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Home My WebLink About196381 04/13/2011 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1 b ONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: $2,708.54 CARMEL, INDIANA 46032 DEPT CH 10241 PALATINE IL 60055 -0241 CHECK NUMBER: 196381 CHECK DATE: 4/1312011 DEPARTM ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 102 4239011 4966709 -01 168.00 SPECIAL DEPT SUPPLIES 102 4239011 7828367 -01 21.00 SPECIAL DEPT SUPPLIES 102 4239011 7835202 -01 2,308.56 SPECIAL DEPT SUPPLIES 102 4239011 7835202 -02 210.98 SPECIAL DEPT SUPPLIES HSI ORDERIJ ORDER DATE DUE DATE 89876968 03/30/11 04/29/11 WHSE DEA# RH0162494 Fed ID: 11- 3136595 MW ne e o c °a r m om= s 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 1 .840 -9710 100 /BX BENZOIN TINCTUR AMPULE SQ 8 21.00 168.00 1 F YOU ARE PARTICIPATING IN A DISCOUNT PROG (E.G. POIN S, GIFTS OR 0-HER PECIAL AWARDS "DISCOUNT WITH THIS PURCHASE YOU HAVE EARNED A CREDI TOWARD GOODS OR SERVICES, RECEIVABLE OR REDEEMABLE N ACCO DANCE WITH DISCOUNT PROGRAM RULES'. UPO4 DISCOUNT RECEIPT OR REDEMPTION;. YOU ARE.RECEI ING OR WILL RECEIVE .IT OTICE OF TIE DISCOUNT VALUE. FROM TIME TO TIME, MEDICARE, MEDICAID, TRI ARE OR THER'PAYER MAY REQUEST�INFORMATION REGARDING SUCH V LUE, D UPON.ANY.SlJCH R EQUEST, SU H VALUE MUST BE DISCLOSED AS A DI COUNT GAINS7 THE PURCHASE THAT ARNED SUCH VALUE. ACCORDINGLY: SHOULD RE ATN THESE RECORDS'. MERCHANDI E TOTAL 168.00 INVOI E TOTAL .''168.00 I nvoice Date 30 days 168.00 LEASE NOTE NEW REMIT TO ADDRESS lease semi payments only to the following a dress: H ENRY SCHEI4 INC. D EPT CH; 102 1 ALATINE, I 60055 -0241 PILL TO SHIP TO iNVOICE9 INVOICE TOTAL ITEM STATUS KEY REM KEY 1308571 1308'572 4966709 -01 168.00 13 flackordered: hem will follow SK- school Kit DE ORDER DATE E I) Nsconunued Item no longer available NC No Charge F Special Schein Frcc Goods M- Manufacturer will ship hem directly to you 89876968 0 3/ 3 0/ 11 3/30/11 1 P Prescription Drug: Return Authorization Required CUSTO R- Refrigeraled Item: May he shipped uuparatcly Special Schein Pricing U Temporarily unavailable: please reorder MARK 1 OF 1 T- Taxable hem 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: It 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 -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 mall. International Orders: Pl ease Mote: 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 call our Customer Service Department 1- 800 645 -3550, HSI ORDER# ORDER DATE DUE DATE 89823323 03/29/11 04/29/11 WHSE DEA# RHO162494 Fed ID: 11- 3136595 This order has been processed by our MIDWEST D.C. 5315 WES 74TH 3TREET INDIANAP LIS,IN 46268 MIDWEST D.C. State Lic 23 00304 1 507 -0791 PU EA IV EMS SET W /ULTRA SITE 8 15DROPS 137 137 1.54 210.98 1 LEASE NOTE 4990653 IS NOW 5070791 F YOU ARE ARTICIPATING IN A DISCOUNT PROGRAM (E.G. POIN S, GIFTS OR 0 HER PECIAL AWA DS ("DISCOUNT WITH THIS PURCH 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, OU ARE RECEI ING OR WILL R CEIVE OTICE OF T.E DISCOUNT VALUE. FROM TIME TO TILE, MEDICARE, MEDICAID, TRI ARE OR THER PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, PND UPON ANY SITCH REQUEST, SU H.VALUE MUST BE DISCLOSED AS A DI COUNT GAINS •THE PURCHASES THAT EARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN TH SE RECORDS. MERCHANDI E TOTAL 210.98 INVOI E TOTAL 210.98 Invoice Date 30 days 210.98 LEASE NOTE NEW REMIT TO ADDRESS Please remi payments only to the following a dress: HENRY SCHEIq INC. DEPT CH 10211 PALATINE, 11 60055 -0241 IL L TO .91HIP TQ I NVOTCEV INVOICE TOTAL ITEM STATUS KEY REM KEY 1308571 1817102 7835202 -02 210.98 13- llackordered:hcm will follow SK- SehoalKit HSI D Discontinued; Itcm no longer available NC N4, Chargt: D R INV T E E F- Special Schein Free Goods 03/29/11 3/30/11 1 M ManuCac turcrwillshiplicrndirectlytoyon 89823323 F Prescription Drug: Return Amhnriratioa Required ME E R- Reingerated ltem: May be shipped separately Special Schein Pricing MARK 1 OF 1 T- Taxable Item unavailahLe; please reorder LP300 HSI ORI)2kft ORDER DATE DUE. DATE 89826133 03/29/11 04/28/11 WHSE DEA# RHO162494 Fed ID: 11-3136595 d. r t his order has been processed by otir;MIDWEST .C. 5315 WES 74TH 3TREET INDIANAP LIS,IN 46268 MIDWEST D.C. State Lic 23 00304 YIA 317-423-B794 1 840 -9710 100 /BX BENZOIN TINCTUR AMPULE SQ 1 1 21.00 21.00 1 F YOU ARE ARTICIPATZNG IN A DISCOUNT PROG (E.G- POIN S, GIFTS OR OTHER S 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, CU ARE RECEI ING OR WILL R CEIVE OTICE OF. TIE 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 FQUES,T,' ;SU H. -VALUE MUST;'BE'DISCLOSED AS AL DI COUNT kGAINS7 THAT E ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN TH SE RECORDS. MERCHANDi E TOTAL 21.00 INVOi E TOTAL 21.00 I nvoice Date 30 days 21.00 LEASE.NOTE NEW REMIT TO ADDRESS P lease remi payments only to the following a dress: ENRY,SCHEI 4 INC. D EPT CH 10211 TINE, I ;,,60055 0241., BILL TO HIP T INVOT CE TOTAL ITEM STATUS KEY REM KEY 1308571 1308572 7828367 -01 21.00 13 Backordered: Item will follow SK Scht IKit RDER I DATE D Discontinued Item no longer available NC- No Charge HSI I Special Schein Free Goods M Manufacturer will ship Item directly to you 89826133 0 3/ 2 9/ 11 3/29/11 1 p- prescription Drug: Retum Authorization Required T MER R Refrigerated Item: May be shipped separately Special Schein Pricing U Temporarily unavailable; please reorder MARK 1 OF 1 T Taxable Item LP300 rls L10ADER ORDER DATE DUE DATE 89823323 03/29/11 04/28/11 WHSE DEA# RHOI62494 Fed 1D: 11-3136595 T his order has been processed by our MIDWEST .C. 5315 WES 74TH 3TREET 1NDI_ANAP LIS,IN 46268 MIDWEST D.C. State Lic 23:00304 220 -1398 3 /ST BODY STRAP SET DISP YELLOW 100 100 4.80 480.00 19 2 879 -8581 30 /PK MEDI -TRACE SNAP FOAM ELEC 530ECG 120 120 C 4':'50 540. 00 5 ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. 3 602 -8100 EA COLLAR STIFNECK SELECT ADULT 50 50 C 5.75 287.50 6 ASE GOOD 2 EM, MAY BE SHIPPED SEPARATELY. 4 360 -1359 EA SAM.SPLINT ORANGE /BLUE 36X4.25 12 12 6.67 80.04 19, 5 507 -0791 PU EA IV EMS SET W /ULTRA SITE 8 15DROPS 200 63 1.54 97.02 20 ARTIAL SHI MENT WILL SHIP AND INVOICE WHEN AVAILA LE, P LEASE NOTE 4990653 IS NOW 5070791 6 891 -3037 PU 50 /CA IV PREP KIT W/ TEGADERM 8 8 C 61.00 488.00 14 ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. 