HomeMy WebLinkAbout194214 02/03/2011 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1
ONE CIVIC SQUARE HENRY SCHEIN INC
CARMEL, INDIANA 46032 DEPT CH 10241 CHECK AMOUNT: $527.20
PALATINE IL 60055 -0241
CHECK NUMBER: 194214
CHECK DATE: 2/3/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 4239011 8810708 -01 527.20 SPECIAL DEPT SUPPLIES
HSI ORDER# ORDER 11111r,
l 87735538 01/14/11
WHSE DEA# RHO162494 Fed [D: 11-3136595
e m
51 z w
o e�W
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
101 -5979 6 /BX CLOTH SURGICAL` TAPE 2 "y10YD 12 12 8.10 97.20 1
2 220 -1398 3 /ST BODY STRAP SET DISP YELLO W 40 40 4.80 192.00 1
3 499 -5079 EA STYLET W /DISTAL TIP 12FR 20 20 1.65 33.00 -1
4 102 -4985 100 /CA EXTENSION SET SMALL BORE 1 1 205.00 205.00 _1
I F YOU ARE PARTICIPATING IN A DISCOUNT PROGRAM (E.G. POIN S, GIFTS OR OTHER
PECIAL AWA DS "DISCOUNT WITH THIS PURCHASE YOU HAVE EARNED A CRET1i"' TOWARD
GOODS OR SERVICES, RECEIVABLE OR REDEEMABLE N ACCO DANCE WITH DISCOUNT PROGRAM
RULES. UPON DISCOUNT RECEIPT OR REDEMPTION, yOU 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 SUCH V LUE.- PND UPON ANY S CH
EO_UEST, SU H VALUE MUST BE DISCLOSED AS A DI COUNT kGAINSq THE PURCHASES THAT
ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN TH SE RECORDS.
MERCHANDI E TOTAL 527.20
INVOI7 TOTAL 527.20
PLEASE PAY WITHIN THIRTY(3 DAYS OF RECEIPT OF THIS NVOICE. 527.20
BIL i o INVOICEW INVO M TAb ITEM STATUS KEY' REM KEY
1308571 1817102 8810708-01 5 2 7 2 0 B- Backordered; Item will fol SK School Kit
D Discontinued: Item no longer available NC -No Charge
I D R DATE t7V F E P Special Schein Free Goods
M Manufacturer will ship hem directly to you
87735538 01 14 11 1/14/11 1 P Prescnption Drug: Retum Authorization Required
CUSTO PO FA R Refrigerated lwm: May he shipped separately
Special Schein Pncing
MARK 1 OF 2 T Ta. able he. unavailable: please reorder
Continued on Next Page
LP300
HENRY CHEIN
Matrx Med SHIP TO /SOLD TO:
Carmel Fire Department MI
135 Duryea Road, Melville, NY 11747 IN 540 w 136 St
Station 46 Michael Kaufmann
Carmel,IN 46032 -8806
010000130857 108810 708110010000000527200114113 BILL TO:
Carmel Fire Dept MI
2 Civic Sq
Carmel, IN 46032 -7543
Carmel Fire Dept MI
2 Civic Sq BILL, pro stile io:: INVOICE TOTAL
Carmel, IN 46032 -7543
1306571 1817102 527.20
INVOICE INVOICE DATE
8810708 -01 1/14/11
CUSTOMER'PO
N-ARK
Please detach here and mail the above with your payment
HSI ORDER ORDER
L 8773SS38 01/14%11
WHSE DEA# RHO] 62494 Fed ID: 11- 3136595
1 W G n e a
W S
Fes
u !8 a a N E.. g
LEASE NOTE NEW REMIT TO ADDRESS
P lease remi payments only to the following a dress:
H ENRY SCHEIN INC.
D EPT CH 102 1
ALATINE, I 60055 -0241
13ILL TO S HIP TO INVO ICE:# INVO TO TAL ITEM STATUS KEY REM ICEY
1308571 1817102 8810708-01 52 7 .20 13 Backordered: Item will follow sx school it
Dtscominued: Item no longer available NC No Charge
HSI RD R ORDER DATE BOXES
F- Special Schein I'na; Goods
87735538 01 14 11 1/14/11 1 M Manufacturer will ship 9cm directly io you
P Prescription i)rug: Return Authoriiatiao Required
R Refrigerated Item: May he shipped separately
CU STOMER P E
Special Schein Pricing
U Tempofanly unavailable: please reorder
MARK 2 OF 2 T Taaabie Item
LP300
HENRY SCHEIN
Matrx i z E Y
i
:el rn< ke iery effaE' t^ ainta prii es tar the duration of a Payment by CHECK car by the HENRY HEIN CREoir CARO,
catalog, o a' =cr, v. reserve the right to make price adjust
o s 1n VISA, MASTERCARD, DISCOVER and AMERICAN EXPRESS
response to manufacfur2rs` price changes
Guaranteed Satisfaction:
It ,vou have tr.ed a oro:fuc and it is detedive or does not of perlo
or
Bi ll Your Or s, To Your Open Account i
satlstac`•Orily, fie will prov de a (:rBdit, refund, or exchange; Its vour t
&nice. Simp y oa`l our cusforner seriice det)ar a, :en1 vx^ thin 30 days
o A,�ilab:e to licensed p[a it F,r.ar- r t ll... A'1 invoic« s are
f reci i:t of tf3e rner4f ar dise to arrange is r th return. t"or a
payable Mth n 30 days,
yv;arranly pair or if you v ere sent, something you did not order,
s call: x Products Controlled Substances,
atrx Medical 1-500 545-3550
cif gulat €on-r r °quire us to liml the sale of Rx and contrelle-d
substances on" to registered, icenseu �ealthc<.re p[ateasionals.
if you are a n9 «rd customer or have recep.tly rnruveiJ, please tun€ is l
us ,arith a copy of your updated state registration. For controlled
substances, furnish a copy of your DEA cediiicafe, verifying your
shipping a.tdrr ss. Glass 11 dwas can be orderer( only by mail.
Int ernationa l Orders:
P le a se tot
�r� EPtEG t7an piA ^a tFG e {iJtpm Pif ri fly' P1Qt 1 8 Cet rn2d t r We proudly serve healthcare profosskcntaIs an,! governments
c,edit, b is it be repa ed or r «P;placo t fine word, o pace orders or for nqu r€es en export
3 r iG iii s "t44v[��ttnCE!'�[fl
lerei and conidtions, pi coon °act o w I? 4 ernational Department:
manufa rer ^.<;rr Be`orr opening hz or X00 d `6
equip l le �Yv�e s pit that, yo ::hG ill to e s I pp ng co
and pa&i"g tist to y ou ave raceivee exactly' ivihat
you ordered.Opened Corp «fQr Software is not returnable. Prescription Drug Set rns Instructions:
Other restrictions may also;ppp'y. h
ri Return ?uthorization is Required for al' t re.sciption Drugs. Si€�lply call
our Service Depar went 800.845 -3550.
VOUCHER NO, WARRANT NO.
ALLOWED 20
Henry Schein
IN SUM OF
Dept Ch 10241
Palatine, I!_ 60055
$527.20
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
1120 I 8810708 -01 I 102 390.11 $527.20 I 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
JAN 3 1 2011
r
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))
8810708 -01 $527.20
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