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Home My WebLink About196816 04/26/2011 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1 ONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: $169.00 CARMEL, INDIANA 46032 DEPT CH 10241 PALATINE IL 60055 -0241 CHECK NUMBER: 196816 CHECK DATE: 4/26/2011 DEPARTM ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 102 .4239011 8497600 -01 169.00 SPECIAL DEPT SUPPLIES HST. ORDER ORDER DATE DUE DATE 89836748 03/29/11 05/05/11 WHSE DEA# RHO162494 Fed ID:- 11- 3136595 1 116 -0999 EA DISPENSER F /EMESIS BAG 1 1 45.00 45.00 PRODUCT IS 3EING SHIPPED.TO YOU DIRECTLY FROM THE MAZUFACTLRER. 2 116 -1000 144 /BX EMESIS BAG;1000ML BLUE 1 1 124.00 124.00 PRODUCT IS 3EING SHIPPED TO YOU DIRECTLY FROM THE FACT RER.. IF :YOU ARE ARTICIPATING IN A DISCOUNT PROGRAM (E.G. POIN S, GIFTS OR OTHER PECIAL AWA ZDS "DISCOUNT WITH THIS PURCHASE YOU HAVE EARNED A CREDI TOWARD GOODS OR SERVICES, RECEIVABLE.OR'REDEEMABLE N ACCORDANCE WITH DISCOUNT PROGRAM RULES. UPOq DISCOUNT RECEIPT OR REDEMPTION, OU ARE RECEI ING OR WILL RECEIVE OTICE OF T E DISCOUNT VALUE. FROM TIME TO TI E— MED CARE,. EDICAID,.TRI ARE OR THER PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, PND UPON ANY S CH REQUEST, SU H VALUE!MUST BE DISCLOSED AS A DI COUNT GAINS THEPURCHASES THAT EARNED SUCH VALUE, ACCORDINGLY, YOU SHOULD RE AIN THESE RECORDS. MERCHANDI E TOTAL 169.00 INVOI E TOTAL 169.00 nvoice Date 30 days 169.00 LEASE NOTE NEW REMIT TO ADDRESS Please remi payments only to the following a dress: ENRY SCHEI INC( EPT CH 102 1 >N ALATINE; I ;60055 =0241: BTLL. TO TNVOTC INVOTCE TOTAL ITEM STATUS KEY REM KEY 1 1308571 1308572 8497600 -01 169.00 Il liaekord —dl lien) will follow SK School Kil HSI Q Rr)ER# RDER A INVOICE DATE 4 OF BOXES 1) Disnmlinued: Item no longer available NC No Charge F- Special Schcin Free Goods V7 Manufacturer will ship Ilan dimclly to you 89836748 03/29/11 4/05/11 I' prescription Drug; Return Authorization Required CUS TOMRR R Refrigerated Itcm, May he tihipped separately Special Schcin Pricing U Temporarily unavailable: plcasu reorder MARK 1 OF 1 T Taxable lmm rayfIEC161, Vl111zt. 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 ill 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 fax 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: P lease 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 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. v LP300 VOUCHER NO. WARRANT NO, ALLOWED 20 Henry Schein IN SUM OF Dept Ch 10241 Palatine, IL 60055 $169.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO. ACCT #!TITLE AMOUNT Board Members 1120 I 8497600 -01 1 102- 390.11 I $169.00 1 hereby certify that the attached invoice(s), or 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 APR 2 2 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 N (or note attached invoice(s) or bill(s)) 8497600 -01 $169.00 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