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HomeMy WebLinkAbout192461 12/07/2010 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: $126.00 `o PALATINE IL 60055 -0241 CHECK NUMBER: 192461 CHECK DATE: 12/7/2010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 102 4239011 5800832 -01 126.00 SPECIAL DEPT SUPPLIES HENRY SCHEN Matrx ffi SHIP TO /SOLD TO: e` Carmel Fire Dept Head Quarters MI 135 Duryea Road, Melville, NY 11747 I \V' LC 2 civic sq �V Carmel,IN 46032 -2584 010000130857105800832110010000000126001122103 BILLTO: Carmel Fire Dept MI 2 Civic Sq Carmel, IN 46032 -7543 Carmel Fire Dept MI 2 Civic SCI BILL TO I SHIP TO INVOICE TOTAL Carmel, IN 46032 -7543 1308571 1308572 1 126.00 1:NVOICE# I INVOICE DATE 5800832 -01 11/22/10 CUSTOMER P0 MARK Please detach here and mail the abide wilh your payment HSI ORDER# ORDER DATE 86424872 11/22/10 WHSE DEA# RHO 162494 Fed ID: 11-3136595 IN his order ias been processed by our MIDWEST M.C. 5315 WES 74TH STREET INDIANAP LIS,IN 46268 MIDWEST D.C. State Lic 23 00304 1 499 -0467 EA MATRX GLOVE CADDY 6 6 21.00 126.00 1 HIS PRODucr IS BEING SHIPPED FROM OUR NORTHEAST DIS RIBUT ON CENTER. F YOU ARE DARTICIPATING IN A DISCOUNT PROG (E.G. POIN S, GIF'T'S OR OTHER PECIAL AWA DS (''DISCOUNT")), WITH THIS PURCHASE YOU HAVE EARNED A CREDI TOWARD GOODS OR S RVICES, RECEIVABLE OR REDEEMABLE N ACCO DANCE WITH DISCOUNT PROGRAM RULES. UPOY DISCOUNT RECEIPT OR REDEMPTION, OU ARE RECEI ING OR WILL R CEIVE OTICE OF T42 DISCOUNT VALUE. FROM TIME TO TI E, MEDICARE, MEDICAID, TRI ARE OR OTHER PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, PND UPON ANY SITCH EQUEST, SU H VALUE MUST BE DISCLOSED AS A DI COUNT IGAINSI THE PURCHASES THAT E ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN THESE RECORDS, MERCHANDI E TOTAL 126.00 INVOI E TOTAL 126.00 PLEASE PAY WITHIN THIRTY(3 DAYS OF RECEIPT OF THIS NVOICE. 126.00 LEASE NOTE NEW REMIT TO ADDRESS lease remi payments only to the following a dress: HENRY SCHEI INC. D EPT CH 102 1 ALATINE, I 60055 -0241 ILL TO SHIP TO INV OICE� I NVOICE T.QTAL ITEM STATUS KEY REM KEY 1308571 1308572 5800832 -01 126.00 H- Backordered: Item will follow SK SchoolKit D Discnnlioued: Item no longer a itable NC- No Charge H I E DER DATE I h Spacial Schein l`we Crowds M !,,I-ul aclurer will ship Item directly to you 8 6424 8 72 11 /2 2 10 11/22/10 1 1 I'u scription Drug: Remm Authorization Required R Rctrigcmlcd ttcm; May he shipped Separately Special Schein Pricing U Tcmporanly unavailahle: please reorder MARK 1 OF 1 T T Item LP300 f HENRY SC EIN"" I Matrx a ER MS SAL Payment ce rns. 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: arsA r If you have tried a product and it is detective or does not perform or e Account satisfactorily, we shill provide a credit, refund, or exchange; it's your Available to lic ensed dill Your Order To "car choice. Simply call our customer service department within 30 days payable w it h in to tic 3© days. practitioners in the tJ.S. All invoices are p 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: Matrx Medical 800 845 3550 Regulations require us to limit the sale of Fix and controlled substances onh, 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 DEA certificate, verifying your shipping address. Glass II 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 throughout the world. To place orders or for inquiries o� export manufacturer warranties. Before opening handpieces or terms and conditions, please contact our International Department: equipment, we suggest that you check the shipping container 1 800-845-3550 and packing list to verify that you have received exactly what Prescription Drug Returns Instructions. you ordered.Opened Computer Software is not returnable. Other restriction may also apply. A Return Authorization is Required for all Prescription Drugs. Simply call our Customer Service Department 3 -800- 845 -3550. Q �r� VOUCHER NO. WARRANT NO. ALLOWED 20 Henry Schein IN SUM OF Dept Ch 10241 Palatine, IL 60055 $126.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members 1120 5800832 -01 102 390.11 $126.00 1 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 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)) 5800832 -01 $126.00 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