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Home My WebLink About197659 05/26/2011 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1 ONE CIVIC SQUARE HENRY SCHEIN INC CARMEL, INDIANA 46032 DEPT CH 10241 CHECK AMOUNT: $2,860.69 PALATINE IL 60055 -0241 CHECK NUMBER: 197659 CHECK DATE: 5/26/2011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 102 4239011 207995501 937.07 SPECIAL DEPT SUPPLIES 102 4239011 212138601 496.40 SPECIAL DEPT SUPPLIES 102 4239011 402073201 901.01 SPECIAL DEPT SUPPLIES 102 4467006 402073201 526.21 EMS EQUIP HS L':ORDER .ORDER DATE :DUE DATE. 91589712 05/13/11 06/12/11 WHSE DEA# RHO 162494 Fed ID: 11-3136595 S Y a.G,_ a A': i...G' s Y `n fl a.. t .R his order has been processed by our MIDWEST L.C. 5315 WES 74TH TREET INDIANAP LIS,IN 46268 MIDWEST D.C. State Lic 23 00304 17- 428 -876 1 153 -2007 20 /RL BIOHAZARD BAG 14.5X19 RED 3GAL 20 20 C 2.07 41.40 2 ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. 2 879 -8581 30 /PK MEDI -TRACE SNAP FOAM ELEC 530ECG 40 40 C 4.50 180.00 4 ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. 3 602 -8100 EA COLLAR STIFNECK SELECT ADULT 50 50 C 5.50 275.00 5 ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. F YOU ARE DARTICIPATING IN A DISCOUNT PROG (E.G. POIN S, GIFTS OR OTHER PECIAL AWA DS "DISCOUNT WITH THIS PURCHASE YOU HAVE EARNED A CREDI TOWARD GOODS OR S RVICES, RECEIVABLE OR REDEEMABLE IN ACCORDANCE WITH DISCOUNT PROGRAM RULES. UPOJ DISCOUNT RECEIPT OR REDEMPTION, YOU ARE RECEI ING OR WILL R CEIVE OTICE OF TIE DISCOUNT VALUE. FROM TIME TO TIME, MEDICARE, MEDICAID, TRI ARE OR THER PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, PND UPON ANY S CH EQUEST, SU H VALUE MUST BE DISCLOSED AS A DISCOUNT kGAINS1 THE PURCHASES THAT E ARNED SUCH VALUE, ACCORDINGLY, YOU SHOULD RETAIN THESE RECORDS. MERCHANDISE TOTAL 496.40 nvoice Date 30 days 496.40 BILL TO'. 10 Z[1V `.I .R TOTAL ITEM STATUS KEY REM KEY 1308571 1817102 2121386 -01 496.40 B- l3ackordered:hem wilt follow SK School Kit D Discantinued; Item no longer available NC No Charge HST Ubng ORDE R DA :INVOICE E.. 5 P Special Schein Free Goods 05/13/11 5 13 11 rj M Manufacturer will ship Item directly to you q1989'712 Prescription Drug; Return Authorization Required CUSTOME 0 B GE R Refrigerated Item: May he shipped separately Special Schein Pncing U Temporarily unavailable; please reorder MARK 1 OF 2 T Taxable Rem Contlnuedon Next Page LP300 *HENRY SCHEIN"' Matrx Medical SHIP TO /SOLD TO: O ICE Carmel Fire Department MT 135 Duryea Road, Melville, NY 11747 540 w 136 St Station 46 Michael Kaufmann Carmel,IN 46032 -8806 010DO0 13085710212138611001000DD00496400513119 BILLTo: Carmel Fire Dept MI 2 Civic Sq Carmel, IN 46032 -7543 Carmel Fire Dept MI 2 Civic .Sq BRILL TO I SHIP TO INNOICE TOTAL Carmel, IN 46032 -7543 1308571 1817102 496.40 INVOICE INVOICE QATE 2121386 -01 5/13/11 CUSTOMER PO MARK Ftease detach here and mail the above with your payment HSL MIER# I ORDER DATE LVE DATE i 91589712 05/13/11 06/12/11 WHSE DEA# RHO162494 Fed ID. l 1- 3136595 a >.a.._a s e :as ..,i ..Irk LEASE NOTE NEW REMIT TO ADDRESS Please remi payments only to the following a dress: HENRY SCHEIV INC. DEPT CH 10211 ALATINE, I 60055 -024.1 HILL T'O HIP TO INVOICE L' ITEM STATUS KEY REM KEY 1308571 1817102 2121386-01 496.40 fi Backordered: Item wilt fellow sK School x f H ORDER AT INVOICE DATE F B XE 1) Discontinued' Item no longer available NC No Charge F Special Schein Free Goods 91589712 05/13/11 