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Home My WebLink About202586 10/11/2011 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1 ONE CIVIC SQUARE HENRY SCHEIN INC CARMEL, INDIANA 46032 DEPT CH 10241 CHECK AMOUNT: $1,700.45 PALATINE IL 60055 -0241 CHECK NUMBER: 202586 CHECK DATE: 10/11/2011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 102 4239011 1770523 -01 63.71 SPECIAL DEPT SUPPLIES 102 4239011 1770533 -01 292.13 SPECIAL DEPT SUPPLIES 102 4239011 2255561 -01 254.92 SPECIAL DEPT SUPPLIES 102 4467006 2265461 -01 169.19 EMS EQUIP 102 4239011 4104071 -01 920.50 SPECIAL DEPT SUPPLIES HSI ORDER ORDER DATE DUE DATE 94571804 09/20/11 10/20/11 WHSE DF,A# R110162494 Fed ID: 11- 3136595 KIM In. his order' been processed by our MIDWEST .C. 5315 WES 74TH 3TREET INDIANAP LIS,IN 46268 MIDWEST D.C. State Lic 23 00304 1 681 -5673 16RL /CA COFLEX- AFD -ABSRB FM DRESS 2X2.5YD 1 1 33.48 33.48 1 2 681 -6150 8RL /CA COFLEX- AFD -ABSRB FM DRESS 4X2.5Y1D 1 1 30.23 30.23 2 HIS PRODUCC IS BEING SHIPPED FROM OUR WEST C AST DI TRIBU ION CENTER, OUR ORDER 4571804 HAS BEEN SPLIT INTO MULTI LE SHI MENTS. CERTAIN ITEM WILL E SHIPPED EPARATELY. YOU WILL BE BILLED FOR THESE ITEMS 1AHEN THEY ARE HIPPED. F YOU ARE DARTICIPATING IN A.DISCOUNT PROGRAM (E:G: POIN S, GIFTS OR or HER PECIAL AWA DS "DISCOUNT WITH THIS PURL SE YOU HAVE EARNED A CREDI TOWARD GOODS OR SERVICES, RECEIVABLE.OR REDEEMABLE N ACCO DANCE WITH DISCOUNT PROGRAM RULES. UPO DISCOUNT RECEIPT OR REDEMPTION, MU ARE RECEI ING OR WILL R CEIVE 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, AND UPON ANY SITCH REQUEST, SUM VALUE MUST BE DISCLOSED AS A DI 3COUNT GAINS71 THE PURCHASE THAT EARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN THESE RECORDS. MERCHANDISE TOTAL 63.71 nvoice Date 30 days 63.71 BILL TO SHIP' TO INVOICE AMPUN7 ITEM STATUS KEY REM KEY 1308571 1308572 1770523 -01 63.71 H Back-decd Item will nunw SK- School Kit i RD R ORDER -D E ]INVOICE 1) Discontinued Item no longer available NC No Charge P Special Schein Free. Goods M Manufacturer will ship Item directly m you 94571804 09 /20/11 9/21/11 2 1'- Prescription Drug; Return Authoriraion Required R Refrigerated Item; May be shipped separately CUSTOM Special Schein I'ncing U Temporarily unavailable: please reorder MARK 1 OF 2 T Taxable Item Continued on Next Page LP300 MHE I NRY SCHEINO EMS SHIP TO /SOLD TO: Carmel Fire Dept Head Quarters MI 135 Duryea Road, Melville, NY 11747 I I NVOI CE 2 Civic Sq V V Carmel,IN 46032 -2584 010000130857101770523 ],10010000000061?109211116 BILL TO: Carmel Fire Dept MI 2 Civic Sq Carmel, IN 46032 -7543 Carmel Fire Dept MI 2 Civic Sq 6TLL TO SHIP TO INVOICE AMOUNT Carmel, IN 46032 -7543 1308571 1308572 63.71 TNVOICE4 INVOICE DATE 1770523 -01 9/21/11 CUSTOMER PO Please detach here and mail the above with your payment HSI ORDER# ORDER DATE DUE DATE 94571804 09/20/11 10/20/11 WHSE DEA# RHO162494 Fed ID: 11 3136595 f es a n LEASE NOTE NEW REMIT TO ADDRESS lease remi payments only to the following address: H ENRY SCHEIT INC. D EPT CH 10211 ALATINE, 1 60055 -0241 is .BILL TO SHIP TO I NVOYCEJJ INVCICE AMO= ITEM STATUS KEY REM KEY 1308571 1308572 1770523-01 63 .71 13 13ackordured. Item will follow SK School Kit 1) Discontinued; item no longer available NC No Charge H RDER DE D Z E F Special Schein Free Goods 9/21/11 2 M Manufacturer will ship llcm directly to you 94571804 09/20/11 P- Prescription Drug: Return Authorization Required PA E R Refrigerated Item; May be shipped separately Special Schein Pricing U- Temporarily unavailable; please reorder MARK 2 OF 2 T Taxab3e Item L 9i E i HENRY CHEI EMS .E. 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: If you have tried a product and it is detective or does not perform or satisfactorily, we will provide a credit, refund, or exchange; it's your Bill Your Order To Your Open 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 If drugs can be ordered only by mail. International Orders: Pl 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 antl candilions; phase contact our International Department; equipment, we suggest that you check the shipping container 1 -800- 845 -3550 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. H5' ORDER# ORDER DATE .DUE DATE 94571321 09/20/11 10/21/11 WHSE DEA# RHO162494 Fed ID: 11-3136595 his order aas been processed by our MIDWEST D.C. 5315 WEST 74TH 3TREET INDIANAP LIS,IN 46268 MIDWEST D.C. State Lic 23 00304 1 220 -1652 EA COLLAR STIFNECK SELECT PEDI 50 50 5.50 275.00 4 2 507 -8362 RX 100 /BX NACL PREFILL SYRINGE IOML ST 2 2 36.00 76.00 4._ N PEDIGR E ITEM. OC:6380701 010 3 555 -5396 PU EA PROTECTIV ACUVNC SFT CATH 20X1.25 150 150 2.73 409 :50 4 4 890 -6800 'E SHARPS SHUTTLE SINGLE USE P2 50 50 1.60 8 0i00 4 5 120 -0186 EA:. SHARPS. CONTAINER RED 1 GAL 32 32 C 2.50 80.00' 3, ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. F YOU ARE PARTICIPATING IN A DISCOUNT PROGRAM (E.G. POIN S, GIFTS OR OTHER SPECIAL 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. UPO4 DISCOUNT RECEIPT OR REDEMPTION, IOU ARE RECEI ING OR WILL R CEIVE OTICE OF.T E.DYSCOUNT VALUE. FROM TIME TO TI E, MEDICARE, MEDICAID, TRI ARE OR THER PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, PND UPON ANY SUCH REQUEST, SU H.VALUE MUST BE DISCLOSED AS A DI COUNT. GAINS THE PURCHASE THAT EARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN THPESE RECORDS. 1 4 N HENRY. CHEIN, INC..HAS PURCHASED THE SPE IFIC JIT OF THE PRESCRIPT DRUG DIRECTLY F OM THE MANUFACTURER. I E AM 17'F.M STATUS KEY REM KEY 1308571 1817102 41Z 04071 -01 920.50 B nackordertd ucm will follow sK- school Kit H I n RDERATE I[JVOIE DAT D Discontinued loan no longer available NC -No Charge F Spcciai Schein Free Goods 94 5 713 21 0 9 2 0 11 9 2 5 2 11 M Manufacturer will ship Item directly to you P Prescription Drug; Return Authorization Required R Refrigerated Item; May he shipped separately T MER. Special Schein Pricing U Temporarily unavailable; please reorder MARK 1 OF 2 T Taxable Item Continued on Next Page LP300 N SCHEIN �AAA 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 010000130857104104071110010000000920500922114 BILL TO: Carmel Fire Dept MI 2 Civic Sq Carmel, IN 46032 -7543 Carmel Fire