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Home My WebLink About199507 07/20/2011 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1 ONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: $446.86 CARMEL, INDIANA 46032 DEPT CH 10241 PALATINE IL 60055 -0241 CHECK NUMBER: 199507 CHECK DATE: 7/20/2011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 102 4239011 5226695 98.76 SPECIAL DEPT SUPPLIES 102 4467006 5998363 348.10 EMS EQUIP Please detach here and mail the above with your payment HSI ORDER# ORDER DATE DUE DATE 92545601 06/23/11 07/31/11 WHSE DEA# RH0162494 Fed ID: 11-3136595 A 0 a s o e m r a 1 109 -8454 EA OMNI BLS /ALS TOT SYST BAG EMPTBAG 2 2 174.05 348.10 PRODUCT IS 3EING SHIPPED TO YOU DIRECTLY FROM THE MAVUFACTIRER. OUR ORDER 2545601 HAS BEEN SPLIT INTO MULTIPLE SHI MENTS. CERTAIN ITEM WILL E SHIPPED 5FPARATELY. YOU WILL BE BILLED FOR THESE FTEMS 1 AHEN THEY ARE HIPPED. F YOU ARE ARTICIPATING IN A DISCOUNT PROG (E.G. POIN S, GIFTS OR O HER PECIAL AWARDS "DISCOUNT WITH THIS PURC SE YOU HAVE EARNED A CREDI TOWARD GOODS OR S RVICES, RECEIVABLE OR REDEEMABLE N ACCO DANCE WITH DISCOUNT PROGRAM RULES. UPO DISCOUNT RECEIPT OR REDEMPTION, OU ARE RECEI ING OR WILL R CEIVE OTICE OF TIE DISCOUNT VALUE. FROM TIME TO TI E, MED CARE, MEDICAID, TRI ARE OR THER PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, IND-UPON ANY S CH REQUEST, SU H VALUE MUST BE DISCLOSED AS A DI COUNT GAINS7 THE PURCHASE THAT EARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN THESE RECORDS. MERCHANDI E TOTAL 348.10 invoice Date 30 days 348.10 LEASE NOTE NEW REMIT TO ADDRESS lease remi payments only to the following a dress: ENRY SCHRII INC. EFT CH 10211 ALATINE, I 60055 -0241 B ILL TO QI I NVOICE ITEM STATUS KEY REM KEY 1308571 1308572 5998363 -01 348.10 It Backordered; hem will follow SK SchUOIKit 14SI ORDER4 F h Discontinued: Item no longer available NC No Charge P Special Schein Free Goods 92545601 06 23 11 7/01/11 M Manul;icmrcr will ship hem directly w you P- Prescription Diog: Renton Authorization Required R Refrigerated Item; May he shipped separately CUSTOM A Spacial Schein Pricing U Tentporatily unavailahte_ please reorder MARK 062311 1 OF 1 T- Taxah7e hem Payment Terms: We make 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 MASTERCARD DISCOVER and AMERICAN EXPRESS response to manufacturers' price changes Guaranteed Satisfaction: APO 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 Year Opera 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 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 DEA certificate, verifying your shipping address. Class II drugs can be ordered only by mail. International Orders: Please N ote: 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: 1-800-845-3550 equipment, :�e suggest that you check the shipping container 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. LP300 Please detach hem, and mail the above with your payment-. a -HSI ORDER# ORDER DATE `.DUE DATE. 92634005 06/28/11 07128/11 WHSE DEA# RHO162494 Fed ]D: 11- 3136595 M .r, a a s idC xs M uu_ ae� z T his order has been processed by our MIDWEST B.C. 5315 WES 74TH 3TREET INDIANAP LIS,IN 46268 MIDWEST D.C. State Lic 23 00304 1 250 -9611 EA ACCU -CHEK CONTROL COMFORT HI /LO 12 12 8.23 98.76 1 F YOU ARE ARTICIPATING IN A DISCOUNT PROD (E.G. POIN S, GIFTS OR 0-HER PECIAL AWA DS "DISCOUNT WITH THIS PURCHASE YOU HAVE EARNED A CREDI TOWARD GOODS OR SERVICES, RECEIVABLE OR REDEEMABLE N ACCO DANCE WITH DISCOUNT PROGRAM RULES.., UPOI DISCOUNT RECEIPT OR REDEMPTION, 'IOU ARE RECEIIvING OR WILL RECEIVE OTICE OF T E DISCOUNT VALUE. FROM TIME TO TI E, MEDICARE, MEDICAID, TRI ARE OR THER PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, D UPON ''ANY S CH R EQUEST, SU H VALUE MUST BE DISCLOSED AS A DI COUNT GAINS71 THE PURCHASE THAT E ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN THESE RECORDS. MERCHANDI E TOTAL 96.76 Invoice Date 30 days 98.76 LEASE NOTE NEW REMIT TO ADDRESS lease remi payments only to the following a dress: ENRY SCHEI INC. EPT CH 10211 ALATINE, I 60055 -0241 IL.