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HomeMy WebLinkAbout194611 02/16/2011 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1 ONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: $2,561.99 .r CARMEL, INDIANA 46032 DEPT CH 10241 PALATINE IL 60055 -0241 CHECK NUMBER: 194611 CHECK DATE: 2/16/2011 DEPARTMENT ACCOU PO NUMBER I NUMBER AMOUNT DESCRIPTION 102 4239011 2919321 -01 31.50 SPECIAL DEPT SUPPLIES 102 4239011 3231281 -01 412.00 SPECIAL DEPT SUPPLIES 102 4239011 4384633 -01 236.16 SPECIAL DEPT SUPPLIES 102 4239011 9193598 -01 144.00 SPECIAL DEPT SUPPLIES 102 4239011 9470998 -01 1,332.49 SPECIAL DEPT SUPPLIES 102 4239011 9522245 -01 405.84 SPECIAL DEPT SUPPLIES HSI ORDER# ORDER DATE 85987589 11/05/10 WHSE DEA# RHO162494 Fed ID: 11- 3136595 1 499 -5839 EA PICK PLUCK FOAM INSERT 6 6 5.25 31.50 PRODUCT IS BEING SHIPPED TO YOU DIRECTLY FROM THE MAqUFACTLRER. OUR ORDER 35987589 HAS BEEN SPLIT INTO MULTI LE SHI MENTS. CERTAIN ITEM WILL E SHIPPED EPARATELY. YOU WILL BE BILLED FOR THESE ITEMS HEN THEY ARE HIPPED. F YOU ARE ARTICIPATING IN A DISCOUNT PROGRAM (E.G. POIN S, GIFTS OR OTHER PECIAL AWA DS "DISCOUNT WITH THIS PURL SE YOU HAVE EARNED A CREDI TOWARD GOODS OR S ERVTCES, RECEIVABLE OR REDEEMABLE IN ACCO ZDANCE WITH DISCOUNT PROGRAM RULES. UPO4 DISCOUNT RECEIPT OR REDEMPTION, OU ARE RECEI ING OR WILL RECEIVE OTICE OF T E DISCOUNT VALUE. FROM TIME TO TI E, MEDICARE, MEDICAID, TRI ARE OR THER PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, PND UPON ANY S fC EQUEST, SU H VALUE MUST BE DISCLOSED AS A DI COUNT CAINSU THE PURCHASE THAT EARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN TH SE RECORDS. MERCHANDI E TOTAL 31.50 INVOICE TOTAL 31.50 PLEASE PAY WITHIN THIRTY(SC) DAYS OF RECEIPT OF THIS NVOICE. 31.50 LEASE NOTE NEW REMIT TO ADDRESS lease remi :payments only to the following address: ENRY SCHEI4 INC. DEPT CH. 102 11 ALATINE, I 60055 -0241 L L TO SHIP TO Mvc)IcEit INVOICE TOTA ITEM STATUS KEY REM KEY 1308571 1308572 2919321 -01 31.50 It- Backordered; Item will follow SK SehoofKit HSI O RDER111 ORDER DATE DATE It OF BOXES D Discontinued; Item no longer available NC- No Charge F Speoid Sehoin I— Goods M Manufacturer will ship [loin direCtly to you 85987589 11/05/10 2/02/11 1'- Prescription Drug: Return Authorisation Required CUSTO R Refrigerated Item: May be shipped separately Special Schein Pricing U Temporarily unavailable: ploasc reorder I MARK 1 OF 1 T- 'taxable Item 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: 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 nt 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, 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 II drugs can be ordered only by mail. International Orders: Pleas 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 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 cal! our Customer Service Department 91 -800- 845 -3550. ,4 �E a E U 0 HSI 11P011R1 ORDER DATE• 88325103 02/03/11 WHSE DEA# RHO] 62494 Fed ID: 11- 3136595 This order has been processed by our MIDWEST D.C. 5315 WEST 74TH TREET INDIANAP LIS,IN 46268 MIDWEST D.C. State Lic 23 00304 1 220 -1398 3 /ST BODY STRAP SET DISP YELLOW 100 100 5.95 595.00 1 2 108 -2772 10 /CA MEGAMOVER PLUS TRANSPORT STRETCH 1 1 C 231.94 231.94 3 HIS PRODUCU IS BEING SHIPPED FROM OUR WEST C AST DI TRIBU ION CENTER. ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. 3 130 -3957 KIT SYSTEM 5 MULTICUFF BP KIT BLUE 5 5 101.11 505.55 1 F YOU ARE ARTICIPATING TN A DISCOUNT PROGRAM (E.G. POINTS, GIFTS OR OTHER PECIAL AWARDS "DISCOUNT WITH THIS PURL SE YOU HAVE EARNED A CREDI TOWARD GOODS OR SERVICES, RECEIVABLE OR REDEEMABLE IN ACCORDANCE WITH DISCOUNT PROGRAM RULES. UPOU DISCOUNT RECEIPT OR REDEMPTION, tOU 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 REGARDING SUCH VALUE, IND UPON ANY SlICH EQUEST, SU H VALUE MUST BE DISCLOSED AS A DI COUNT AGAINSI THE PURCHASES THAT ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN TH SE RECORDS. MERCHANDI E TOTAL 1332.49 INVOI E TOTAL 1332.49 PLEASE PAY WITHIN THIRTY(3 DAYS OF RECEIPT OF THIS INVOICE. 1332.49 LL I ITEM STATUS KEY REM KEY 11308571 1308572 9470998 -01 1332.49 II Backordcred :Item will rollow SK School Kit D Discontinued: Item no longer available NC No Charge I DER RD DATE d F B X I Special Schein Free Goods 88325103 02/03/11 2/03/11 P M- Manufacturer willship Item directly w you Prescription Drug: Return Authorization Required R Refrigerated Item: May he shipped separately M P Spcciul Schein Pricing U Temporurily unavailable; please reorder MARK 1 OF 2 T Taxable Itcm Continued on Next Page LP300 HEI HENRY SI�,T Matrx Medical SHIP TO /SOLD TO: 135 Duryea Road, Melville, NY 11747 IN 2aCitvicFSre Dept Head Quarters MI 4 Carmel,IN 46032 -2584 010000130857], 09470998 ],1001000000],332490203118 BILL TO: Carmel Fire Dept MI 2 Civic Sq Carmel, IN 46032 -7543 Carmel Fire Dept MI 2 Civic Sq HILL TO I SHIP TO I INVOICE TOTAL Carmel, IN 46032 -7543 1308571 1308572 1332.49 INVOTCE# I INVOICE DATE 9470998 -01 2/03/11 CUSTOMER PO MARK Please detach here and mail the above with your payment HSI ORDER ORDER DATE 88325103 02/03/11 WHSE DEA# RHO162494 Fed ID: 11- 3136595 LEASE NOTE NEW REMIT TO ADDRESS Please remi payments only to the following a dress: ENRY SCHEIN INC. DEPT CH 102 1 ALATINE, U 60055 -0241 L TO SHIP TO TNVQIrFfi INVOICE TOTA ITEM STATUS KEY REM KEY 1308571 1308572 9470998 -01 1332.49 H- liackordmcd: Item will follow 9K-Schno1Kit i RD DER D E BOXES D Discontinued; Item no longer available NC Nn Charge P Special Schcin Pree Goods 88325103 02/03/11 2/03/11 3 M- Manul'acturcr will ship Item directly to you P- Flcseription Drug; Return Authorization Required R Refrigerated Item: May be shipped separately E PA E SpcetiaL Schein Pricing U Temporarily unavailable: please reorder MARK 2 OF 2 T Taxable Item LP300 I ENRY C HEIN trx 3 Med T ERMS OF S AL E �I Payrnent Ternis: 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: It you have tried a product and it is detective or does not perform or Bill Yo Or T o Your Open curet 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 within n days. 