Dept MI 2 Civic Sq HILL TO 1 SHIP TO INVOICE AMOUNT Carmel, IN 46032 -7543 1308571 1817102 920.50 1NVOICE INVOICE DATE 4104071 -01 9/22/11 CUSTOMER PO MARK Please detach here and mail the abuvu with your payment HSI'ORDER :ORDER DATE I DUE DATE 94571321 09/20/11 10/21/11 WHSE DEA# RHO162494 Fed ID: 11-3136595 Al� MERCHANDI E TOTAL 920.50 ,Invoice Date 30 days 920.50 LEASE NOTE NEW REMIT TO ADDRESS lease lremi payments only to the following a dress: ENRY SCHEI INC. EPT CH 102 1 ALATINE, I 60055 -0241 L SHI I E INVOICE AMOU NT ITEM STATUS KEY REM KEY 1308571 1817102 4104071 -01 920.50 17 Backordered Item will follow SK School Kit HSI QRnER DATE ll Discontinued Item no longer available NC -No Charg I E DA E e F P Special Schcm Free Goods 94571321 09/20/11 9 2 2 11 5 M Manufacturer will ship Item directly to you I' Prescription Dfug; Rctum Authorm2lion Required CUSTOMER PO# P 2# R Refrigerated item; May he shipped separately Special Schein Pricing U Temporarily unavailable; please reorder M�RK 2 OF 2 T- T— ble llem L AHE. S.- EMS S ALE 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: vrsa,,r, If you have tried a product and it is defective or does not perform or satisfactorily, we vJ11 provide a credit, refund, or exchange, it's your Bill Your Order To Your Open 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 tali; Rx Products Controlled Substances: Matrx Medical 1.300 -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: Ple !V Opened handpieces and equipment may not be returned for We proudly serve healthcare professionals and governments credit, Taut wrill 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. equipment, we suggest that you check the shipping container 1- 800 -845 -3550 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 a 1- 800 845 -3550. �M Mn I HSI ORDER# ORDER DATE DUE DATE 94571804 09/20/11 10/26/11 WHSEDEA# R140162494 Fed ID: 11-3136595 a r 1 116 -0999 EA DISPENSER F /EMESIS BAG 4 4 42.00 168.00 PRODUCT IS 3EING SHIPPED TO YOU DIRECTLY FROM THE MAIUFACTURER. 2 116 =1000 144 /BX EMESIS BAG 1000ML BLUE 1 1 124.13 124.13 PRODUCT IS 3EING SHIPPED TO YOU DIRECTLY FROM THE FACT RER. OUR ORDER 34571804 HAS BEEN SPLIT INTO MULTIPLE SHIPMENTS. CERTAIN ITEM WILL E SHIPPED 3EPARATELY. YOU WILL BE BILLED FOR THESE ITEMS IIHEN THEY ARE HIPPED. F YOU ARE ARTICIPATING'IN A DISCOUNT FROG (E.G. POIN S, GIFTS OR O SPECIAL AWA DS "DISCOUNT WITH THIS PURCHASE YOU HAVE FARNED 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 TIME, MEDICARE, MEDICAID, TRI ARE OR THER PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, PND UPON ANY S CH EQUEST, $U H VALUE MUST BE DISCLOSED AS A DI COUNT GAINS THE PURCHASE THAT EARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN TH SE RECORDS. MERCHANDI E TOTAL 292.13 Invoice Date 30 days 292.13 LEASE NOTE NEW REMIT TO ADDRESS Please remi payments only to the following a dress: HENRY SCHE14 INC. DEPT CH 102 1 ALATINE, 1 60055 -0241 HIL TNV ()Ic It INVOICE AMOUNT ITEM STATUS KEY REM KEY 1308571 1308572 1770533 -01 292.13 N Backordered: Item will fellow SK SchoolKit D Di.wommucd; hem no longer