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Home My WebLink About203878 11/21/2011 a CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1 ONE CIVIC SQUARE HENRY SCHEIN INC CARMEL, INDIANA 46032 DEPT CH 10241 CHECK AMOUNT: $2,691.43 PALATINE IL 60055 -0241 CHECK NUMBER: 203878 CHECK DATE: 11/21/2011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 102 4239011 565469 291.00 SPECIAL DEPT SUPPLIES 102 4239011 727224 2,332.72 SPECIAL DEPT SUPPLIES 102 4239011 727315 67.71 SPECIAL DEPT SUPPLIES HSI ORDER# ORDER DATE DUE DATE 95799245 11/09/11 12/09/11 WHSE DEA# RHO] 62494 Fed ID: 11- 3136595 This order has been processed by our MIDWEST .C. 5315 WES 74TH 3TREET INDIANAP LIS,IN 46268 MIDWEST D.C. State Lic 23 00304 7========== 1 782 -6449 EA RESUSCITATOR BAG MASK DIS ADULT 12 12 C 8.15 97.80 2 ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. 2 107 -0530 100 /BX PURPLE NITRILE PF GLOVE LARGE 40 40 C 8.45 338.00 6 ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. 3 107 -0502 100 /BX PURPLE NITRILE PF GLOVE MEDIUM 20 20 C 8.45 169.00 8 ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. 4 107 -0501 100 /BX PURPLE NITRILE PF GLOVE SMALL 20 20 C 8.45 169.00 10 ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. 5 654 -5076 PU 50 /BX PROTECTIV ACUVANCE SAFETY 22GX1" 2 2 137.77 275.54 18 6 555 -8844 PU EA PROTECTIV PLUS IV CATHETE 14X1.25 1 1 1.77 1.77 19 HIS PRODUCC IS BEING SHIPPED FROM OUR SOUTHW ST DISTRIBUTION CENTER. 7 102 -4985 100 /CA EXTENSION SET SMALL BORE 1 1 213.02 213.02 18 8 507 -8362 100 /BX NACL PREFILL SYRINGE 10ML ST 2 2 38.00 76.00 17 N PEDIGREE ITEM. DC:6380701 010 9 420 -4674 EA NASAL ATOMIZATION DEVICE W /SYR 50 50 2.87 143.50 17 BILL TO SHIP I INVOICE AMOUNT ITEM STATUS KEY REM KF_Y 1308571 1817102 727224 -01 2332.72 H- Backordered: Item will follow SK School Kit U Discontinued: Item no longer available NC No Charge HSI RDER ORDER DATE INVOICE DATE F BOXES F- Special Schein free Goods M Manufacturer will ship Item directly to you 95799245 11 0 9 11 11/09/11 19 P Prescription Drug: Return Authorintion Required CUS TOMER P PA E R Refrigerated Item: May be shipped scparatcl Special Schein Pricin MARK 1 OF 3 -T Cntp grar; h. MHENRY SCHEINO SHIP TO /SOLD TO: EMS Carmel Fire Department MI 135 Duryea Road, Melville, NY 11747 INVOI Sta W 136 St Station 46 Michael Kaufmann Carmel, IN 46032 -8806 0100001308571100727224110010000002332721109115 BILL TO: Carmel Fire Dept MI 2 Civic Sq Carmel, IN 46032 -7543 Carmel Fire Dept MI 2 Civic S q BILL TO SHIP TO INVOICE AMOUNT Carmel, IN 46032 -7543 1308571 1817102 2332.72 INVOICE4 INVOICE DATE 727224 -01 11/09/11 CUSTOMER PO MARK HSI ORDER ORDER DATE DUE DATE 95799245 11/09/11 12/09/11 WHSE DEA# RHO162494 Fed ID: 11- 3136595 01 r M� nr, av ti� s r P M M No E ll t�Mti: 10 360 -1359 EA SAM SPLINT ORANGE /BLUE 36X4.25 24 24 6.71 161.04 17 11 987 -8154 PU 100 /BX SYR DISP 3CC W/22X11/2 LUERLCK 2 2 12.38 24.76 17 12 857 -8871 EA NASAL AIRWAY LF 24FR 10 10 2.29 22.90 17 13 890 -6868 3 /PK LIFEPAK 12 PAPER EKG 18 18 10.87 195.66 17 14 153 -2007 20 /RL BIOHAZARD BAG 14.5X19 RED 3GAL 5 5 2.05 10.25 18 15 267 -0012 160 /PK SANI -CLOTH AF LARGE 6X6.75 24 24 C 5.27 126.48 12 ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. 16 507 -0791 U EA IV EMS SET W /ULTFA SITE 8 15DROPS 200 200 C 1.54 308.00 16 ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. F YOU ARE ARTICIPATING IN A DISCOUNT PROGRAM (E.G. POIN S, GIFTS OR O HER PECIAL AWA DS "DISCOUNT WITH THIS PURCH SE YOU HAVE EARNED A CREDI TOWARD GOODS OR S RVICES, RECEIVABLE OR REDEEMABLE N ACCO DANCE WITH DISCOUNT PROGRAM RULES. UPON DISCOUNT RECEIPT OR REDEMPTION, oU 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 VALUE, PND UPON ANY S CH R EQUEST, SU H VALUE MUST BE DISCLOSED AS A DI COUNT %GAINSr1 THE PURCHASE THAT E ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN THESE RECORDS. N HENRY CHEIN, INC. HAS PURCHASED THE SPE IFIC