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 1 -800- 845 -8550 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 verifying your shipping address. Class II drugs can be ordered only by mail. International Orders: Please N 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 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 Return Authorization is Required for all Prescription Drugs. Simply call our Customer Service Department 9- 1- 800 845 -3550. y i ®R, E I E I E N N HSI ORDER ORDER DATE 88280974 02/01/11 WHSE DEA# RHO162494 Fed ID: 11- 3136595 This order has been processed by our MIDWEST D.C. 5315 WES 74TH TREET INDIANAP LIS,IN 46266 MIDWEST D.C. State Lic 23 00304 1 827 -2329. 'EA SUCTION UNIT W /DISP:CANN 1 B 0.00 0.00 ITEM BACK O DERED, WILL FOLLOW SHORTLY 2 203 -3856 EA SURETEMP PLUS THERM ORAL 4' CORD 1 1 225.00 225.00 1 3 499 -1918 EA RING CUTTER 2 2 5.58 11.16 1 F YOU ARE ARTICIPATING IN A DISCOUNT PROG (E.G. POINTS, GIFTS OR or HER PECIAL AWA DS "DISCOUNT")), WITH THIS PURL SE YOU HAVE EARNED A CRIED I TOWARD GOODS OR SERVICES, RECEIVABLE OR REDEEMABLE IN ACCO DANCE WITH DISCOUNT PROGRAM RULES. UPOR DISCOUNT RECEIPT OR REDEMPTION, OU ARE RECEI ING OR WILL R CEIVE OTICE OFT HE DISCOUNT VALUE.. FROM TIME TO TI E, MED CARE, MEDICAID, TRI ARE:OR THER PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, PND UPON ANY S CH EQUEST„ SU H VALUE MUST BE:DISCLOSED.AS A DI COUNT AGAINSI THE PURCHASES THAT EARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN THESE RECORDS. MERCHANDISE TOTAL 236.16 INVOICE TOTAL 236.16 PLEASE PAY WITHIN THIRTY (3 DAYS OF RECEIPT OF THIS NVOICE. 236.16 BI LL TO SHIP TO INVOICF4 TNVQTCF T07A ITEM STATUS KEY REM KEY 1308571 1308572 4384633 01 236.16 R- 13aAordered: Item will follow SK- SchoolKir ORD ER DATE INVOICE DATE 4 OF BOXES I) Discontinued: Item no longer available NC No Charge F Special Schein free Goods 01 11 2/02/11 1 M Manufacturer will ship Item directly to you 88280974 0 2 P prescription Drug: Return Authorization Required R Refrigerated Item: May he shipped separately Special Schein Pricing U Temporarily unavailable: please reorder MARK 1 OF 2 T- Taxable Item Continued on Next Page LP300 HENRY SCHEIN Matrx SHIP TO /SOLD TO: Med 135 Duryea Road, Melville, NY 11747 INVOICE 2aCivicFSre Dept Head Quarters MI q Carmel,IN 46032 -2584 010000130857104384633110010000000236160202 7,12 BILL TO: Carmel Fire Dept MI 2 Civic Sq Carmel, IN 46032 -7543 Carmel Fire Dept MI 2 Civic Sq BILL. TO I SHrP TO INVOICE TOTAL Carmel, IN 46032 -7543 1308571 1 1308572 236.16 INVOICE INVOICE 4384633 -01 2/02/11 CUSTOMER PO MARK Please dclach here and mail the above wish your payment HST OPDER# ORDER ©ATE 88280974 02 /01 /1I WHSE DEA# RHO] 62494 Fed ID: 11-3136595 LEASE'NOTE NEW REMIT TO ADDRESS lease remi payments only to the following address: ENRY SCHEIN INC. EPT CH 1021 ALATINE, I 60055 -0241 I NVOICE4 rNV OT CE TOTAL ITEM STATUS KEY REM KEY 1308571 1308572 4384633 01 236.16 e- 13ackordcrcd: Item will follow SK- School Kit RDER