available NC No Charge E 9 DATE Trry I DATE P -Special Schein Free Goods M Manufacturer will ship Item directly 10 you 94571804 09/20/11 9/27/11 P- Prescription Drug: Retum Authorization Required R' P PA E R Rcfrigerated Item; May he shipped separately Special Schein Pricing U 'remporartly unavailable: please rcordcr MARK 1 OF 1 T- Taxahlchcm 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, save reserve the right to make price adjustments in VISA, MASTERCARD, DISCOVER and AMERICAN EXPRESS response to manufacturers' price changes Guaranteed Satisfaction: 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 Your Open Account choice. Simply calf our customer service department within 30 days Available to licensed practitioners in the U.S. Ali invoices are of receipt of the merchandise to arrange for the return. For a payable within 30 days. warranty repair or it 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 it 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 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, we 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. ME LP300 HSI ORDER ORDER DATE DUE. DATE, 94654986 09/22/11 10/22/11 WHSE DEA# RHO] 62494 Fcd ID: 11- 3136595 �E T his order ias been processed by our MIDWEST P.C. 5315 WES 74TH 3TREET INDIANAP LIS,IN 46268 MIDWEST D.C. State Lief#: 23 00304 RK HUIETT 17 -571 -266 1 857 -6255 EA BERMAN AIRWAY 90MM SZ 4 20 20 0.35 7.00 4 HIS PRODUCE IS BEING SHIPPED FROM OUR NORTHEAST DIS RIBUT ON CENTER. 2 499 -0538 PU EA ROBERTAZZI NASO AIRWAY 24FR 1 1 2.42 2.42 3 3 826 -5078 EA NASOPHARYNGEAL AIRWAY 30 FR 12 12 2.49 29.88 3 4 826 -7565 EA NASOPHARYNGEAL AIRWAY 32 FR 12 12 2.49 29.88 3 5 153 -6483 RX 250ML /BT STERILE WATER FOR IRRIG 250ML 48 48 C 1.15 55.20 2 ASE GOOD I EM, MAY BE SHIPPED SEPARATELY- VI N PEDIGREE ITEM. DC:0033800 402 6 987 -1566 PU 100 /BX SYR.W /NEEDLE SCC 20X11/2 LUERLCK 2 2 17 -81 35.62 3 7 101 -5979 6 /BX CLOTH SURGICAL TAPE 2 "X10YD 12 12 7.91 94.92 3 F YOU ARE ARTICIPATING IN A DISCOUNT PROGRAM (E.G. POIN S, GIFTS OR OTHER PECIAL AWA DS "DISCOUNT WITH THIS PURCHASE YOU HAVE EARNED A CRRDjr 1 TOWARD GOODS OR SERVICES, RECEIVABLE OR REDEEMABLE N ACCO DANCE WITH DISCOUNT PROGRAM BILL NV :.'i, INVOICE AMO ITEM STATUS KEY REM KEY 130:85; 1 1817102 2255561 -01 254 92 e- Backordered. Item Will follow -1 School Kit U Dist.onhnued; Item no Conger available NC Nu Charge H 't:r RDE DATE INV D F B XE AT P Special Schein l- Goods M Manufaetnrcr will chip Item directly to you 94654986 0 9/ 2 2/ 11 9/22/11 4 P- Prescription Drug: Return Authorization Required TOMSR FA R Refrigerated Item, May be shipped separately Special Schein Pricing U Temporarily miavailable: please reorder MARK 092211 1 OF 2 T- Taxable Item Conlinued on Next Page....,_.. LP300 i T T riENRY SCHEIN SHIP TO /SOLD TO: EMS Carmel Fire Department MI 135 Duryea Road, Melville, NY 11747 540 W 136 St Station 46 Michael Kaufmann Carmel,IN 46032 -8806 0100001308571022555611100 100000002549209221,1,9 BILL To: Carmel Fire Dept MI 2 Civic Sq Carmel, IN 46032 -7543 Carmel Fire Dept MI 2 Civic Sq BILL TO I SHIP TO I INVOICE AMOEINT:�,�'. Carmel, IN 46032 -7543 1308571 1817102 254.92 INVOICE INVOICE DATE:`. 