5 13 11 5 M Manufacturer wil ['em directly to you 1' Prescriplion Drug; Retum Aulhoriraliun Required es pP s eparately CU ME -J> PA E Refri Se el hem: May :tit eJ se ar tel 5pccial tichcin I'ncmg U Temporarily unavailable; please reorder MARK 2 OF 2 T Taxable Item LP300 HENRY SCHEIN 'ayrr cr'rr,32, vlk, make e�iery etfo maintam prices' ,r the duration of a Payment by CHECK or by the HENRY S CHEIN CREDIT CARD, ata oG, l °ow2rer, vr;e reserve the right to make price adjustments l' VISA MASTERCARD DISCOVER and Ai ERtCAN EXPRESS response to manufactr,rers`prlce f�anues E:s Guaranteed Satisfaction vrsa Vm or It you have triad a product and it is defective or does not aedo U )'o �r er o r Open r Acc satis vie evil provide a credit, refund, or exchange; it's your E ra c' a Available to licensed practitioner e r t e U S A ll' Pvoives are I cnoice, rrnp!v oalf our cusforner service d., rV .hin� 3C :tars pay<Et�fe r�ith n 3f days, o' rece ipt of thu rnerchar disc to arrange for the return. For a ,vEarranfy r'eep air or it vot. ',,vere s€ rit sornothi g you did not order, s plj call:' x Products Controlled Substances: Matrx Medical ical 1- 500-845 -3550 Regulafiors require us to limit the sale. of Rx and controlled sulast Pr:.ces Drily to registered, lcenseu healthcare professionals, If you are a nAw custorner or have rece -Mly moved. please lurr:rs"r us with a copy of your updated state registration. For controlled substances, lurnish a cop,/ o' your DEA certificate, verifying your shipping address. Class If drugs can be ordered only 1 by r-lail. International Orders: Pleas Not e €aed hand ie es and e' uipme� a rant be r,t n�J r We proudly serve healthcare professionals an govern mo-nts p p q n. Y l throughout the world. o place o tiers or,o inquiries on expo t cred+f, f r t L.'iil tie repairwd or replacod in accordance v�vAh terms and conditions, please eoi tact our l= tern ati3nal Department man uf« cturer v.arrant, Be re ope ning har dp races or e i; pment, we suggest that you :.beck fhe shipping container and pack €no list to `Jerif',v tnc z•: yyujj f':av0 received exactly what 'ruu ordered,0pened Computer Software is not returnable. Prescription Drug returns Instructions: Other restrictions may also apply. A ire °urn Aut'^oriz.:,tier is f?equired for all Pr¢crip :ion ;?rugs. :;all our Customer Service Department `4° t 8M 843 3551. i Hsiibi6Eitt ORDER DATE DUE: DATE 91527002 05/11/11 06/10/11 WHSE DEA# RHO162494 Fed ID: 11-3136595 Big WR This order ias been processed by our MIDWEST 11. C. 5315 WES 74TH TREET INDIANAP LIS,IN 46268 MIDWEST D.C. State Lic 23 00304 1 499 -0814 24 /CA INSTANT WINTER COLD PK OD 6 6 C 7.67 46.02 6 ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. 2 499 -0661 EA 02 CYLINDER BAG GREEN D SIZE 3 3 78.75 236.25 B HIS PRODUCU IS BEING SHIPPED FROM OUR NORTHEAST DIS RIBUT ON CENTER. 3 120 -8438 EA NIPPLE NUT PLASTIC 8 8 0.75 6.00 7 4 677 -4617 EA BRASS REGULATOR W /FLOW 2 DISS 4 4 72.49 289.96 7 5 555 -4687 PU EA PROTECTIV ACUVNC SFT CATH 22GX1" i 1 4.79 4.79 9 HIS PRODUC7 IS BEING SHIPPED FROM OUR NORTHEAST DIS17RIBUTION CENTER. 