RDER D E D Discaminucd: Item no longer available NC No Charge 1 Special Schein Frec Goods 88280974 02 01 11 2/02/11 M Manuracturer will ship Item directly to you P Prescription Drug: Return Authorization Required R Refrigerated Item: May be shipped separately CUSTOMER PO# A E Special Schein I'riciag U Temporarily unavailable: please reorder MARK 2 OF 2 T TaxahleItem LP300 HSI ORDER# ORDER DATE 87999501 01/21/11 WHSE DEA# RHO 162494 Fed ID: 11- 3136595 7 order' as been processed by our MIDWEST .C. 5315 WES 74TH 3TREET INDIANAP LIS,IN 46268 MIDWEST D.C. State Lic 23 00304 RK 317-517-2663 17- 428 -878 1 677 -;4617 EA BRASS REGULATOR W /FLOW 2 DISS 2 2 72.00 144.00 1 F YOU-ARE DARTICIPATING IN A DISCOUNT PROGRAM (E.G. POIN S, GIFTS OR OTHER PECIAL AWARDS "DISCOUNT WITH THIS PURC SE YOU HAVE EARNED A CREDI TOWARD GOODS OR S RVICES, RECEIVABLE OR REDEEMABLE N ACCO DANCE WITH DISCOUNT PROGRAM RULES. UPON DISCOUNT RECEIPT OR.REDEMPTION, OU ARE RECEI ING OR WILL R CEIVE OTICE OF TEE DISCOUNT VALUE. FROM TIME TO TI E, MEDICARE, MEDICAID, TRI ARE OR THER PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, PND UPON ANY S CH R EQUEST, SU H VALUE MUST BE DISCLOSED AS A DI COUNT GAINSa THE PURCHASE THAT E ARNED SUCH VALUE.: ACCORDINGLY, YOU SHOULD RETAIN THESE RECORDS. MERCHANDI E TOTAL 144.00 INVOI E TOTAL 144.00 PLEASE PAY WITHIN THIRTY(3 DAYS OF RECEIPT OF THIS NVOICE, 144.00 LEASE NOTE NEW REMIT TO ADDRESS P lease remi payments only to the following a dress: H ENRY SCHEIN INC. D EPT CH 10211 ALATINE, I 60055 -0241 TNVOICE4 INVOICE TOTAL ITEM STATUS KEY REM KEY 1308571 1308572 9193598 -01 144.00 H- Backordered: hem will rohow SK- School Kit ER 8 1) Discontinued: Item no longer available NC No Charge HSI F Special Schein Free Goods M Manuracmrer will ship hem directly to you 87999501 0 1/ 2 1/ 11 1/21/11 1 P- Prcw;riptinn Drug: Return Authorization Required R- Rel igeraied Item: Maybe shipped u pamlcly CUSTOME Special Schein Pricing U Temporarily unavailable: rlcav rcordcr MARK 1 OF 1 'r Tax blcllem 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: If ou have tried a product and it is defective or does not perform or satisfactorily, we will provide a credit, refund, or exchange; it's 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, simply call: Rx Products Controlled Substances: Matrx Medical 1- 500 -845 -3550 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, verifying your shipping address. Class 11 drugs can be ordered only by mail. International Orders: Plea 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, 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 Return Authorization is Required for all Prescription Drugs. Simply call our Customer Service Department @1 -800- 845 -3550. END -RSI oRbmg ORDER` DATE 88175756 01/28/11 WHSE DEA# RHO 162494 Fed ID: 11- 3136595 his order ias been processed by our MIDWEST D.C. 5315 WES 74TH 3TREFT INDIANAP LIS,IN 46268 MIDWEST D.C. State Lic 23 00304 1 499 -0650 EA BREATHSAVER ULTRA ROYBLUE 1 1 C 250.00 250.00 1 ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. 2 565 -1031 100 /BX NITRILE PF GLOVE BLACK LARGE 20 20 8.10 162.00 2 F YOU ARE >ARTICIPATING 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 IN ACCO ANCE WITH DISCOUNT PROGRAM RULES. UPON DISCOUNT RECEIPT OR REDEMPTION, YOU ARE RECEI ING OR WILL R CEIVE OTICE OF'T E DISCOUNT VALUE. FROM TIME TO TIME, MED CARE, MEDICAID, TRI ARE OR THER PAYER MAY REQUEST INFORMATION REGARDING SUCH VALUE, PND UPON ANY S CH EQUEST, SU H VALUE MUST BE DISCLOSED AS A DI COUNT AGAINSI THE PURCHASES THAT ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN THESE RECORDS. MERCHANDI E TOTAL 412.00 INVOI E TOTAL 412.00 PLEASE PAY WITHIN THIRTY(3 DAYS OF RECEIPT OF THIS NVOICE. 4.12.00 BILL 'TQ INVOI r# INVOICE li ITEM STATUS KEY REM KEY 1308571 1308572 3231281-01 412.0 0 n Backordered: Item wit] follow SK School Kit z A D Discontinued: Item no longer available NC NoCharge R ORDE Am B F Special Schein Free Goods 2 8 11 1/28/11 2 M Manufacturer will ship item directly to you 88175756 01 P- Prescription Drug; Return Authorization Required R Refrigerated Item; May be shipped separately S MEI2 e0 -Special Schein pricing U Temporarily unavailable: please reorder MARK 1 OF 2 T Taxahle ttem Continued on Next Page LP300 HENRY:SCHEN ]d Matrx SHIP TO /SOLD TO: Med 135 Duryea Road, Melville, NY 11747 INVOICE 2aCivicFSre Dept xead. Quarters MI 4 Carmel,IN 46032 -2584 0100001308571032312811100100000004 7,2000128119 BILL TO: Carmel Fire Dept MI 2 Civic Sq Carmel, IN 46032 -7543 Carmel Fire Dept MI 2 Civic SCI BILL TO, -SHIP T11 J INVOICE TOTAL Carmel, IN 46032 -7543 1308571 1308572 412.00 INVOICE' INVOICE DATE 3231281 -01 1/28/11 cuSTOMER PO MARK Please detach here and mail the above with your payment NSI: ORDER ORDER DATE. 88175756 01/28/11 WHSE DEA# RHO162494 Fed ID: 11- 3136595 LEASE NOTE NEW REMIT TO ADDRESS Please remi payments only to the following address: HENRY SCHEIN INC. DEPT CH 1 PALATINE, I 60055 -0241 '6ILL W SHIP TO iN E# NV I E ITEM STATUS KEY REM KEY 1308571 1308572 3231281 -01 412.00 B Baekordered: Item will follow SK School Kit 1) Discontinued: Item no longer available NC -No Charge R :'ORDER DATE NV ATE F Special Schein Free Goods 88175756 01/28/11 1/28/11 2 I' M Manufacturer will ship Itemdirecdy you Prescription Drug; Return Authorization Required :CUST OMER e R Refrigerated Item; May be shipped sepamlcly Special Schein Pricing U Temporarily unavailable; please reorder MARK 2 OF 2 T T- abletern LP300 HS L. ORDER ORAER.DATE-: 88170436 01/28/11 WHSE DEA# RHO162494 Fed ID: 11- 3136595 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 RK 317 -42 -8784 17 -571 -266 1 890 -6668 3 /PK LIFEPAK 12 PAPER EKG 24 24 10.91 261.84 1 2 677 -4617 EA BRASS REGULATOR W /FLOW 2 DISS 2 2 72.00 144.00 2 HIS PRODUCC IS BEING SHIPPED FROM OUR SOUTHW ST DIS RIBUT ON CENTER. F YOU ARE DARTICIPATING IN A DISCOUNT PROG (E.G. POTN S, GIFTS OR OTHER PECIAL AWA DS "DISCOUNT WITH THIS PURC SE YOU HAVE EARNED A CREDI TOWARD GOODS OR SERVICES, RECEIVABLE OR REDEEMABLE N ACCO ZDANCE WITH DISCOUNT PROGRAM RULES. UPON DISCOUNT RECEIPT OR REDEMPTION, 'IOU ARE RECEI ING OR WILL RECEIVE N OTICE OF T E DISCOUNT VALUE. FROM TIME TO TI E, MED CARE, MEDICAID, TRI ARE OR THER PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, D UPON ANY S CH R EQUEST, SU H VALUE MUST BE DISCLOSED AS A DI COUNT GAINSU THE PURCHASE THAT ARNED.SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN THESE RECORDS. MERCHANDI E TOTAL 405.84 INVOI E TOTAL 405.84 PLEASE PAY WITHIN'THIRTY(3 DAYS OF RECEIPT OF THIS NVOICE. 405.84 ILL S TO ITEM STATUS KEY REM KEY 1308571 1308572 9522245 -01 405.84 u Bacl.ordered;Item will follow F -school Kit 5 R 4RF)E E 65 Discontinued; Item no longer available C No Charge P Special Schein Free Goods 11 1/28/11 2 M- Manufacturer will ship Item directly to you 88170436 O 1 2 8 P Prescription Drug: Return Authorization Required R Refrigerated Item: May be shipped separately CUSTOMER P 09 PA E' Special Schein Pricing U Temporaril unavailable; please reorder MARK 1 OF 2 T Taxable Item Continued on Next Page LP300 HENRY SCHE SHIP TO /SOLD TO: 135 Duryea Road, Melville, NY 11747 I NVOI CE 2aCivicFSre Dept Head Quarters MI q Carmel,IN 46032 -2584 01000013085710952224511001000 0000405840128118 BILL TO: Carmel Fire Dept MI 2 Civic Sq Carmel, IN 46032 -7543 Carmel Fire Dept MT 2 Civic S q BILL TO 1 SHIP TO I INVOICE'. TOTAL. Carmel, IN 46032 -7543 1308571 1308572 1 405.84 INVOICE4 INVOICE DATE 9522245 -01 1/28/11 CUSTOMER PO MARK Please detach here and mail the above with your payment HSIORDER ORDER DATE 88170436 01/28/11 WHSE DEA# RHO162494 Fed ID: 11- 3136595 ss ago s >«Ex wom LEASE NOTE NEW REMIT TO ADDRESS lease remit payments only to the following address: HENRY SCHEIN INC. D EPT CH 102:1 ALATINE, 11 60055 -0241 S HIP TO r TNVOIC INVOICE TOTAL ITEM STATUS KEY 7 RE MI r KEY 1308571 130 8572 9522245 -01 405.84 H Hacxardered.ltemwillfellow ulR E D Discontinued: Item no longer available Charge F Special Schein Free Goods 1/28/11 2 M Manufacturer .vmshipItemdirectl y ou 88170436 01/28/11 P Prescription Drug: Return Authorization Required R m Refrigerated Item: May be shipped separately CU STOMER P SpucWl 5chmn Pricing U Temporarily unavailable: please reorder MARK 2 OF 2 T Taxable Item LP300 VOUCHER NO. WARRANT NO. ALLOWED 20 Henry Schein IN SUM OF Dept Ch 10241 Palatine, IL 601055 $2,561.99 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members 1120 9470998 -01 102 390.11 $1,332.49 1 hereby certify that the attached invoice(s), or 1120 4384633 -01 102 390.11 $236.16 bill(s) is (are) true and correct and that the 1120 2919321 -01 102 390.11 I $31.50 materials or services itemized thereon for 1120 9522245 -01 102 390.11 I $405.84 which charge is made were ordered and 1120 3231281 -01 102 390.11 $412.00 received except 1120 9193598 -01 102 390.11 $144.00 FEB 14 2011 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)) 9470998 -01 $1,332.49 4384633 -01 $236.16 2919321 -01 I I $31.50 9522245 -01 $405.84 3231281 -01 $412.00 9193598 -01 $144.00 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