The URL can be used to link to this page

Home My WebLink About199956 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