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Home My WebLink About200886 08/30/2011 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1 i ONE CIVIC SQUARE HENRY F10 SCHEIN INC CHECK AMOUNT: $1,868.23 D CARMEL, INDIANA 46032 PALATINE IL 60055 -0241 CHECK NUMBER: 200886 CHECK DATE: 8/30/2011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 102 4239011 1516721 -01 1,868.23 SPECIAL DEPT SUPPLIES HSI.IORDER ORDER. DATE DUE. DATE 93828795 08/18/11 09/17/11 WHSE DEA# RHO162494 Fed ID: 11- 3136595 a a n:I -a,., :eat.. Y his order i as been processed by our MIDWEST D.C. 5315 WEST 74TH 3TREET INDIANAP LIS,.IN 46268 MIDWEST D.C. State Lic#: 23:00304 1 879 -8581 30 /PK MEDI -TRACE SNAP FOAM ELEC 530ECG 80 BO C 4.50 360.00 3 ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. 2 602 -8100 EA COLLAR STIFNECK SELECT ADULT 100 100 C 5.50 550.00 5 ASE GOOD 2 EM, MAY BE SHIPPED SEPARATELY. 3 555 -5396 PU EA PROTECTIV ACUVNC SFT CATH 20X1.25 200 200 2.73 546.00 6 4 555 -1166 PU EA PROTECTIV ACUVNC SFT CATH 18X1.25 150 150 2.73 409.50 6 5 555 -4687 PU EA PROTECTIV ACUVNC SFT CATH 22GX1" 1 1 2.73 2.73 6 F YOU ARE ARTICIPATING IN A DISCOUNT PROGRAM (E.G. POTNrIS, 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. UPO N DISCOUNT RECEIPT OR REDEMPTION, OU ARE RECEI ING OR WILL RECEIVE OTICE OF TIE DISCOUNT VALUE. FROM TIME TO TIME, MEDICARE, MEDICAID, TRI ARE OR THER PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, D UPON ANY S CH EQUEST, SUM VALUE MUST BE DISCLOSED AS A DISCOUNT %GAINSI THE PURCHASE THAT ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN THESE RECORDS. MERCHANDT E 'TOTAL 1868.23 BILL -TO 'Hip z uv rlvoze amornuT ITEM STATUS KEY REM KEY 1308571 1817102 1516721-01 18G8.23 It Backordered. hem will follow SK School Kit I) Discontinued: hem no longer available NC No Charge HS1 ORDER BOXES P- SPcdal Schein Free Goods M ManLLl=UCCr will .ehlp licm direclty to you 93828795 08/18/11 8/18/11 6 P- hrescripdnnu ug Remrn nutharizution Rcyuircd R Itelrigeraled kern; May he shipped sap.rreiely PAGE4 Special Schein Pricing T -T ableltelmnnavailable: please r Continued on Next Page_ ARK HUL]J'Z'T 1 OF 2 LP300 ri ENRY SCHEIN@ SHIP TO /SOLD TO: EMS Carmel Fire Department MI 135 Duryea Road, Melville, NY 11747 INVOI 540 w 136 St Station 46 Michael Kaufmann Carmel,IN 46032 -8806 01000013085710151672111 ,0010000001,8682308118113 BILL TO: Carmel Fire Dept MI 2 Civic Sq Carmel, IN 46032 -7543 Carmel Fire Dept MI 2 Civic Sq BILL TO SHIP TO I INVOICE AMOUNT Carmel, IN 46032 -7543 1308571 1817102 1868.23 IISVOICE INVOICE DATE- 1516721-01 8/18/11 CUSTOMER PO MARK HULETT please detach here and mail the above with your payment HsT ORDER 'ORDER DATE DUE DATE 93828795 08/18/11 09f17/11 WHSE DEA# RH0162494 Fed ID: 11-3136595 Invoice Date 30 days 1868.23 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 BILL TO SHIP TD .INVOICE INVOICE AMOUNT ITEM STATUS KEY R8M KEY 1308571 1817102 1516721 -01 1868.23 u Backordomd. Item will rollow SK SchmAKit .x. Il Discontinued. Item no longer available NC No Charge H RDER ORDER DATE P- Special Schein line (roods DI Manufacturer will ship Item diwcdy to you 93828795 08/18/11 8/18/11 6 1'- Prescription Drug: Return Authorirutioo Required R Retngerated Item. May he shipped separately PAGE Special Schein Pricing U Temporarily unavailable: please reorder MARK HULETT 2 OF 2 T- Paxablcllcin LP300 HENRY SCHEW EMS T FRms OF S All 'tr rat enns We eke every r ffio tc maintain, prices for the duradotl of a Payment by CHECK or by the HENRY SCHEIN CREDIT GARB, 's,8'rE!','t ":E rp5erfe t ;s? right 4Q matte Price adjustmen s :l VISA, MAST RCA Q. DISCOVER and AMERICAN EXPRESS response to manufacturers price changes Guaranteed Satisfaction: vsa If you have tried a Product and it is defective cr does not of pedorn' o E Your Order To £av r t%- Account. f satis'actoril;.r, t will provide a credit, refund, or exchange, its your choice. Simply ca;l our custorner servive departa enf odthin 30 days Available to licensed frra :titiuners in the U.S. Ai in lC)Ict 5 are 0•: r r IPt t f lu CTl( r4r u x payable within 30 days. d st fo arrangr rcr the return. F ora warranty repair or if you were se somothi; g you did not 'oruto si y ail Px Products Controlled Substances: Matra Medical 1 -800-845-3550 Reaulat'ionS rtqu rt us t0 limi the 5s c of Rx and roil! rolled subst {�r :.cts r r,fy o eaistered, i censed hea professionals. If you are a new cu stome r er or have recentiv moved, please. furt?ish us with a copy of your updated State registry ion. For controlled substances, furnish a copy of your DEA certificate, verity;rg •dour shipping address. Class II drugs can be ordered only by ,mail. International Orders: Pleas No rJ er,ee hand reces and tr uiPrre{ a not t c retrrr ed `crr We proudly serve h&tt .are professi and governments p fltroughcut t he Yvorid. To puce rdErs or fcr ;r%q r es Or expo t credit, but roil be repa or n placed in accordance- e- ,'ith terms and conditions, Please �ontacf our International Ueparfrtient: manufacture toarrant es. Petare oat ning ha dpieces or 800 8�5 35 0 eq.0 pmzsnt, vo s :=ages' t'h at you ::heck the shippsna container and paWfcnG irsf to ter`y that YUAJ avE rE Erec exactly what Prescription Drug Returns Instructions: yo n ordere d.0pened computer Software is not returnable. Other restrictions may also apply. A Fleturn :authorization is required for ali Prescription Drugs. S.1 -nPly calf our Customer Service Depar'ment d 1- 800 845 -3`1% n VOUCHER NO. WARRANT NO. ALLOWED 20 Henry Schein IN SUM OF Dept Ch 10241 Palatine, IL 60055 $1,868.23 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO. ACCT #!TITLE AMOUNT Board Members 1120 I 1516721 -01 1 102- 390.11 I $1,868.23 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 AUG t.9 2om 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)) 1516721-01 $1,868.23 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