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Home My WebLink About195064 03/02/2011 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1 O ONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: $2,773.35 CARMEL, INDIANA 46032 DEPT CH 10241 PALATINE IL 60055 -0241 CHECK NUMBER: 195064 CHECK DATE: 31212011 DEPARTMENT ACCOUNT P O NUM I NUMBER AMOUNT DESCRIPTION 102 4467006 4384633 -02 721.00 EMS EQUIP 102 4239011 4385741 78.00 SPECIAL DEPT SUPPLIES 102 4239011 5057936 -01 1,974.35 SPECIAL DEPT SUPPLIES HSI ORDER# ORDER DATE 88280974 02/01/11 WHSE DEA# RHO162494 Fed 1D: 11-3136595 PS a•n o ...p 4 his order ias been processed by our MIDWEST M.C. 5315 WES 74TH TREET INDIANAP LIS,TN 46268 MIDWEST D.C. State Lic 23 00304 1 827 -2329 EA SUCTION UNIT W /DISP CANN 1 1 C 721.00 721.00 1 ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. F YOU ARE ARTICIPATING IN A DISCOUNT PROG (E.G. POINTS, 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. UPO4 DISCOUNT RECEIPT OR REDEMPTION, CU ARE RECET ING OR WILL R CEIVE OTICE OF T E DYSCOUNT.VALUE. FROM TIME TO TI E, MEDICARE, MEDICAID', TRT ARE'OR THER PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, IND UPON ANY Sl CH R EQUEST, SU H VALUE MUST BE DISCLOSED AS A DI COUNT %GAINS71 THE PURCHASE THAT E ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN THESE RECORDS. MERCHANDI E TOTAL 721.00 INVOI E TOTAL 721.00 PLEASE PAY WITHIN THIRTY(3 DAYS OF RECEIPT OF THIS NVOICE. 721.00 LEASE NOTE NEW REMIT TO ADDRESS P lease remi payments only to the following a dress: H ENRY SCHEI INC. D EPT CH 10211 ALATINE, 11 60055 -0243 HILL TO SHIP To 'INV INVO T TAL ITEM STATUS KEY REM KEY 1308571 1308572 4384633 -02 721.00 li Nickordcrcd:hcmwiuiouow sK school HST QRDFR4 ORE)EF DA INV ATE F H XE D Ih+ConlinttCd: hcm no longer available NC- No Charge F Special Sohcin 1 Goods 1 M- ManulacLUmr will ship Rem dircc Lly lo you 8 6280974 02 2/ 09/11 P NmSCription Drug: R11um AllLhori --ion Rcyuircd ER P E R Rcl6gcreLCd Ilan: May 1 shipped sepuratcly Special Schein Pricing U -Temporarily unavailahlc: plcas'c rcordcr MARK I OF l T- Taxahlc Ilan 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, i e reserve the right to make price adjustments in VISA, MASTERCARD, DISCOVER and AMERICAN EXPRESS response to manufacturers' price changes Guarantees! Satisfaction; visa. It 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 US. All invoices are of receipt of the merchandise to arrange for the return. For a payable within 30 days. 1,varranty 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 onl °v 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; P lease N ate: Opened handpieces and equipment may not be returned for We proudly serve healthcare professionals and governments credit, but wall 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, :are 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. HSI ORDER ORDER DATE. 88281266 02/01/11 WHSE DEA# RHO162494 Fed ID: 11-3136595 17- 428 -878 MARK 1 499 -7139 EA ECONO 4PACK CARRY BAG ONL 3 3 26.00 78.00 P RODUCT IS 3EING SHIPPED TO YOU DIRECTLY FROM THE MAqUFACTLRER. F YOU ARE ARTICIPATING IN A DISCOUNT PROG (E.G. POIN S, GIFTS: OR O HER PECIAL AWA DS "DISCOUNT")),. WITH THIS PURCH SE YOU HAVE EARNED A CREDI TOWARD GOODS OR SERVICES, RECEIVABLE OR REDEEMABLE N ACCO DANCE WITH DISCOUNT PROGRAM RULES, UPOZ DISCOUNT RECEIPT OR REDEMPTION, OU ARE RECEI ING OR WILL R CEIVE 0TICE OF T E DISCOUNT VALUE..FROM•TIME TO TI E, MED CARE; MEDICAID; TRI ARE OR THER PAYER MAY REQUEST INFORMATION.REGARDING SUCH VALUE, D UPON ANY S CH R EQUEST, SU H!VALUE MUST.BE "DISCLOSED AS A DI COUNT %GATNS5 THE PURCHASE THAT E ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD-RE AIN THESE RECORDS. MERCHANDI E. TOTAL 78.00. INVOI E TOTAL 78.00 PLEASE PAY WITHIN THIRTY(30) DAYS OF RECEIPT OF THIS NVOICE. 78.00 LEASE NOTE NEW REMIT TO ADDRESS P lease remi payments only to the following a dress: H ENRY SCHEII INC, EPT CH 10211 ALATINE, 2 60055 -0241 BILL To S HIP To TUVO INVOIC13 TOTAL ITEM STATUS KEY REM KEY 1308571 1308572 4385741 -01 78.00 H- Ibrkurdued ;Item il[follow SK SchoolKit R RD INV I F BOXES 1) Diticontomed�. lien] ao longer available INC No Charge HSI F Special Schein Free Goods M Manafacturer will ship Item directly to you 88281266 02 0 1 11 2/11/11 l' Fres —ption D ug; Retura Amhorization Rcyuired CUSTO POP R Refrigerated llem; May be shipped separately PA E 5pccia7 Schcio I'iicing U Temporarily unavailable: please reorder MARK 1 OF 1 T- Tauhlc Item L Payment 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, HASTERCARD, DISCOVER and AMERICAN EXPRESS response to manufacturers' price changes Guaranteed Satisfaction: I If you have tried a product and it is detective 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- 800 8453550 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 DA certificate verifying your shipping address. Class II drugs can be ordered only by mail. International Orders: Please Nate. 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 Authorisation is Required for all Prescription Drugs, Simply call our Customer Service Department 1- 800 845 -3550. r VIA HSI ORDER# ORDER DATE 88727560 02/17/11 WHSE DEA# RH0162494 Fed ID: 11- 3136595 F 6 -x ^o. x� S a Y:. ....a.. �k a >(..F '•yJ,h `rF n` Sze i aH�. his order ias been processed by our MIDWEST P.C. 5315 WES 74TH STREET INDIANAP LIS,IN 46268 MIDWEST D.C. State Lic 23 00304 vIARK 317-572663 1 602 -8100 EA COLLAR STIFNECK SELECT ADULT 100 100 C 5.75 575.00 2 ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. 2 107 -0530 100 /BX PURPLE NITRILE PF GLOVE LARGE 30 30 C 8.50 255.00 5 ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. 3 107 -0502 100 /BX PURPLE NITRILE PF GLOVE MEDIUM 10 10 C 8.50 85.00 6 ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. 4 360 -1359 EA SAM SPLINT ORANGE /BLUE 36X4.25 24 24 6.75 162.00 9 5 879 -8581 30 /PK MEDI -TRACE SNAP FOAM ELEC 530ECG 60 60 C 4.50 270.00 8 ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. 6 102 -4985 100 /CA EXTENSION SET SMALL BORE 4 3 205.00 615.00 9 ARTIAL SHI MENT WILL SHIP AND INVOICE WHEN AVAILA LE. 7 987 -8154 PU 100 /BX SYR DISP 3CC W/22X11/2 LUERLCK 1 1 12.35 12.35 9 F YOU ARE ARTICIPATING IN A DISCOUNT PROG (E.G. POIN S, GIFTS OR HER PECIAL AWA DS "DISCOUNT WITH THIS PURL SE YOU HAVE EARNED A CREDI TOWARD BIL To SHIP TO INVOICE INVOICE4 INVOICE T OTAL ITEM STATUS KEY RM KEY E 1308571 1817102 5057936 -01 1974.35 n Harkordcr l Item witltbtlow SK School Kit �Hsl ORDER# RDE E AT ES 1) Disu atiuucd. Item no longer availuhle NC Nu Charge T Special SLI16n free GoudS 2/17/11 10 M- Manufacturer will Ship Item directly to you 68727560 02/17/11 P PrreseOplion Drug; Return Authorization Required TOMER P P R Rclrigcrawd Item. May he shipped :separately Special Schein Pricing U Temporarily unavailable; please reorder I MARK 1 OF 2 T Ta- bleItem Continued on Next Page LP300 HENRY SCHE .I Matrx Med SHIP TO /SOLD TO: VOIC I� Carmel Fire Department MI 135 Duryea Road, Melville, NY 11747 540 w 136 St Station 46 Michael Kaufmann Carmel,IN 46032 -8806 010000130857105057936110010000001974350217110 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 I INVOICE T0TA' Carmel, IN 46032 -7543 1306571 1817102 1 1974.35 INVOILCE# INVOICE DATE- 5057936 -01 2/17/11 CCISTOMER P0 MARK Hcasc detach here and mail the above with your payment HST ORDER ORDER': DATE 88727560 02/17/11 WHSE DEA# RHO162494 Fed ID: 11-3136595 R mm GOODS OR SERVICES, RECEIVABLE OR REDEEMABLE N ACCO DANCE WITH DISCOUNT PROGRAM RULES. UPON DISCOUNT RECEIPT OR REDEMPTION, IOU ARE RECEI ING OR WELL RECEIVE OTICE OF THE DISCOUNT VALUE. FROM TIME TO TIME, MEDICARE, MEDICAID, TRI ARE OR O 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 AGAINSU THE PURCHASE THAT E ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE 7 AIN TH sSE REC ORDS, MERCHANDI E TOTAL 1974.35 INVOI E TOTAL 1974.35 PLEASE PAY WITHIN THIRTY(3 DAYS OF RECEIPT OF THIS NVOICE. 1974.35 P LEASE NOTE NEW REMIT TO ADDRESS P lease remi payments only to the following a dress: H ENRY SCHEIJ INC. D EPT CH 10211 ALATINE, I 60055 -0241 ILL TO >T I NVQICP TOTAL ITEM STATUS KEY REM KEY 1308571 18117102 5057936 -01 1974.35 B- Hackordered.licmwillfollow SK SchoolKit HSY ORDE A E NV ATE B E D Discontinucd; item no lnagcr available NC- No Charge 4 OF h Special Schein Free Goods 17 11 2/17/11 10 M Manufacturer will ship Item directly to y ou 88727560 0 2 P Prescription Drug; Return Authorization Required STONER k Refrigerated hem; May be shipped separately Special Schein Pricing U -Temporarily unavailable; please reorder MARK 2 OF 2 T- 'paxahie ltcm LP300 s. -A HENRY SCHEIN" T ERMS 0 A Matrx Medical Payment .No make every o1w.1 to maintain prices for the durat or of a Payment by CHECK or by the HENRY SCHSIN CREOIT CARD. cata og, however, ,e rese, =je the right to make price adjustment s i VISA, MASTERCARD, D ISCOVER and AMERICAN XPR SS response to manutactiTers' price changes G uaranteed Satisfaction: If v ou- have triad a product and it is detective or does not perfonm, or satisfactorily, we wilt orcv de a credit, refund, or exchange; it's your fi l rr roer To Your Open Acco r3 cn .3ce. 5i €rr ca l our cuslorner service depar[men` w&ii 30 :lays Avai :ab e to licensed prat t €t!a ers p`. of rG€ sipt f thu rnerOn dis4 tc arra €age fu €the return. Frr a pay< ;b. within ;?0 days, warranty r >e, air €3r it you were sera something you did of order, si pl,- platl:' Rx Products Controlled Substances: atrx Medical 1-800-845-3550 fie gulat of s. require us to limit the s< i of fax and €;ortr lied sr,hstances ortiy to registered, licensed healthcare professionals. If you are a new customer -or have rece moved, please fur, ish us with a copy; of updated state registration. For controlled substances, furnish a'copy of your DEA certificate, verifying your Shipping address, Class it drutys can be ordered onid Lw €nail, International Orders: Please tvota.° C erec Eland ,a cs ai d equipment a sat be returned t .r We proudly servo healthcare professionals and governments p p y throughout the word. To p €ace -order- or for'gik i es on exporf credit, but be repai ed or replaced in accordanc€ ,oilh terms and" conditions, please contact our Depa- Iment; manl lactturej :9s, Botore opening t':andpiece "s or �j�jC} g45 a5 v e( €<ipme,nt, vie suggest (hal you c hack the shipping con':.ainer and pack r`a list to verity that ycu have received exactly 1n�hat you o dered.Opened Computer Software is not returnable. Prescription Dry Returns Instructions: Other restrictions may also apply. A Return Authorizat on is Required for all PrpscrVium :.)rugs. S,niply call our i ustomer L ervice Piepar ment t- 800.84D- 3550, VOUCHER NO. WARRANT NO. ALLOWED 20 Henry Schein IN SUM OF Dept Ch 10241 Palatine, IL 60055 $2,773.35 i I ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# 1 Dept. INVOICE NO. ACCT #/TITLE AMOUNT' Board Members 1120 4384633 -02 102 670.06 $721.00 1 hereby certify that the attached invoice(s), or 1120 4385741 102 390.11 $78.00 bill(s) is (are) true and correct and that the 1120 I 5057936 -01 1 102- 390.11 I $1,974.35 materials or services itemized thereon for which charge is made were ordered and received except FEB 2 8 2011 Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund Prescribed by State Board of Accounts City Form No. 2011 (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)) 4384633 -02 $721.00 4385741 $78.00 5057936 -01 I I $1,974.35 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