6 555 -5396 PU EA PROTECTIV ACUVNC SFT CATH 20X1.25 200 200 2.75 550.00 7 7 155 -1166 PU EA PROTECTIV ACUVNC SFT CATH 18X1.25 100 100 2.75 275.00 7 8 499 -0652 EA PENLIGHT METALITE 8 8 2.40 19.20 7 F YOU ARE 3 ARTICIPATING IN A DISCOUNT PROD (E.G. POIN S, GIFTS OR 0 HER.. PECIAL AWARDS "DISCOUNT WITH THIS PURL SE YOU HAVE EARNED A CREDI 7 TOWARD GOODS OR SERVICES, RECEIVABLE OR REDEEMABLE N ACCO ZDANCE WITH DISCOUNT PROGRAM RULES. UP0q DISCOUNT RECEIPT OR REDEMPTION, I OU ARE RECEI ING OR WILL R CEIVE BILL i INVOF E TOTAL ITEM STATUS KEY REM KEY 1308571 1308572 4020732 -01 1427.22 It nnckordered7 Item Will follow sx- sehoolxa E ATE. Y ATE:: I) Disconnnucd, Item no longer available NC Nu Char ge 1 5rcciai Schein Free Goods M Manufacturer will ship Item directly to you 91527002 05/11/11 5/11/11 9 P Prescription Drug; Return Authorization Required r.. R Refrigerated Item; May be shipped separately rte.,.....;, Special Schein Pricing U Temporarily unavailable; please reorder MARK 1 OF 2 T Taxable hem Continued on Next Page L rjuu Matrx Medical SHIP TO /SOLD TO: Carmel Fire Dept Head Quarters MI 135 Duryea Road, Melville, NY 11747 I® 2 Civic Sq I Carmel,IN 46032 -2584 0100001308571040207321 10010000001427220511118 BILL TO: Carmel Fire Dept MI 2 Civic Sq Carmel, IN 46032 -7543 Carmel Fire Dept MI 2 Civic Sq BILL .TO SHIP TO INVOICE TOTAL.. Carmel, IN 46032 -7543 1308571 1308572 1427.22 INVOICE INVOICE DATE 4020732 -01 5/11/11 CUSTOMER PO MARK Please detach here and mail the above with your payment_ HSI ORDER ORDER DATE 91527002 05/11/11 06/10/11 WHSE DEA# RHO162494 Fed ID: 11-3136595 ON s� 1 40TICE OF THE DISCOUNT VALUE. FROM TIME TO TIME, MEDICARE, MEDICAID, TRI ARE OR THER PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, PND UPON ANY S CH R EQUEST, SU H VALUE MUST BE DISCLOSED AS A ]DISCOUNT GAINS THE PURCHASES THAT E ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN TH SE RECORDS. MERCHANDI E TOTAL :x'1427122 Invoice Date 30 days 1427,..22 LEASE NOTE NEW REMIT TO ADDRESS Please remi payments only to the following a dress: .LIENRY SCHE14 INC. DEPT CH 10211 ALATINE, I 60055 -0241 BILL TO E. TOT ITEM STATUS KEY REM KEY 1308571 1308572 4020732 -01 1427.22 ]s Backordered Item will follow SK $ChOUl Kit HSI 6 RD R A E INVOICE DATE 4 OF g II DisCantinlled. Item no longer avuilahle NC Charge b Special Schein Free 6 ds M Manufacturer will ship Item directly to you 9152' n 2 05/11/11 5 11 11 9 P Prescription Drug: Return Authorization Rugmrud U T MliB P R Rufrigerated Item: May be shipped separately Special Schein Pricing U Temporarily unavailahlo; please reorder MARK 2 OF 2 T Taxable hem L HENRY SCREW `1 Marx Medicai IERMS OF "=a3ment rr s- e rn<,ke e ;ery f #or' to mainfai f,rices for the duraf o of a Payment by CHECK or by the HENRY CHEIN CREDIT CARD, data ;cry, hn,ae,er, ,,,e reserve the right to make price, adj ustments i n VISA, MASTERCARD, DISCOVER and AMERICAN EXPRESS response tc manufacturers' price changes Guaranteed Satisfaction: If you have tried a product and it is defec'ivc or does not pednml; of Bill Your Order T o dour e Azccount satis'ac`or €ly, we will provide a credit, refund, or exchange it's your Ava� :able to keens >zd prat tit i r ens r t,. W U.S �1 €vai es are choloe, sirrVv cal o. #r cuslor er servi ^e departmert °.0fin 30 da of receipt of the rrrerchandis-o to arrant/ for thex return. For a payable within 30 days, Y=.1crair or it yo:, v:ere sent someliing yo u i id not order, 1-!t call: lax Products Controlled Substances. atrx Medical 1- 500 -845 -3550 Reaulat ons roqu us to limit the &ile of px and conlr fled substances only to registered, !:tensed healthcare professionals. U you are a new customer or have recently moved. please fur-:&h us with a copy of your updated state registration. For cortrolled substances, furnish a copy of your DEA