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Home My WebLink About198553 06/22/2011 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1 ONE CIVIC SQUARE HENRY SCHEIN INC i 1 CARMEL, INDIANA 46032 DEPT CH 10241 CHECK AMOUNT: $2,940.16 PALATINE IL 60055 -0241 CHECK NUMBER: 198553 CHECK DATE: 6/22/2011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 102 4239011 5298977 -01 2,940.16 SPECIAL DEPT SUPPLIES HENRY SCHEIN Matrx Medical SHIP TO /SOLD TO: I Carmel Fire Department MI 135 Duryea Road, Melville, NY 11747 540 W 136 St Station 46 Michael Kaufmann Carmel,IN 46032 -8806 010000130857105298977110010000002940160607112 BILL TO: Carmel Fire Dept MI 2 Civic Sq Carmel, IN 46032 -7543 Carmel Fire Dept MI 2 Civic Sq BILL TO I SHIP TO INVOICE TOTAL Carmel, IN 46032 -7543 1308571 1817102 2940.16 INVOICE# INVOICE DATE 5298977 -01 6/07/11 CUSTOMER PO MARK Please detach here and mail the above with your paymem HSI ORDER ORI)ER DATE DOE ➢ATE 92149815 06/07/11 07/07/11 WHSE DEA4 RHO162494 Fed ID: 11-3136595 a m m e m 10 101 -3137 100 /BX BANDAGE STRIPS BUGS DAF 3/4 11 X3" 24 24 C 3.80 91.20 17 ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. F YOU ARE ARTICIPATING IN A DISCOUNT PROGRAM (E.G. POIN S, GIFTS OR O HER PECIAL AWA DS "DISCOUNT WITH THIS PURC SE YOU HAVE EARNED A CREDI TOWARD GOODS OR S RVICES, RECEIVABLE OR REDEEMABLE IN ACCO DANCE WITH DISCOUNT PROGRAM RULES, UPON DISCOUNT RECEIPT OR REDEMPTION, YOU ARE RECEI ING OR WILL RECEIVE OTICE OFT 4E DISCOUNT VALUE. FROM TIME TO TIME, MEDICARE, MEDICAID, TRI ARE OR THER PAYER MAY REQUEST INFORMATION REGARDING SUCH VALUE, PND UPON ANY S CH EQUEST, SU H VALUE MUST BE DISCLOSED AS A DISCOUNT GAINS THE PURCHASE THAT E ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RETAIN THESE RECORDS. MERCHANDI E TOTAL 2940.16 nvoice Date 30 days 2940.16 LEASE NOTE NEW REMIT TO ADDRESS lease remi payments only to the following address: ENRY 53CHEII INC. DEPT CH 10211 ALATINE,I 60055 -0241 BILL TO SHIP TO INVOICE# INVOTCE TOTAL ITEM STATUS KEY REM KEY 1308571 1817102 5298977 -01 2940.16 H_Hackordered:llcmw ill lollow SK SchnmKit D Discommucd: Item no longer available 1 NC No Charge HSI O RDER# OMER NV P Special Schein Frcn 6.uds M Manulacimcr will ship Item directly to you 92149815 0 6 0 7 11 6/07/11 2 0 l' Pwscripuon Drug: Retum Authorization Required R Rclogeraied Imm: May be shipped separately PAGE Sp,mal Schein Pricing U Tempurarily unavailable: please reorder MARK- 2 OF 2 T Taxable Hem L rJuU HENRY SCHEIN I Matrx Medical T ERM OF SALE Payment Terms: We rnake 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, UASTERCARD 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; 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 calf: Rx Products Controlled Substances: Matrx Medical 1 -840 -845 -3550 Regulation 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. Glass 11 drugs can be ordered only by mail. International Orders: Please 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 vmrranties. Before opening handpieces or terms and conditions, please contact our International Department: equipment, v e 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 Soitware is not returnable. Other restrictions may also apply, A Return Authorization is Required for all Prescription Drugs. Simply call our Customer Service Department '4 1- 800 -845 -3550. �to Em VOUCHER NO. WARRANT NO. ALLOWED 20 Henry Schein IN SUM OF Dept Ch 10241 Palatine, IL 60055 $2,940.16 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO. I ACCT #/TITLE I AMOUNT Board Members 1120 I 5298977 -01 1 102- 390.11 I $2,940.16 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 JUN 20 2011 PLA41— d VQ) 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)) 5298977 -01 $2,940.16 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