- zn SHIP To- i NVOIC E4 InrvolcE TQTAL ITEM STATUS KEY REM KF� 1308571 1308572 5226695 -01 98.76 B iv knrdern.ncmwiulo#ow SK- SchnalKit I ER ORDER INVOICE DATE BOXES U D is contimicd.Itemnu NC- NaCharge F Special Schein I�reu Goads 6 7R 1 M- Ma— lacmrer will si6p hum thrrAdv to you 9 2634005 06/28/11 9 11 1'- Prescription Drug; Return Authorization Required CUS TOMER K Kcingerated Item. May be shipped separately PA Special Schein I'Eidng MARK 1 OF 1 U- 'Iempor;ui]yuna ailable;plcasereorder T Taxable Item LP300 111 z•.,a aYrra rit Terms: ;`le rn<<ke every elfo- t o mainta;c, prices for the durat:or of a Payment by CHECK or by the HENRY SCHEIN CREDIT CARD, cafe +og, ha aeYer, oue reserve the right to snake price adjustmentSfltl VISA, MASTERCARD, DISCOVER andAMERICAN E XPRES S response to manufacturers' price chanties i Guaranteed Satisfaction: If you have tried a product and it is defective or does :got perform or i saf slacto €€ly. ,ve will provide a credit, refund, or exchange: it s yo rr Bill a O rder c Your r' pen ccoun' Choice. Sire r r =Y; A ai2abie to licensee pracfit €oners :r the U S, A c :�vorc es are p:y Call our cusfor= e, se: vice depart::.en' '30 :lays payablr; roith r: ?u days, of r :creipt of the inerd"2ndso to arrange "or the return. For a ,,6ranty repair or it you ,vere sen' sortie hing you (,ikj not order, s: ;,ply lax Products Controlled Substances: atrx Medical 1-800- 845 -3550 Regulafions roqullre us to lint the gala o f Px and controlled substances or;ly to registered, licensed healthcare professionals, U you are anew customer or have recently moved, please furnish us with a copy of your updated state registration. For controlled substances, kirnish a copy of your DFA certika- te, verifying yo r shippirig address. Class fi drugs can be ordered only b'-rail, International Orders: Please 'ate. We proudly serve healthcare ;professionals and governments Opened handpieces and e laced in j fh equipment may not be returned for tl',roughout tipe :vorld. "o place prod ?rs or for npu: r;�s cr expo f credit but vpvill bo repaired or r I accareance p p terms and coneitio,'s please contact our International Department: m:� warrant'as. Before opening l h,p ndpteras or g00 845-3yS� esouipment, Y suggest IN'd you clh the soipp:r g co Mi er and pack :na list to ver;sy iris„ ycprr ,,eve noel sec exactly Mat s yo ordered.Opened Computer Software is not returnable. Prescription Drug Returns Instructions: Other restrictions may also apply. A Fieturn Authorization is Required 'or at' Prescription Drugs. Sl ^ppl call cur Customer Service Department 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)) 5998363 $348.10 5226695 $98.76 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. WARR N O. ALLOWED 20 Henry Schein IN SUM OF Dept Ch 10241 Palatine, IL 60055 $446.86 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# I Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 1120 5998363 j 102 670.06 j $348.10 1 hereby certify that the attached invoice(s), or 1120 5226695 102 390.11 $98.76 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 JUL 18 2 Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund