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Home My WebLink About195461 03/16/2011 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1 ONE CIVIC SQUARE HENRY SCHEIN INC CARMEL, INDIANA 46032 CHECK AMOUNT: $926.00 DEPT CH 10241 PALATINE IL 60055 -0241 CHECK NUMBER: 195461 CHECK DATE: 3/16/2011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 102 4239011 4696095 -01 721.00 SPECIAL DEPT SUPPLIES 102 4239011 5057936 -02 205.00 SPECIAL DEPT SUPPLIES HSI ORDER11 ORDER DATE 88875354 02/22/11 WHSE DEA# RHO] 62494 Fed ID: 11- 3136595 a all This order has been processed by our MIDWEST .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 PARTICIPATING IN A DISCOUNT PROG (E.G. POINTS, GIFTS OR Cr HER PECIAL AWA DS "DISCOUNT WITH THIS PURCHASE 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, OU ARE RECEI ING OR WILL RECEIVE OTICE OF TIE DISCOUNT VALUE. FROM TIME TO TI E, MEDICARE, MEDICAID, TRI ARE OR THER PAYER MAY REQUEST INFORMATION REGARDING SUCH V UE, PND UPON ANY S CH REQUEST, SU H VALUE MUST BE DISCLOSED AS A DI COUNT AGAINSq THE PURCHASES THAT EARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN TH ESE 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 Please remi payments only to the following a dress: ENRY SCHEIR INC. DEPT CH 10211 PALATINE,: I 60055 -0241 a` L Hip i VoicE# luvoigg TOTAL ITEM STATUS KEY REM KEY 1308571 1308572 4696095 -01 721.00 13 Backordered; Item will follow SK School Kit E 1) Discuminued Item no longer available- NC No Charga R X F Special Schein Free Goads 2/23/11 1 M- Manufacturer will ship ItemdimctlytoYOU 68875354 02/22/11 P- Prescription Drug; Return Authorization Required z ME p GE R Refrigerated Item; May he shipped separately Special Schein Pricing MARK 1 OF 1 T Ta able Be r n navailah[e: please reorder LP300 Payment Terms. We make osier v edolA to marita':prices tor the durafionof a 11 once adjustments Payment by CHECK or by the HENRY SCHEIN CREOIT CARO, catalog, hmp�lever, �we reserve fi:e right to make once VISA, MASTERCARD, DISCOVER andAMERICAN EXPRESS response t, manufacturers' price changes Guaranteed Satisfaction: or If you have Vied a Product and it is detective or does not,Derforrn Bill Your Ord T� o Your Open Account satisfactorily. will prov'dc- a credit, refund, or exchange it's your Available to licensed practitioners in the U.S. Alinvoices are choice, S[n)p v call our customer scrvice deuarlrrjerilvd'hin 30 days of re."Iciot of the rnerdhaj arrange f f or the return. For a payable within 30 days, -Narranty or it you were sent something you grid not order, s0ply "III: Rx Products Controlled Substances: Matra Medical 1-800-845-3550 Regulation require us to limit the sale of Rx anal controlled substances only to registered, licensed healthcare professionals. If you are a new customer or have recei illy moved, please fur ish us with a copy of your updated state reg'strallon, For controlled substances, furnish a copy of your DEA certificate, verify:nq hm� yo:!r shipping address. Class 11 drugs can. be ordered only by mail. International Orders: Please Note: We proudly servo healthcare prcfessi ovals and governments Opened handpieces and equipment rt ay not be returned for throughout the world. To 0ace orders or 1 crinq iries on export credit, but ,viii be repain d or replaced in accordance 1;viih terms and condil'uns, please contact our International Department manufacturer warranhes. Before opening handpieces or 1-800-845-3550 equipment, we suggest thiat y ou -heck the shipping container and oal&na list to ve t`'at you have received exactly what D you ordered,Opened Computer Software is not returnable. Prescription rug Returns Instructions: Other restrictions may also apply. A Return Mth:Ori2ation is Required for all Prescription Drugs. Simply call our Customer Service Deparnent 1-800.845-3550, r,iax u.1...111— au"— 11 y w yuyii11 HSI ORDER11 ORDER DATE 88727560 02/17/11 WHSE DEA# RH0162494 Fed ID: 11- 3136595 o t 9 f t t t tl tlt' his order as been processed, by our MIDWEST D.C. 5315 WES 74TH TREET INDIANAP LIS,IN 46268 MIDWEST D.C. State Lic#: 23 00304 ARK 317 -57 -2663 1 102 -4985 100 /CA EXTENSION SET SMALL BORE 1 1 205.00 205.00 .:1 F YOU ARE ARTICIPATING IN A DISCOUNT PROGRAM (E.G. POIN S, GIFTS OR or HER SPECIAL -AWARDS "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. UP0 DISCOUNT RECEIPT OR REDEMPTION, OU 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, P.ND UPON ANY.S CH REQUEST, SU H VALUE MUST BE DISCLOSED AS A DI COUNT AGAINS7 THE PURCHASE THAT EARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN THESE RECORDS. MERCHANDI E TOTAL 205.00 INVOI E TOTAL 205.00 PLEASE PAY WITHIN THIRTY(3 DAYS OF RECEIPT OF THIS NVOICE. 205.00 LEASE NOTE NEW REMIT TO ADDRESS lease remi payments only to the following a dress; ENRY SCHEIN INC. EPT CH 10211 ALATINE, I 60055 -0241 BIT ITEWSTATUS KEY REM KEY 1308571 1817102 5057936 -02 205.00 H- Hackordcred: Item will follow Sx School xiI I RDER ORDER DATE E D Discontinued: Item no longer available NC -No Charge 1=- Special Schein Free Goods M Martul'acturcr will ship Item directly to you 88727560 0 2/ 17 11 3/03/11 1 1' Prescription Drug: Return Authorization Required R Refrigerated Item: May be shipped separately CUSTO Special Schein lacing U Temporanly ana% please reorder MARK 1 OF 1 T Taxable Item L 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 "R� Guaranteed Satisfaction: If you have tried a product and it is defective or does not perform or satisfactorily, rage will provide a credit, refund, or exchange; it's your Bill Your Order To Your Opera 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: latrx Medical 1 -800 -545 -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: Please N ote: 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 manutacturer 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 1- 800 -845 -3550. m VOUCHER NO. WARRANT NO. ALLOWED 20 Henry Schein IN SUM OF Dept Ch 10241 Palatine, IL 60055 $926.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO Dept. INVOICE NO. ACCT #!TITLE AMOUNT Board Members 1120 4696095 -01 102 390.11 $721.00 1 hereby certify that the attached invoice(s), or 1120 5057936 -02 102 390.11 $205.00 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 MAR 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)) 4696095 -01 $721.00 5057936 -02 $205.00 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