HomeMy WebLinkAbout199956 08/03/2011 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1
ONE CIVIC SQUARE HENRY SCHEIN INC
t t CARMEL, INDIANA 46032 DEPT CH 10241 CHECK AMOUNT: $740.90
PALATINE IL 60055 -0241 CHECK NUMBER: 199956
CHECK DATE: 8/3/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 4239011 2046481 -01 740.90 SPECIAL DEPT SUPPLIES
HS L!.ORDER 'ORDER DATE. :Z DUE•DRTE'
92937104 07/12/11 08/11/11
WHSE DEA4 RHO162494 Fed ID: 11- 3136595 N 0 ON
al ME I A111-111 u
his order has been processed by our MIDWEST .C.
5315 WES 74TH 3TREET
INDIANAP LIS,IN 46268
MIDWEST D.C. State Lic 23 00304
17 -571 -266
VIARK
1 555 -5396 PU EA PROTECTIV ACUVNC SFT CATH 20X1.25 100 100 2.73 273.00 4
2 654 -5076 PU 50 /BX PROTECTIV ACUVANCE SAFETY 22GX1" 1 1 136.50 136.50 4
3 701 -9859 PU 100 /BX VANISH PT SYR 3CC W /NEEDL 22GX1" 2 2 41.95 83.90 4
4 107 -0530 100 /BX PURPLE NITRILE PF GLOVE LARGE 30 30 C 8.25 247.50 3
ASE GOOD I EM, MAYBE SHIPPED SEPARATELY.
F YOU ARE ARTICIPATING IN A DISCOUNT P:OG (E.G. POIN S, GIFTS OR OTHER
PECIAL AWA DS "DISCOUNT WITH THIS PURCH SE YOU HAVE EARNED A CREDI TOWARD
GOODS OR SERVICES, RECEIVABLE OR REDEEMABLE IN ACCO DANCE WITH DISCOUNT PROGRAM
RULES. UPO4 DISCOUNT RECEIPT OR REDEMPTION, OU ARE RECEITvING OR WILL R CEIVE
N OTICE OF T E DISCOUNT VALUE. FROM TIME TO T2 F, MEDICARE, MEDICAID, TRIIIARE OR
THER PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, PND.UPON ANY S CH
R EQUEST, SU H VALUE MUST BE DISCLOSED AS A DI COUNT GAINSq THE PURCHASES THAT
E ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN THESE RECORDS.
ERCHANDI E TOTAL 740.90
INVOICE
BILL TO HIP TO
ITEM STATUS KEY REM KEY
1308571 1817102 2046481 -01 74u
n U
R Rackordered Item wtEl lollc, SK School Kit
1) e,oinued: Item nu longer available NC No Charge
A K E A INV A F H XES Spe Schein Free Clouds
M NI—f -lure, will ship Item dlreetiy to you
92937104 07/12/11 7 12 11 4 1' Amsc ipliun Drug: Return Authorization Required
T p K Kely�gcr;c,. be shippoA separately
PAGEH
Spemal Schein Pncin
U Temporarily unavailable; please morda
MARK 1 OF 2 T Tzxahle Item Continued on Next Page
FAHENRYSCHEIN
SHIP TO /SOLD TO:
Matric Carmel Fire Department MI
135 Duryea Road, Melville, NY 11747 540 w 136 St
Station 46 Michael Kaufmann
Carmel,IN 46032 -8806
01 00001 30857102046481110010000000740900712116 BILL TO:
Carmel Fire Dept MI
2 Civic Sq
Carmel, IN 46032 -7543
Carmel Fire Dept MI
2 Civic Sq 13ILL. TO -SHIP TO INVOICE: TOTAL:.:
Carmel, IN 46032 -7543
1308571 1817102 740.90
INVOICE INVOICE DATE
2046481 -01 7/12/11
CUSTOMER PO'
MARK
Please detach here and mail the above with your payment-----
HSI ORDER, DATE DUE DATE
92937104 07/12/11 08/11/11
WHSE DEA# RHO162494 Fed I1): 1.1- 3136595
invoice Date 30 days 740.90
LEASE NOTE NEW REMIT °'T0 ADDRESS
Please rem payments only to the following a dress:
ENRY SCHEI4 INC.
DEPT CH 102 1
ALATINE, I 60055 -0241
siLL aNVOI E INIV e r ITEM STATUS KEY REM KEY
1308571 1817102 20464ui 01 740.gO 13 Backordered: Itcm will fulww SK- School Kit
D Discontinued. Itcm no longer available NC No Charge.
H4. D •R ..ORDER:: DATE INV IE E DATE.::::::.:. ub BOXES P Special Schein Pmc Goods
M Manufacturer will ship Item directly to you
92937104 0 7 12 11 7/12/11 4 P 1 Drug. Return .Authorization Required
:y R- Refrigerated Item: May he shipped separately
MER >P
Special Schein Pricing
U Temporarily unavaatable; ptease reorder
MARK 2 OF 2 T Taxable Item
Matrx Medical
JIL ERMS OF A'
Payment by CHECK or by the HENRY SCHEIN CREDIT CARD,
na�bg towovo�wereserve the right lo make price *djustnont�|n VISA,, MASTERCARD, DISCOVER andAMERICAN EXPRESS
m�o0��man���mm'pricoch0mSoo
Guaranteed Satisfaction:
or
|1ynu have tried opmduc| and itixdefeuiveo/ does, :oiperfu,m
Bill Your Order To Youv Open Account
oafida=o/i|y credit, refund, or h ii'nyour
Available to licensed practiflonem:n the U.S, 4'nvoices are
choice. Simply call our ouxtcmeranmiondepart n1.MthinSOdays
n�mcai�d|!�oma�ho�d|��onango(u/�her�um
payable within 30 days,
Fora
airorityo:*ereosmtomnmzhingyomdidnotorder,
simply call: Rx Products &Controlled Substances:
Matrx Medical 1-800-845-3550
Rego|uUo«omquim uu|o|imitthe ua|enf Rx and nun!mUo�d
.substances on|yto registered, |ioonaodkouiihoam profess ionn!n,
if you unaoo*ouutomecr have rooend mnvdp|oaoe[un|ah
us with a copy of your updated state reglstral�on. For -controlled
substances, furnish a copy of your DEA certilicate, verifying yo; �'r
shipping address. Class 11 drugs can be, ordeqed only by
International Orders:
PA�vs�8��te:
'Ne proudly serve healthcare profes_sJonals and pvernments
Opened d d equipment �b nd ad�x
p"~" (hmughou1the wodd Tnp|e000�omor�r|nqu|hao
nmdK bdw0boepukedor��|anodinaouc��oco»i|h terms d ndiii no |ommn �i
a oan un n p on��uur enm�mmouepommeo�
man ofa�u�r»mrmnUon Bo�omopeoix0huodp|eooaor
1��U�45'3Ef0
equipment We Suggest that you check the ship container
and. pa^""' list `"verily w''"' Prescription Drug Returns Instructions:
umdmedO dC So�wam|nnmdr�ur�b}e.
6errestrictions may also apply.
ARo|umAu�nhz�oninRequimd�r�'P�auhphnnDm%a.S|m��md\
our Customer
VOUCHER NO. WARRANT NO.
ALLOWED 20
Henry Schein
IN SUM OF
Dept Ch 10241
Palatine, IL 60055
$740.90
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# I Dept. INVOICE NO. I ACCT /TITLE I AMOUNT Board Members
1120 2046481 -01 j 102 390.11 1 $740.90 I 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
AUG -1 2011
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))
2046481 -01 $740.90
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