7 107 -0530 100 /BX PURPLE NITRILE PF GLOVE LARGE 40 40 C 8.40 336.00 18 ASE GOOD I EM; MAY BE SHIPPED SEPARATELY. F YOU ARE DARTICIPATING IN A DISCOUNT PROG (E.G. POIN S, 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 IN ACCO DANCE WITH DISCOUNT PROGRAM BILL NVO C£ INV I TAL ITEM STATUS KEY REM KEY 1308571 1817102 7835202 -01 2308.56 8 8ackordcrcd:hemw ill follow SK school Kit H R R E IP1V A E D Disconnnucd" Item no longer available NC No Charge Special Schein Rue Goods M Manufacturer will ship Item directly to you 89823323 0 3/ 2 9/ 11 3/29/11 20 P- Prescription Drug: Return Authorization Required R Refrigerated hem; May be shipped separately Special Schein Pricing MARK 1 �F 2 T Ta able It lm unavailable: please rmrdcr Continued on Next Page LP300 HENRY S CHEN Med Matrx SHIP TO /SOLD TO: Carmel Fire Department MI 135 Duryea Road, Melville, NY 11747 540 I �O I!� 540 w 136 St i V V Station 46 Miuiecl Kaufmann Carmel,IN 46032 -8806 010000130857107835202110010000002308560329113 BILL TO: Carmel Fire Dept MI 2 Civic Sq Carmel, IN 46032 -7543 Carmel Fire Dept MI 2 Civic Sq BILL TO: 1 SHIP TO INVOICE'. TOTAL Carmel, IN 46032 -7543 1308571 1817102 2308.56 INvuICE INVOICE DATE: 7835202 -01 3/29/11 CUSTOMER.PO MARK Please detach here and mail the above with your payment HS F. CRDER# ORDER DATE' �i:DUE DATE! 89823323 03/29/11 04/28/11 WHSE DEA# RHO162494 Fed ID: 11- 3136595 A RULES. UPO DISCOUNT RECEIPT OR REDEMPTION, OU ARE RECEI ING OR WILL RECEIVE OTICE OF T E DISCOUNT VALUE. FROM TIME TO TIME, MEDICARE, MEDICAID, TRI ARE OR THE: PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, D UPON ANY S CH R EQUEST, SU H VALUE MUST BE DISCLOSED AS A DISCOUNT GAINSI THE PURCHASES THAT E ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN THESE RECORDS. MERCHANDI E TOTAL 2308.56 INVOI E TOTAL 2308.56 Invoice Date 30 days 2308.56 LEASE NOTE NEW REMIT TO ADDRESS Please remi payments only to the following a dress: ENRY SCHEI 4 INC. D EPT.. CH 10211 PALATINE, I 60055 -0241 B SHIP TO INVOICE TOTAL ITEM STATUS KEY REM KEY 1308571 1817102 7835202-01 2308.S6 Backordered: Item will follow sx- Scbontxit D Discontinued: Item no longer available t<C No Charge 'HS RD R AT INVOTCE DATE OF BOXES P Special Schein Preu Goods 89823323 0 3/ 2 9/ 11 3/29/11 2 0 M Manufacturer will Return Item thoecuy rizati o y ou P Proscription DReturn Authoon Reyuired S OMER' O pA R Refrigerated Item: May he shipped separately Special Schein 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 60055 $2,708.54 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members r 1120 7835202 -01 102 390.11 $2,308.56 1 hereby certify that the attached invoice(s), or 1120 7828367 -01 102 390.11 $21.00 bills) is (are) true and correct and that the 1120 I 7835202 -02 1 102- 390.11 $210.98 materials or services itemized thereon for 1120 4966709 -01 1 102 390.11 $168.00 which charge is made were ordered and received except A PR n 201 r '411 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)) 7835202 -01 $2,308.56 7828367 -01 $21.00 7835202 -02 I I $210.98 4966709 -01 I $168.00 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 2a Clerk- Treasurer