HomeMy WebLinkAbout198553 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
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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