The URL can be used to link to this page

Home My WebLink About192833 12/15/2010 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1 ONE CIVIC SQUARE HENRY SCHEIN INC CARMEL, INDIANA 46032 CHECK AMOUNT: $519.32 DEPT CH 10241 `o PALATINE IL 60055 -0241 CHECK NUMBER: 192833 CHECK DATE: 12/15/2010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 102 4239011 8948250 -01 519.32 SPECIAL DEPT SUPPLIES HSI ORDER ORDER DATE 86578433 11/30/10 WHSE DEA# RHO] 62494 Fed ID: 11- 3136595 sr r oe� r r o o T his order has been processed by our MIDWEST D.C. 5315 WES 74TH TREET INDIANAP LIS,IN 46268 MIDWEST D.C. State Lic 23 00304 17 -571 -266 1 116 -9264 EA SEP -T -VAC SYSTEM IT 12000C 25 25 2.90 72.50 7 2 891 -3037 PU 50 /CA IV PREP KIT W/ TEGADERM 6 6 C 61.37 368.22 6 ASE GOOD I rEM, MAY BE SHIPPED SEPARATELY. 3 499 -0776 5 /PK OXYGEN GASKET METAL 20 20 3.93 78.60 9 HIS PRODUCU IS BEING SHIPPED FROM OUR NORTHEAST DIS RIBUT ON CENTER. F YOU'ARE DARTICIPATING IN A DISCOUNT PROGRAM (E.G. POINTS, GIFTS OR OTHER PECIAL AWA DS "DISCOUNT")), WITH THIS PURL SE YOU HAVE EARNED A CREDI TOWARD GOODS OR S RVICES, RECEIVABLE OR REDEEMABLE N ACCfl DANCE WITH DISCOUNT PROGRAM RULES. UPO DISCOUNT RECEIPT OR REDEMPTION, OU ARE RECEI ING OR WILL R CEIVE OTICE OF T E DISCOUNT VALUE. FROM TIME TO TI E, MEDICARE, MEDICAID, TRI ARE OR THER PAYER MAY REQUEST INFORMATION REGARDING SUCH VALUE, PND UPON ANY SITCH R EQUEST, SU H VALUE MUST BE DISCLOSED AS A DISCOUNT AGAINSI THE PURCHASES THAT E ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN TH SE RECORDS. MERCHANDISE TOTAL 519.32 INVOI E TOTAL 519.32 PLEASE PAY WITHIN THIRTY(3 DAYS OF: RECEIPT OF 'THIS NVOICE. 519.32 BILL T. SHIP To TNVQT INVOICE TOTAL ITEM STATUS KEY REM T EY 1308571 1817102 8948250 -01 519.32 H- Hackordered:ltemwllllolloa SK ScheolKit ll Discontinued: Itcm no longer available NC No Charge H I RDER I- Special Schein Free Goods M Manufacturer will ship Item directly to you 86578433 11 3 0/ 10 11 9 P- Prescription Drug: Return Authorization Required R Refrigerated Item: May be shipped separately Special Schein Pncing IKA� U Temporarily unavailable: pleaso reorder 1 OF 2 T Taxable Item Continued on Next Page LF3G0 HENRY SCHEIN Matrx Medical SHIP TO /SOLD TO: INVOIC Carmel Fire Department MI 135 Duryea Road, Melville, NY 11747 540 W 136 St Station 46 Michael Kaufmann Carmel,IN 46032 -8806 01000013085710894825D110D1D00000D519321130102 BILL TO: Carmel Fire Dept MI 2 Civic Sq Carmel, IN 46032 -7543 Carmel Fire Dept MI 2 Civic Sq BILL TO I SHIP TO INVOICE TOTAL. Carmel, IN 46032 -7543 1308571 1817102 1 519.32 TNVOTCEU I INVOICE DATE 8948250 -01 11/30/10 CUSTOMER PO MARK Please detach here and mail the above with your payment HSI ORDER ORDER DATE 86578433 11/30/10 WHSE DEA# RHOI62494 Fed ID: 11- 3136595 an M. e f C i ON M LEASE NOTE NEW REMIT TO ADDRESS lease remi payments only to the following address: ENRY SCHEI4 INC. EPT CH 102:1 ALATINE, I 60055 -0241 L To SHIP T E ITEM STATUS KEY REM KEY 1308571 1817102 8948250 -01 519.32 I- Backordered: Item will loll— Sx Schoolxit D Discontinued: Item no longer available NC Cha�c BOX f Special Schein free Goads M Manufacturer will ship hem directly to you 86578433 11 3 0 10 11/30/10 9 I' Prescription Drug: Return Authorization Required R Refrigerated Item: Maybe shipped separately C1JqTQ PQ# PAGE# S Special Schein Pricing U Temporarily unavailable: please reorder MARK 2 OF 2 T Taxabk Item LP300 HENRY SCHEI V Uatrx Medical TERMS OF SALE Payment Terms; 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 vasa n' 0. Guaranteed Satisfaction; ti If you have tried a product and it is defective or does not performifl Yo�rr}rdera Your Open Ac satisfactorily, we will provide a credit, refund, or exchange; it s your Available to licensed practitioners in the US. All invoices are choice. Simply call our customer service department within 30 days payable w t i c 30 days, of receipt of the merchandise to arrange for the return. For a warranty repair ar if you were sent something you did not order simply call: Rx Products Controlled Substances: Matrx 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 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. Class 11 drugs can be ordered only by mail. International Qrderse Pleas /Vote: Opened handpieces and equipment may not be returned for We proudly serve healthcare professionals and governments credit, but w'ili be repaired or replaced in accordance with throughout the world. To place orders or for inquiries on export manufacturer tAmrranties. 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 restrictions may also apply, A Retort Authorization's Required for all Brescription Drugs. Simply call our Customer Service Department @1- 800 -845 -3550. VOUCHER NO. WARRANT NO. Henry Schein ALLOWED 20 IN SUM OF Dept Ch 10241 Palatine, IL 60055 $519.32 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members 1120 8948250 -01 102- 390.11 $519.32 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 DEC 113 2010 Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund Prescribed by State Board of Accounts City Form No. 261 (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)) 8948250 -01 $519.32 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