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Home My WebLink About203473 11/09/2011 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1 ONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: $1,348.50 CARMEL, INDIANA 46032 DEPT CH 10241 PALATINE IL 60055 -0241 CHECK NUMBER: 203473 CHECK DATE: 11/9/2011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 102 4239011 359098 -01 1,348.50 SPECIAL DEPT SUPPLIES HSI ORDER# ORDER DATE DUE DATE 95464381 10/26/11 11/25/11 WHSE DEA# RHO] 62494 Fed ID: 11- 3136595 u M t o« t r•w is •r x m e a his order ias been processed by our MIDWEST D.C. 5315 WES 74TH 3TREET INDIANAP LIS,IN 46268 MIDWEST D.C. State Lic 23:00304 1 602 -8100 EA COLLAR STIFNECK SELECT ADULT 50 50 C 5.50 275.00 1 ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. 2 891 -3037 PU 50 /CA IV PREP KIT W/ TEGADERM 6 6 C 61.97 371.82 7 ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. 3 220 -1398 3 /ST BODY STRAP SET DISP YELLOW 100 100 4.80 480.00 9 _4 338-2 PU '100 /CA, EXTENSION SET STD BORE UL 1 1 C 221.68 221.68 8 ASE GOOD ITEM, MAY BE SHIPPED SEPARATELY. F YOU ARE DARTICIPATING IN A DISCOUNT PROGRAM (E.G. POIN S, GIFTS OR OTHER PECIAL AWA DS "DISCOUNT WITH THIS PURCH SE YOU HAVE ARNED A CREDI TOWARD GOODS OR SERVICES, RECEIVABLE OR REDEEMABLE N ACCO DANCE WITH DISCOUNT PROGRAM RULES. UPOI DISCOUNT RECEIPT OR REDEMPTION, OU ARE RECEI ING 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, PND UPON ANY S CH EQUEST, SU H VALUE MUST BE DISCLOSED AS A DI COUNT GAINSU THE PURCHASE THAT ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN TH SE RECORDS. MERCHANDI E TOTAL 1348.50 nvoice Date 30 days 13'48:50 13 ILL To SHIP TO Inn I E INVOI ITEM STATUS KEY REM KEY 1308571 1817102 359098 -01 1348.50 13- Backordered: Item will follow SK School Kit D Discontinued: Item no longer available NC No Charge I ORDER# ORDER DATE INVOICE DATE OF BOXES P Special Schein Free Goods M Manufacturer will ship Item directly to you 95464381 10 2 6 11 10/26/11 9 P Prescription Drug: Return Authorization Required CUS TOMER PO PA E R Refrigerated Item: May be shipped separately 5 Special Schein Pricing U Temporarily unavailable: please reorder MARK 1026 1 OF 2 T- Taxable Item ContlnuedonNextPage.......... L HENRY SCHEINS EMS SHIP TO /SOLD TO: IC Carmel Fire Department MI 135 Duryea Road, Melville, NY 11747 540 W 136 St Station 46 Michael Kaufmann Carmel, IN 46032 -8806 0100001308571003590981100100000013485010261 ,19 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 INVOICE AMOUNT Carmel, IN 46032 -7543 1308571 1817102 1348.50 INVOICE INVOICE DATE 359098 -01 10/26/11 CUSTOMER PO MARK 1026 Please detach here and mail the above with your payment HSI ORDER# ORDER DATE DUE DATE 95464381 10/26/11 11/25/11 WHSE DEA# RHO] 62494 Fed ID: 11-3136595 as a o e t o a a a .s a. PY3 w a s LEASE NOTE NEW REMIT TO ADDRESS Please remi payments only to the following a dress: HENRY SCHEIH INC. DEPT CH 102 1 ALATINE, I 60055 -0241 BILL T I INV INV Z E AM OUNT ITEM STATUS KEY REM KEY ]08 571 1817102 359098 -01 1348.50 H- Backordered: Item Will follow SK School Kit RDER ORDER DATE INVOICE DATE XE D Discontinued: Item no longer available NC No Charge F Special Schein Free Goods 95464381 1 2 6 /11 10/26/11 9 M Manufacturer will ship Item directly to you F Pr scription Drug; Return Authorization Required CUSTO PO# PA E R Refrigerated Item: May be shipped separately Special Schein Pricing U Temporarily unavailable: please reorder MARK 1026 2 OF 2 T Taxable Item LP300 EN RY SCHEIN@ EMS SAL Payment Terrine: 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 defective or does not perform or satisfactorily, Order To Four Open 000ut satisfactorily, we will provide a credit, refund, or exchange; it's your Available to licensed practitioners in the U.S. All invoices are choice. Simply call our customer service department within 30 days payable within 30 days. of receipt of the merchandise to arrange for the return. For a 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. It 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 Note: We proudly serve healthcare professionals and governments Opened handpieces and equipment may not be returned for throughout the world. To place orders or far, inquiries on export credit, but will a repaired e replaced in accordance with terms and conditions, please contact our International Department manufacturer warranties. Before opening handpieces or 1- H00 -H�5 -3550 equipment, we suggest that you check the shipping container and packing list to verify that you have received exactly what you ordered.Opened Computer Software is not returnable. Prescription Drug Returns Instructions: Other restrictions may also apply, A Return Authorization is Required for all Prescription Drugs. Simply call our Customer Service Department 1- 800 -845 -3550. MIEN- E ME '�ffl 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)) 359098 -01 $1,348.50 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. WARRANT NO. ALLOWED 20 Henry Schein IN SUM OF Dept Ch 10241 Palatine, IL 60055 $1,348.50 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 1120 I 359098 -01 1 102 390.11 I $1,348.50 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 NOV 2011 Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund