HomeMy WebLinkAbout193781 01/19/2011 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1
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ONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: $1,476.35
CARMEL, INDIANA 46032 DEPT CH 10241
PALATINE IL 60055 -0241 CHECK NUMBER: 193781
CHECK DATE: 1119/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 4467006 3075203 118.95 EMS EQUIP
102 4239011 3350171 -01 1,357.40 SPECIAL DEPT SUPPLIES
HE NRY C EIN
SHIP TO /SOLD TO:
Matrx Medical 540
Carmel Fire Department MI
135 Duryea Road, Melville, NY 11747 INVOICE Sta W 136 St
Station 46 Michael Kaufmann
Carmel,IN 46032 -8806
0100001308577, 03350 171111001,0000001357400104113 BILL TO:
Carmel Fire Dept MI
2 Civic Sq
Carmel, IN 46032 -7543
Carmel Fire Dept MI
2 Civic .SCI HILL TO SHIP TO INv.'dt :TOTAL
Carmel, IN 46032 -7543 1 1308571 1817102 1357.40
IAMOI CE INVOICE DATE
3350171 -01 1/04/11
CUSTOMER PO
MARK
HSI 0 R D ER# ORDER DATE
87468924 01/04/11
WHSE DEA# RH0162494 Fed ID: 11-3136595
his order ias been processed by our MIDWEST E.C.
5315 WES 74TH STREET
INDIANAP LIS,IN 46268
MIDWEST D.C. State Lic 23:00304
1ARK 317-421l-8784
1 507. -.8362 100 1BX NACL PREFILL SYRINGE 1OML ST 4 4! 37.00 148.00 15
N PEDIGREE ITEM.
JDC:6380701)010
2 107 -0530 100 /BX PURPLE NITRILE PF GLOVE LARGE 60 60 C 8.25 495.00 6
ASE GOOD I EM, MAY BE SHIPPED SEPARATELY.
3 107 -0502 100 /BX PURPLE NITRILE PF GLOVE MEDIUM 20 20 C 8.25 165.00 6
ASE GOOD I EM, MAY BE SHIPPED SEPARATELY.
4 891 -3037 PU 50 /CA IV PREP KIT W/ TEGADERM 6 6 C 61.00 366.00 14
ASE GOOD I EM, MAY BE SHIPPED SEPARATELY.
5 677 -4617 EA BRASS REGULATOR W /FLOW 2 DISS 2 2 72.00 144.00 15
6 496 -2369 100 /BX LANCET SURGILANCE ORANGE 21G 4 4 9.65 39.40 15
F YOU ARE PARTICIPATING IN A DISCOUNT PROG (E.G. POIN S, GIFTS OR C HER
PECIAL AWARDS "DISCOUNT WITH THIS PURC SE YOU HAVE EARNED A CREDI TOWARD
GOODS OR SERVICES, RECEIVABLE OR REDEEMABLE N ACCO DANCE WITH DISCOUNT PROGRAM
RULES. UPOI 1 4 DISCOUNT RECEIPT OR REDEMPTION, rOU ARE RECEI ING OR WILL R CEIVE
a "LL -T HIP TO I.. i ITEM STATUS KEY REM KEY
1308571 1817202 3350171 -01 1357.40 H Backordered. hem will follow SK School Kil
D Discommucd. Irian nil longer available NC No Churge
H R ORDER DA AT OF 3QXES f Special Schma Free Goods
M Manufacturer will ship Item directly lu you
87468924 01 04 11 1/04/11 15 P Prescription Drug: Rcl¢rn Authorization Required
ST MER`P R Rolrigurated Item; May beshipped separately
Special Schein Pricing
U Tomporanl_y unavailable: please murder
MARK 1 OF 2 T- Ta-blu hem Continued on Next Page
I'Icase detach here and mail the above with your payment
HSI ORDER# ORDER DATE`:
87468924 01/04/11
WHSE DEA# RHO 162494 Fed 1D: 1 1- 3136595
x a_
a :.'##3:i, �i? a: •tea M
OTICE OF THE DISCOUNT VALUE. FROM TIME TO TIME, MEDICARE, MEDICAID, TRT ARE OR
THER PAYER MAY REQUEST INFORMATION REGARDING SUCH VALUE, PND UPON ANY SITCH
R EQUEST, SUCH VALUE MUST BE DISCLOSED AS A DI COUNT AGAINS7 THE PURCHASES THAT
ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE 'AIN TH PSE RECORDS.
N HENRY CHEIN, INC. HAS PURCHASED THE SPE IFIC U4IT OF THE PRESCRIPTION DRUG
DIRECTLY F OM THE MANUFACTURER.
MERCHANDISE TOTAL 1357.40
INVOI E TOTAL 1357.40
PLEASE PAY WITHIN THIRTY(3 DAYS OF RECEIPT OF THIS NVOICE. 1357.40
P LEASE NOTE NEW REMIT TO ADDRESS
P lease remi payments only to the following a dress:
ENRY SCHE14 INC
D EPT CH 10211 i
ALATINE, >I (50055
BILL TO H TO' INVOICE9 INVOICE TOTAL
ITEM STATUS KEY REM KEY
1308571 1817102 3 3 5 0171- 01 13S7.40 B Backordered: Item will 1`0110w SK Sch0o1 Kit
ORDE I! ORDER DATE B ll Disconnnued. Item no longer available NC Nu Chargc
HSI 1� Special Schein free Goods
1/ lrj M- Manufaeturerwillship Item directly wyou
87468824 01/04/11
1'- Prescription Drug: Return Authorization Required
MER E k Refngeraied Item: May be shipped separately
Spacial Schein Pricing
U Temporarily unavailable: plutse reurdcr
MARK 2 OF 2 T Taxable Item
Paymeut
We make evm offoll 1 10 maintain prices 'or the duration of a
Payment by CHECK or by the HENRY SCHEIN CREDIT CARD,
Ca
taiog, huwevcr, we reserve the right to make price adjustments in
VISA, MASTERCARD, DISCOVER and AUERICAN EXPRESS
response to manufacturers' price changes
Guaranteed Satisfaction:
or
If you have tried a product and it is defective or does not perform
Bill Your Order To Your Oper, A-I-Int
satisfactorily, we wil' provide a credit, refund, or exchange, it's your Avai!able to licensed practTor-,ors In the U.S. All:nvoicos are
ch ice. Si a
ompiv c al l our custorner ser vice deparlmeniviMin 30 days
at receipt J�' a k 0 payable withtin 30 days,
:1 ;1 he mord 1- d;sr-- to arrange r the return. For a
r r
or it yoil:',VM Sena sornothing yo J did not order,
Rx Products Controlled Substances:
Matrx Medical 1-800-845-3550
Regulations rocli're us to limi she s£ i'3 fix and coninolled
substances orIy to registered, licensed healthcare professionals.
It you are a new customer or have recently moved, -lease furnish
us %Avith a copy of your updated state registration. For Controlled
substances, furnish a copy of your DEA certificate, verifying your
shippingaddri, Class 11 drugs can be ordered only by mail.
International Orders:
Please Note.
01e proudly serve healthcare professionals and governments
Opered handpieces and equipment m t b
ay t! noe rear fo r M
roughout thevvorld. To Place orders or for g
ii qle S On eXexport cfedit, butvfll be Tepa or replaced in accordance with
terms and conditbins, please con our k Department:
rnanufacturerwarrantes, Wore ooening hardp or l ro
eqiiprnent, wo suggest that you check ft ship ccori
an y ou Packing list to ver tha you 1 ave received- exactly what
you ordered,0pened Computer Software is not returnable, Prescription Drug Returns Instructions:
Other restrictions may also apply.
A Refijm Authorization is Required for al Prescription Drugs. S call
our
Customer Service Department d6l 1-800-845-3550.
LP300
MARK
Please detach here and mail the above with your payment
:.HSI ORDER ORDER DATE
87468420 01/04/11
WHSE DEA# RHO162494 Fed ID: 11-3136595
hi s. order has been processed by our MIDWEST. D.C.
5315 WEST 74TH TREET
INDIANAP LIS,IN 46268
MIDWEST D.C. State Lic 23 00304
1 387 -4399 EA BREATHSAVER BAG SIZE D GREEN 1 1 118.95 118.95 1
F YOU ARE ARTICIPATING IN A DISCOUNT PROGRAM (E.G. POIN S, GIFTS OR 0 HER
PECIAL AWA DS "DISCOUNT WITH THIS PURL, SE YOU HAVE EARNED A CREDI TOWARD
GOODS OR S RVICES, RECEIVABLE OR REDEEMABLE N ACCO DANCE WITH DISCOUNT PROGRAM
RULES UPOq DISCOUNT RECEIPT OR REDEMPTION, OU'ARE RECEI ING OR WILL RECEIVE
OTICE OP-TIE DISCOUNT VALUE. FROM TIME TO TIME, MED CARE, MEDICAID, TRI ARE OR
THER PAYER MP _Y REQUEST INFORMATION REGARDING SUCH VALUE, P.ND UPON ANY 5 CH I
EQUEST, SU H VALUE MUST BE DISCLOSED AS A DI COUNT ACAINSI THE PURCHASE THAT
EARNED SUCH VALUE ACCORDINGLY, YOU SHOULD RE .A 114 THESE RECORDS.
MERCHANDISE TOTAL 118.95
INVOI E TOTAL 118.95
PLEASE PAY WITHIN THIRTY(3 DAYS OF RECEIPT OF THIS INVOICE. 118.95
LEASE NOTE NEW REMIT TO ADDRESS
lease.remi payments only to the following a dress:
HENRY SCHEI4 INC.
....DEPT CH 10211
ALATINE, I 60055 -0241
BILL TO Sulp To INVOICE TOTAL ITEM STATUS KEY REM KEY
1308571 1308572 3075203 -01 118.95 a- Backordered: Item will follow SK SchoolKir
D Discontinued: Item no langer available NC -No Charge
E P- Special Schein Free Goads
8 M Ma g et you
7468420 01/04/11 1/04/11 1
P Prescription Dmg: Rctum Authamation Required
CUSTOMER PO4 R Refrigerated Item: May he shipped separately
Special Schein Pricing
U Temporarily uuasailahlc: please reorder
MARK 1 OF 1 T Taxable llem
LP300
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
Guaranteed Satisfaction; v►sa,z
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 Bill Your Order To 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. For a payable within 30 days,
warranty repair or if you were sent something you did not order
simpl call:
Matrx Medical 1 -840- 845 -3550 Rx Products Controlled Substances:
Regulations require us to limit the sale of Rx and controlled
substances only 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, veritying.your
shipping address. Class Il drugs can be ordered only by mail.
International Orders:
!Tease No te:
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 on 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 verity 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.
W 0-,
VOUCHER NO. WARRANT N
ALLOWED 20
Henry Schein
IN SUM OF
Dept Ch 10241
Palatine, IL 60055
$1,476.35
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# 1 Dept. INVOICE NO. ACCT #!TITLE AMOUNT Board Members
1120 3075203 102- 670.06 $118.95 1 hereby certify that the attached invoice(s), or
1120 3350171 -01 102- 390.11 $1,357.40 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
JAN 4
a
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))
3075203 $118.95
3350171 -01 $1,357.40
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