157960 04/01/2008 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1
ONE CIVIC SQUARE HENRY SCHEIN INC
CARMEL, INDIANA 46032 DEPT CH 10241 CHECK AMOUNT: $478.00
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PALATINE IL 60055 -0241 CHECK NUMBER: 157960
CHECK DATE: 411/2008
D EPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIP
102 A 4467006 9627024 -01 478.00 EMS EQUIP
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WHSE DEA# Fed ID: 11- 3136595
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his order as been processed by our NORTHEAS D.C.
41 WEAVEZ ROAD
DENVER, A 175L7
ARK HULETT 317- 571 -2663
1 499-0650 EA BREATHSAVER ULTRA ROYBLUE 2 2 239.00 478.00 1
2 827 -2329 EA SUCTION UNIT W /DISP CANN 2 B 0.00 0.00
T BACK 0 DERED, WILL FOLLOW SHORTLY
F YOU ARE ARTICIPATING IN A DISCOUNT PROG t (E.G. POIN S, GIFTS OR OTHER
PECIAL AWA DS "DISCOUNT WITH THIS PURC SE YOU HAVE EARNED A CREDI TOWARD
II GOODS OR S I RVICES, RECEIVABLE OR REDEEMABLE N ACCO DAiJ' WITH DISCOUNT PROGRAM
RULES. UPO4 DISCOUNT RECEIPT OR REDEMPTION, 'IOU ARE RECEI ING OR WILL RECEIVE
OTICE OF TIE DISCOUNT VALUE. FROM TIME TO TIME, MED CARE, MEDICAID, TRI ARE OR
THER PAYER MAY REQUEST INFORMATION REGARDING SUCH VALUE, TND UPON ANY S CH
R EQUEST, SU H VALUE MUST BE DISCLOSED AS A DI COUNT 5 .GAINSa THE PURCHASE THAT
E ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN =SE RECORDS. IF YOU IAVE
SED A HENRC SCHEIN "HS CREDIT CARD TO MAKE THIS DURCHASE, THEN ANY BENEFITS
F ROM PURCHA ES OF HS PRODUCTS WITH THE CARD IN EXCES3 OF THOSE BENEFITS TIVEN
OR NON -HS DURCHASES MUST ALSO BE TREATED AS A DISCOJNT ANE SIMILARLY DISCLOSED.
OUR ORDER 37010341 HAS BEEN SPLIT INTO MULTI LE SHI MENTS. CERTAIN ITEM WILL
E SHIPPED EPARATELY. YOU WILL BE BILLED FOR THESE TEMS TAHEN THEY ARE SHIPPED
MERCHANDI E TOTAL 478.00
INVOI E TOTAL 478.00
BILL TO INVOICE# CUSTOMER P
ITEM STATUS KEY REM KEY
1308571 9627024-01 MARK HULETT 13 -Backordered: Item will follow SK School Kit
D Discontinued: Item no longer available NC No Charge
IP T INVOICE DATE F BOXES F Special Schein Free Goods
M Manufacturer will ship Item directly to ,you
1308572 3/11/08 2 1' Prescription [)rug: Return Authorirntian Required
R Refrigerated Item: May be shipped separately
HSI BER TNVOTCE TOTAL PAGE# Special Schein Pricing
U Temporarily unavailable: please reorder
1145220— 1 478. 0 0 l OF 2 T- Taxable Item Continued on Next Page
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))
03/11/08 9627024 -01 EMS Equipment $478.00
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
VOUCHER NO. WARRANT N
ALLOWED 20
Henry Schein
IN SUM OF
Dept Ch 10241
Palatine, IL 60055
$478.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1120 9627024 -01 102- 670.06 $478.00 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
A
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund