAY REQUEST INFORMATION REGARDING SUCH VALUE, P.ND UPON ANY S CH EQUEST, SU H VALUE MUST BE DISCLOSED AS A DI COUNT AGAINSI THE PURCHASE THAT E ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN TH SE RECORDS. MERCHANDI E TOTAL 301.85 INVOI E TOTAL 301.85 J3 1 LL TO SHIP TO T NVOTCER INVOICE TOTAL ITEM STATUS KEY REM KEY 1308571 1308572 2919225 -01 301.85 H nakordered[ Rem will ro ➢ow sK_seh�.a Kh HST ORDER O RDER# ORDER DATE TDIVOICE DAT13 OF B II Disconliaucd: ]rum nu longer available NC Nu ('hargc P Special Schein Free (nxMs M Manuracturer will Ship Item directly to you 85987589 11 0 5/ 10 11/05/10 1 F- Prc.acritr[wn Drug: Relurn Aumuriaatiun Required R Rclrigcralcd Item: May bu shipped separately CUSTOME Special Schein Pricing U Temp)rarily unavailahle: plcaec reorder MARK 1 OF 2 r- raxahlc hem Continued on Next. Page LP300 M HENRY SH1 Matrx Medical SHIP TO /SOLD TO: Carmel Fire Dept Head Quarters MI 135 Duryea Road, Melville, NY 11747 INVOICE 2 Civic Sq Carmel,IN 46032 -2564 01100001308577, 0291922511001 ,000000030],8517,05104 BILL TO: Carmel Fire Dept MI 2 Civic Sq Carmel, IN 46032 -7543 Carmel Fire Dept MI 2 Civic Sq BI.LL TO I SHIP TO INVOICE TOTAL Carmel, IN 46032 -7543 1308571 1 1308572 1 301.85 INVOICE INVOICE DATE 2919225 -01 11/05/10 CUSTOMER PO MARK case detach here and mail t c above with your payment HSI ORDERH ORDER DATE 85987589 11/05/10 WHSE DEA# RHO162494 Fed ID: 11-3136595 PLEASE PAY WITHIN THIRTY {3 DAYS OF RECEIPT OF THIS NVOICE. 301.85 LEASE NOTE NEW REMIT TO ADDRESS Please remi payments only to the following a dress: ENRY SCHEI INC. EPT CH 102 1 ALATINE, I 60055 -0241 BILL TO H P To INVOICE9 LYVOICE TOTAT, ITEM STATUS KEY REM KEY 1 1308571 1308572 2919225 -01 301.85 It Hncod —d: Item will full— SK SchoolKit H I ORDER RDER DATE I DATE F BOXES D 1)LCeentlnned; hunt no longer available NC No Charge V- Special Sehuin Pmu Clouds M Mannfaewrer will ship Item dmocliy to you 8 59 875 8 9 11/05/10 11/05/10 1 P- PrenriPtino Drug; Remm Authont.ation Required CUSTO P O4 PAGE# H Refrigerated Item; May bus sepamlcly Special Suhei❑ Pricing U Temporarily unavailable: Please, eo'de, MARK 2 OF 2 T Tacahle Item LP300 VOUCHER NO. WARRANT NO. ALLOWED 20 Henry Schein IN SUM OF Dept Ch 10241 Palatine, IL 60055 $724.66 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO. ACCT #£TITLE AMOUNT Board Members 1120 2919225 -01 102 390.11 $301.85 1 hereby certify that the attached invoice(s), or 1120 3209322 -01 102 390.11 $313.67 bill(s) is (are) true and correct and thatthe 1120 8548020 -01 102 390.11 $109.14 materials or services itemized thereon for which charge is made were ordered and received except NOV 2 2 2010 ".-P n 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)) 2919225 -01 $301.85 3209322 -01 $313.67 8548020 -01 $109.14 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