certificate, verifying ,your shipping address. Class 11 druos car be ordered only by r-.af, International Orders: Aleas Note. We proudly serve healthcare professionals an go ernm# nts Opened handpieces ano equipment may not be rel:X !ed for o place orders or for nqu r es on ti roughout the ti ;nr ld. export credit, huf :i11 fie rE,pn r >vd or replaced in aeccrda ^ce ^J th terms and conditions please contact cur 1, tern0onal Department: manufacturer warrantios,. Before opening hzardp eces or 3CC 8 5 35vu equipment, we st ggest that �,r ou check lne shipping cu-lainer and park no list to verify that you received exactly what you ordcred, Opened Computer Software is not returnable. P rescription Returns Instructions: Other restrictions may also apply. A, Return Authorizatinn is Required for all P ption Drugs. S ,.:t,ly call our Customer Service 6epar meat 41 300 345 -3550 mu HSI eRDER9 ORDER DATE '.DUE DATE 91527307 05/11/11 06/10/11 WHSE DEA# RHO162494 Fed ID: 1 1- 3 136595 ,y ''5r' a m T his order has been processed by our MIDWEST D.C, 5315 WES 74TH TREET INDIANAP LIS,IN 46268 MIDWEST D.C. State Lic 23:00304 1 499 -0814 24 /CA INSTANT WINTER COLD PK OD 6 6 C 7.67 46.02 6 ASE GOOD I EM, MAY BE SHIPPED SEPARATELY, 2 647 -4174 10 /TRAY CURITY GAUZE 12PLY STER 4 11 X4" 256 256 C 0.65 166.40 8 ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. 3 496 -2369 .100 /BX LANCET SURGILANCE ORANGE 21G 3 3 9.85 29.55 15 4 360 -1359 EA SAM SPLINT ORANGE /BLUE 36X4.25 30 30 6.67 200.10 15 5 107 -0502 100 /BX PURPLE NITRILE PF GLOVE MEDIUM 60 60 C 8.25 495.00 14 ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. F YOU ARE PARTICIPATING IN A DISCOUNT PROG (E.G. POIN S, GIFTS OR OTHER SPECIAL AWA ZDS "DISCOUNT WITH THIS PURCHASE YOU HAVE RNED A CREDI 11 TOWARD GOODS OR S RVICES, RECEIVABLE OR REDEEMABLE IN ACCO DANCE WITH DISCOUNT PROGRAM RULES. UPOH DISCOUNT RECEIPT OR REDEMPTION, OU ARE RECEI ING OR WILL R CEIVE OTICE OF T E DISCOUNT VALUE. FROM TIME TO TI E, MED CARE, MEDICAID, TRI ARE OR THER PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, PNO UPON ANY S CH EQUEST', SU H VALUE MUST BE DISCLOSED AS A DI COUNT AGAINSI THE PURCHASE!; THAT E ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN THEESE RECORDS. BILL TO s TQ E'' NV I E� L" ITEM STATUS KEY REM KEY 1308571 1817102 2079955 -01 937.07 13- nackoidered: hem will louow SK School Kit I' DE A E IPV E DATE D Discominued; Item no longer available NC Nu Charge F -.Special Schein Free Goods 05/11/11 5 11 11 15 M Manufacturer will shin item directly to you 915273071 P- Prescription Drug Return Authorization Required R Reingerated Item, May he shipped separately Special Schein Pricing U Temporarily unavailable; please reorder MARK 1 OF 2 T Taxable c Continued on Next Page LP300 HEM EI Matrx Medical SHIP TO /SOLD TO: INVOICE Carmel Fire Department MI 135 Duryea Road, Melville, NY 11747 540 w 136 St Station 46 Michael Kaufmann Carmel,IN 46032 -8806 010000130857102079955111001000000093707051 111,6 BILL To: Carmel Fire Dept MI 2 Civic Sq Carmel, IN 46032 -7543 Carmel Fire Dept MI 2 Civic .Sq Bi LL. TO 5HIP TO INVOICE TOTAL Carmel, IN 46032 -7543 1308571 1817102 937.07 INVOICE INVOICE DATE 2079955 -01 5/11/11 CUSTOMERI PO MARK Please detach here and mail the above with your payment HSI <ORDER ORDER DATE `�.D E.DATE:� 91527307 05/11/11 06/10/11 WHSEDEA# RHO162494 Fed ID: I1- 3136595 MERCHANDISE TOTAL 937.07 I nvoice Date 30 days 937.07 LEASE NOTE NEW REMIT TO ADDRESS