HomeMy WebLinkAbout195461 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