2255561 -01 9/22/11 CUSTOMER PO MARK 092211 Please detach here and mail the above with your payment HSI ORDPRif I ORDER DATE DUE .DATE 94654986 1 09/22/11 1 10/22/11 WHSE DEA# RH0162494 Fed ID: 11-3136595 t i x m, �x xa i RULES. UPO4 DISCOUNT RECEIPT OR REDEMPTION, OU ARE RECEI ING OR WILL R13CEIVE OTICE OF TIE DISCOUNT VALUE. FROM TIME TO TIME, MEDICARE, MEDICAID, TRI ARE OR OTHER PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, AND UPON ANY SITCH R EQUEST, SU H VALUE MUST BE DISCLOSED AS A DI 3COUNT kGAINSI THE PURCHASE THAT E ARNED SUCH VALUE- ACCORDINGLY, YOU SHOULD RE AIN TH SE RECORDS. N HENRY SCHEIN, INC. HAS PURCHASED THE SPE IFIC UNIT OF THE PRESCRIPTION DRUG DIRECTLY F OM THE MANUFACTURER. /F: MARK H JIETT MERCHANDI E TOTAL 254.92 Invoice Date 30 days 254.92 LEASE NOTE NEW REMIT TO ADDRESS Please remi payments only to the following a dress: ENRY SCHEIT INC. EPT CH .1021f: PALATINE, I 60055-0241 BILL' HIP TO INV I IWOI E AM ITEM STATUS KEY R8M KEY 1308571 1817102 2255561 -01 254.92 13 Backordered. Item will tallow SK- School Kit R ORDER ATE I ATE ES D Dtscontmuod: Item no longer available NC No Charge HSI F Spceiul Schem Free Goods M Manufacturer will ship Item directly to you 94654986 0 9/ 2 2/ 11 9/22/11 4 p- Prescription Drug: Return Authorization Required C USTOMER Po PA' 6 R Refngeraled Item: May be shipped separately Special Schein pricing MARK 092211 2 OF 2 T Taxable Item unavvilablc please corder L .....I... 0W HENRY SCHEIN rm EMS 'MS 0 rn<<ko o.cry efforA i; paint l€ prises or the duration: of a Payment by CHECK or by the HENRY SCHEIN CREDIT CARP, catalog, 'Qlve4 'er, we reserve the right to make price adjustments response to rrianufacturers' price changes VISA, MA STERCARD, DISCOVER and AMERICAN EXPRESS i Guaranteed Satisfaction: wrs� or If ;.ou have tried a product and it is defer.i e or does not perior� Bi '-four -fot.rr rdr '1 Y �3 ,.,r, Acco evil. Provide a credit, refund, or exchange: its your j choice. Sinop v call our customer service departs ?yen; i €n '30 days rai'ab Eti to licrynswd f sac t€t ur ens r f a U.� jv �iccs arE of recF ipt of the rnerchar vise to arrange r the return. For payable with days, "ve raanf" 'pair or if you vvero sE rtt somet,hing you Kind not order, x s Hiply call Rx Products Controlled Substances: (atrx Medical 1-800-845-3550 Regulations ro-qu re us to limit the sal of Aix ants oNiro knd substances only tc registered, licensed healthcare professionais. 1 you are a qew customer or have recently moved, please fur sl, us ith a copy of your up -ated state registration. For ccnrelled substances, furnish a copy et your DEA certificate verifying your shipping address. Class 11 drool can be orderers oniv hj --ail. International Orders: Please ote ti Yi': u '0M pr. cliv serjo hc-a[Mcare orofefiGronals and governments 0 cried handpie es and equipmer r ~ay not he r t nod for t roughvut the won d. o place orders or for Ir go r es o expo 1 f i3t :P it bo reA� 9d or replaced in accordance >ith terms a nd conditio ^:s Please contact ocr lr :ernvional cpartment: anrrtactuner Betorc ape ning ha or 8 C 845 3 50 equipment, m suggest that you check the shipping 0ain r and packing list to .lerfe= that you have received exactly what Prescription Drug Returns Instructions: you ordered.Opened Computer Software is not returnable. Other restrictions may also apply. n A return Authorization is Required `or all resorption Drugs. Sin ply call cur lusiorner Service Department 1 800- 8,1 -3': 50i 0 HSE ORDER .ORDER DATE ...DUE DATE 94655789 09/22/11 10/22/11 WHSE DEA# RHO162494 Fed ID: 11- 3136595 722 his order as been processed by our MIDWEST .C. 5315 WES 74TH INDIANAP LIS,IN MIDWEST D.C. State Lic 23 00304 OLD FOR MARK HUIETT 17 -571 -266 1 925 -7310 EA SKELETON BUDGET BUCKY 1 1 C 169.19 169.19 1 ASE GOOD I EM, MAY BE SHIPPED SEPARATELY, F'YOU ARE ARTICIPATING IN A DISCOUNT PROG (E.G. POTN S, GIFTS OR OTHER PECIAL AWA DS "DISCOUNT WITH THIS PURCHASE YOU HAVE EARNED A CREDI TOWARD GOODS OR S RVTCES, RECEIVABLE OR REDEEMABLE N ACCC ZbANCE WITH DISCOUNT PROGRAM RULES. UPO4 DISCOUNT RECEIPT OR REDEMPTION, fOU ARE RECEI ING OR WILL R CEIVE OTICE OF T E DISCOUNT VALUE. FROM TIME TO TI E, MED CARE, MEDICAID, TRI ARE OR OTHER PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, D UPON ANY 5 CH REQUEST, SU H VALUE MUST BE DISCLOSED AS A DI COUNT kGAINSI THE PURCHASE THAT EARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN THESE RECORDS. /F: HOLD F R MARK HUIETT MERCHANDI E TOTAL 169.19 Invoice Date 30 days 169.19 `BILL- 70 Slkip INVOIC INVCICE AMO UNT.. ITEM STATUS KEY REM KEY 1308571 1308572 2265461 -01 169.19 a Backordered: [tern will follow SK School Kit D Discontinued. Item no longer available NC Nu Chargc FIST D R ORDER DATE NV ES h Special Schein Free Goods 9/22/11 1 h1- Manufacturer willship hem directly to you 94655789 09/22/11 Y Prescription Drug; Return Authorization Required R Refrigerated Item; Maybe shipped separately Pa E Special Schein Pricing U Temporarily unavailablei please reorder MARK HUIETT 1 OF 2 T Taxable hem Continued on Next Page LP300 RHE tt SHIP TO /SOLD T0: EMS Carmel Fire Dept Head Quarters MI 135 Duryea Road, Melville, NY 11747 2 Civic Sq IN VOI CE Carmel,IN 46032 -2584 01 00001308571 02265461110010000000169190922112 SILL TO: Carmel Fire Dept MI 2 Civic Sq Carmel, IN 46032 -7543 Carmel Fire Dept MI 2 Chi Sq BILL TO I SHIP TO I INVOICE AMOUNT Carmel, IN 46032 -7543 1308571 1308572 169.19 INVOICE INVOICE DATE 2265461 -01 9/22/11 .CUSTOMER 90 MARK HUIETT Ptcase detach here and mail the above with your payment HSI ORDER# ORDER DATE DUE DATE: 94655789 09/22/11 10/22/11 WHSE DEA# RHO162494 Fed ID: 11- 3136595 &�a P�_... I r .s Y �i..'