HomeMy WebLinkAbout203473 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