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Home My WebLink About166704 12/10/2008 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1 of ONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: $296.46 4a CARMEL, INDIANA 46032 DEPT CH 10241 PALATINE 1L 60055 -0241 CHECK NUMBER: 166704 CHECK DATE: 12/10/2008 `DEPARTMENT ACCOUNT PO NU MBER INVOICE NUMBE AMOUNT DESCRIPTION 102 4239011 5492967 -01 296.46 SPECIAL DEPT SUPPLIES d 0 F v e i r�, qi MARK I 1308572 Please detach here and mail the above with your payment WHSE DEA# Fed ID: 11- 3136595 p .II" p t p p �t p p b .0 RK 317-57L-2663 1 110 -6384 10 /BX INTRODUCER PEDI COUDE/ STR TIP 3 3 49.41 148.23 PRODUCT IS 3EING SHIPPED TO YOU DIRECTLY FROM THE MANUFACTURER. 2 932 -7431 10 /PK E -T INTRODUCER W /COUDE 3 3 49.41 148.23 ======z=================== F YOU ARE 3ARTICIPATING IN A DISCOUNT PROGRAM (E.G. POINTS, GIFTS OR OTHER PECIAL AWARDS "DISCOUNT WITH THIS PURCHASE YOU HAVE EARNED A CREDI TOWARD GOODS OR SERVICES, RECEIVABLE OR REDEEMABLE IN ACCO DANCE WITH DISCOUNT PROGRAM RULES. UPOq DISCOUNT RECEIPT OR REDEMPTION, YOU ARE RECEI ING OR WILL RECEIVE OTICE OF T E DISCOUNT VALUE. FROM TIME TO TIME, MEDICARE, MEDICAID, TRI ARE OR THER PAYER MAY REQUEST INFORMATION REGARDING SUCH VALUE, P.ND UPON ANY S CH EQUEST, SU H VALUE MUST BE DISCLOSED AS A DISCOUNT GAINS THE PURCHASES THAT ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN THESE RECORDS. IF YOU VE SED A HENR SCHEIN "HS CREDIT CARD TO MAKE THIS URCHA E, THEN ANY B NEFITS ROM PURCHA ES OF HS PRODUCTS WITH THE CARD I EXCES3 OF T OSE BENEFITS IVEN OR NON -HS URCHASES MUST ALSO BE TREATED AS DISCOJNT ANE SIMILARLY DI CLOSED. MERCHANDI E TOTAL 296.46 INVOI E TOTAL 296 "46 PLEASE PAY WITHIN THIRTY(3 DAYS OF RECEIPT OF THIS NVOICE. 296.46 LEASE NOTE NEW REMIT TO ADDRESS Please remi payments only to the following a dress: HENRY SCHEIN INC. DEPT CH 10211 ALATINE, I 60055 -0241 BILL TO INVOICE# CUSTO ME Poll ITEM STATUS KEY REM KEY 13 0 8 5 71 5492967-01 MARK 13 -Backordered: Item will follow SK School Kit S HIP T I DATE BOXES D Discontinued: Item no longer available NC -No Charge P- Special Schein Frce Goods M Manufacturer will ship Item directly to you 13 0 8 5 7 2 11 /21/08 P Prescription Drug: Return Authorization Required R Refrigerated Item: May be shipped separately H I MBER INVOICE AL PA E Special Schein Pricing 114 5 2 2 0— 1 296.46 l O F 1 T- Ta able Item unavailable; please reorder L Payment Terms: We make every effort to maintain prices for the duration of a Payment by CHECK or by the HENRY SCHEIN PLATINUM BUSINESS catalog, however, we reserve the right to make price adjustments in CARD, VISA, MASTERCARD, DISCOVER and AMERICAN EXPRESS response to manufacturers' price changes 1. v VJSA Guaranteed Satisfaction: If ou have tried a product and it is defective or does not perform or Y p p Bill Your Order To Your Open Account satisfactorily, we will provide a credit, refund, or exchange; it's your Available to licensed practitioners in the U.S. Al' invoices are choice. Simply call our customer service department within 30 days payable within 30 days. of receipt of the merchandise to arrange for the return. For a 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. 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 IDEA certificate verifying your shipping address. Class II drags can be ordered only -by mail. International Orders: Pl 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. 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)) 5492967 -01 EMS Supplies $296.46 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 20 Clerk- Treasurer VOUCHER NO. WARRANT NO. ALLOWED 20 Henry, Schein IN SUM OF Dept Ch 10241 Palatine, IL 60055 $296.46 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 1120 5492967 -01 102 390.11 $296.46 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 f1Er �nnQ �7 C A tj Title Cost distribution ledger classification if claim paid motor vehicle highway fund