P lease remi payments only to the following address: ENRY SCHEI INC. EPT:: CH.:102 1 ALATINE, I 60055 -0241 L11 I BILL 1P TO INVOI ITEM STATUS KEY REM KEY 1308571 1817102 2079955 -01 937.07 N Backordered: Item will rellow Sx School ll H R.... A T g D Discontinued. Item nu longer available NC Nu Charge P Special Schein Free Goods 11 11 5/11/11 15 M Manulaclurtr wilt ship Item directly toyou 91527307 05 P Prescription Drug. Return Awn hozation Required C09TOMER R RoIngerale turn: May he shipped separately Special schcin Neing U Temporarily unavailable: please reorder MARK 2 OF 2 T Taxable hem LP300 HENRY CHEIN r Med ical F-FR a a ment Tans: We make every etfa,A ainta, rAk s r t1he ;curator of a P ayment by CHECK or by the HENRY �f�l�f CREDIT CARD, catalog, 'otr e:er, k,, r?sarite the tight o make price adjustment's i€ VISA, MASTERCARD, DISCOVER and AMERICAN EXPRESS response to manufacturers` price changes Guaranteed Satisfaction. or If voij have tried a product and it is defective or doesnot perform Bill m' r r€ r `To Your Open Acco.� 't satisfac'oril we Will provide a credit, refund, or exchange, iCs your Avai able to licensed practit;or:ers in t e IJ.S. Ai i rvuice are choice. Simply rca l our custom er service detfartmeni.thin 30 days of rfoceipt of the rn erd.t and se to arrange f;or they rown. Fora payable within 30 drays, v,arrantr r; pair or if you were sent sonrothinq you di -lot ;order, sir: :ply ^all; x Products Controlled Substances: Matrx Medical 1-800-845 -3550 Regulations require us to limit the sale of Rx arid! conlrolled substances only to reg stered,'icensed healthcare professionals. if you are a ne`�i cuslomc-r or have recently moved, please furnisi US V.'itl Cflp of your tlp attid state re For controlled substances, I: a copy of your Gas oertilicate, erifyirg -or,r shipping address. Class l! drugs can to ordered only by mail. International Orders: Please Note: erted hand ss and e uipme may not to r it nod for We proudly serve healthollre professionals and governments �v pev q y p i ...i fo Z y'l .fir V r y rt ,`fir; credit tut L till to re arr :?d r its laved in accardaflce .ii`lt throughout the word. c place da or f r r q� es o export F p terms arld condit'ons :lease contact our I: `erlaaional Depart roan €lfactmar warrant e s. Peters opening handpieces or 8G0 945 3vu0 €:quiprn nt, ,ve s sgge st that you ;;heck the shipping cowainer and pack %Cj list t7 a e''y tnt y +o€.I have received exactly vihat you ordered,Opened Computer Software is not returnable. Prescription l�ru �atur Instructions: Other restrictions may also apply. A Return Authorization is Required for all "rescrption Dnrgs. Sirrph cal; our Customer Service Departmehl t -SCrO 845 3550 Fay k �tY k. 9 ".d T s '�s� `O TY ,u,�;,.. VOUCHER NO, WARRANT NO. Henry Schein ALLOWED 20 IN SUM OF Dept Ch 10241 Palatine, IL 60055 $2,860.69 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members 1120 4020732 -01 102- 670.06 $526.21 1 hereby certify that the attached invoice(s), or 1120 2121386 -01 102 390.11 $496.40 bill(s) is (are) true and correct and that the 1120 I 2.079955 -01 102- 390.11 I $937.07 materials or services itemized thereon for 1120 4020732 -01 102 390.11 $901.01 which charge is made were ordered and received except MAY 22 'M11 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)) 4020732 -01 $526.21 2121386 -01 $496.40 2079955 -01 I I $937.07 4020732 -01 1 $901.01 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