�: x a ki .KR �x; ,...a, a a LEASE NOTE NEW REMIT TO ADDRESS P lease remi payments only to the following a dress: H ENRY SCHEIF INC. D EPT CH 102 1 P ALATINE, I 60055 -0241 �B ILL TO ::.INVOICE INVOICE AM OUNT ITEM STATUS KEY REM KEY 1308571 1306572 2265461 -01 169.19 n- Rackordered,Itemwill follow SK School Kit D Discontinued• Item no longer available NC No Charge HSI D R ORDE ATE INV I AT P Speci Schein Free Goods M Manufacturer will ship Item direcily to you 94655789 09/22/11 9/22/11 1 P- Prescription Drug: Rcturn Authorization Required �.CU T E 0 p E R Refrigerated Item; May he shipped separately Special Schein Pricing U Temporarily unavailable; please reorder MARK HUIETT 2 OF 2 T- Taxable Item L HENRY HEIN EMS T ERMS S 0 yap r'_rft 'tenns: y'3n makc, ewery r` fn' lio maim i Prices t;7r the durafiv. of a Payment by CHECK or by the HENRYSCH&N +wR DIT CARD r i ataiog, l :o,;evar, 'y,a reserve the right to maf a price adjust "en VISA, MASTERCARD. DISCOVER and AMERICAN EXPRESS response to manufacl .revs' price chances Guaranteed Satisfaction: If ,rod have trier{ a Droduct and it is defer'ive or does not Derform or d �ar�b I F'.F Your Order o e cc satis`actoril ,S�e will oro'v a credit, refund, or exchange, it's {Oli€ s s i choice. Sirs all cur Gusto er sCraiva d3 >�artme €rt :Y thing 30 Jays A °rai ab e #o lic ensed ractit €ac .r. t 11.S. A invoice are pit payable within days. of re ejpt of the merchar :d'sne to arrange for the return. For a _rranty r> pair or if yo:: weresent soaething you did not order, sir?(:ly sail: x Products Controlled Su stances; Matra Medical 1-800- 845$3550 Regulations require us to limit this saie of Px and cop roll substances 0r=1y to registered, 1 censed healthcare p €nfessiorrals. 11 you era a new customer or have recently moved. please fun:ish rrs Vilith a coax of your updated s °ate regstra ion, For controlled substances, IL rnish a copy of your DER certificate, Verifying yo_i. shipping a dress, Class 11 drucs can be ordered only bi €::ail. International Orders: Please Note: We prOLidly serve health::ares professionals and governments Opened handpiuces anti equipment may n-ol he reLt read for bu r 11 be rE'raa red E re f in accc r a cc h throughout the ,vorld. �a Pbce orders or °�r r q r ?s en a�ao t terms and con cit o ?s. Jlease contact our li;terr,a tonal D�aurtrE�ant manufsecb..rr> r .<.rrant :s. Bet ore opening her lot €ices or t GC �5a equipme wo suggest that Ou Check line s Pipp J cow r and uaClSinG list to Verify thog you lave received exactly what you ordere ,Opened Computer Software is not returnable, P rescription drug returns Instructions: Other restrictions may also apply. R Return Authorization is Required tr all E resor ption Drugs. S niply call our uus omen Service Depar meat i VOUCHER NO. WARRANT NO. ALLOWED 20 Henry Schein IN SUM OF Dept Ch 10241 Palatine, IL 60055 $1,700.45 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members 1120 2265461 -01 102 670.06 $169.19 1 hereby certify that the attached invoice(s), or 1120 1770523 01 102 390.11 $63.71 bill(s) is (are) true and correct and that the 1120 4104071 -01 102 390.11 I $920.50 materials or services itemized thereon for 1120 1770533 -01 102- 390.11 $292.13 which charge is made were ordered and 1120 2255561 -01 102 390.11 $254.92 received except OCT 10 2011 C 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)) 2265461 -01 $169.19 1770523 -01 $63.71 4104071 -01 I $920.50 1770533 -01 $292.13 2255561 -01 $254.92 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