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Home My WebLink About193781 01/19/2011 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1 1 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