UNIT OF THE PRESCRIPT ON DRUG DIRECTLY F OM THE MANUFACTURER. B LL TO SHIP To INVO ICER INVO AMO ITEM STATUS KEY REM KEY 1308571 1817102 727224 -01 2332.72 H- Backordered: Item will follow SK School Kit D Discontinued: Item no longer available NC -No Charge HSI RDER ORDER DATE INVOICE DA F BOXES I Special Schein Prec Goods 9 5 7 9 92 4 5 11/09/11 11/09/11 19 NI Manufacturer will ship Item directly to you I' Prescription Drug: Return Authorization Required CUS TOMER P R Refrigerated Item: May be shipped separately A E Special Schein Pricing MARK U Temporarily unavailable: please reorder 2 OF 3 T Taxable Item Continued on Next Page L HENRY SCHEIN@ SHIP TO /SOLD TO: EMS Carmel Fire Department MI 135 Duryea Road, Melville, NY 11747 540 W 136 St INVOICE Station 46 Michael Kaufmann Carmel, IN 46032 -8806 010000130857100727224111001 ,0000002332721109115 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 2332.72 INVOICE# INVOICE DATE 727224 -01 11/09/11 CUSTOMER PO MARK Please detach here and mail the above with your payment HSI ORDER ORDER DATE DUE DATE 95799245 11/09/11 12/09/11 WHSE DEA# RH0162494 Fed ID: 11-3136595 MERCHANDI E TOTAL 2332.72 Invoice Date 30 days 2332.72 LEASE NOTE NEW REMIT TO ADDRESS Please remi payments only to the following a dress: ENRY SCHEI4 INC. EPT CH 10211 ALATINE, I 60055 -0241 i BILL TO SHIP TO INVOICE# INVOICE INVOICE AMOUNT ITEM STATUS KEY REM KEY 1308571 1817102 727224 -01 2332.72 It- Backordered: Item will lollow SK SchoolKit H I QRDER# ORDER DATE INVOICE DATE OF BOXES D Discontinued: Item no longer available NC No Charge F- Special Schein Free (,foods 95799245 11/09/11 11/09/11 19 ml- MannfawillshipIcmdimcuyyou P Pmu:r ion Drug: ntg; Return Authorization Required CUS TOMER P A E R- Refrigerated Item: May be shipped separately Special Schein Pricing U Temporarily unavailable: please reorder MARK 3 OF 3 T Taxable Item L H ENRY SCHEIN@ EMS T ERM SAL ayrrrent Terrors: 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: visa FUN If vu have tried a p roduct and it is defective or does not p erform or y`n p p satisfactorily, we will provide a credit, refund, or exchange; it's your Bill Y our Order To Your Open Account 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 simpl call: Rx Products Controlled Substances: Matrx Medical 1 -850- 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: Ple No te: Opened handpieces and equipment may not be re for We proudly serve healthcare professionals and governments credit but vrill 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 con :'.ac our International Department: equipm we suggest that you check the shipping container 1-800 -84, 3x50 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. Nl�U HSI ORDER DUE DAT 95649787 11/03/11 12/08/11 WHSEDEA# RHO162494 Fed ID: 11-3136595 MEMO* •z 3 VIARK HUEITT 317-571-2663 1 499-2911 EA XTRA BACKBOARD RED NO PINS 4 4 72.75 291.00 PRODUCT IS 3EING SHIPPED TO YOU DIRECTLY FROM THE M FACTURER. IF YOU ARE ?ARTICIPATING IN A DISCOUNT PROGPAJI (E.G. POINIS, GIFTS OR OTHER SPECIAL AWA ZDS ("DISCOUNT")) WITH THIS PURCHASE YOU HAVE EARNED A CREDI" TOWARD GOODS OR SERVICES, RECEIVABLE OR REDEEMABLE :N ACCOZDANCE WITH DISCOUNT PROGRAM RULES. UPOH DISCOUNT RECEIPT OR REDEMPTION, "OU ARE RECEIwNG OR WILL RICEIVE OF T DISCOUNT VALUE. FROM TIME TO TI E, MEDICARE, MEDICAID, TRI ARE OR DTHER PAYER MAY REQUEST INFORMATION REGARDING SUCH V kLUE, PND UPON ANY S JCH �EQUEST, SU-"H VALUE MUST BE DISCLOSED AS A DI COUNT AGAINS I THE PURCHASE; THAT ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE'AIN THESE RECORDS. MERCHANDI E TOTAL 291.00 Invoice Date 30 days 291.00 PLEASE NOTE NEW REMIT TO ADDRESS Please remi payments only to the following aldress: HENRY SCHEII INC. DEPT CH 10211 PALATINE, 1, 60055-0241 :SHp �6: BILL TO -INVOICE# INVOI CE:AMOUNT:' ITEM STATUS KEY REM �KEY 1308571 1308572 5 65 46 9-0 1 291 .00 13 llackordered; Item will follow SK School Kit J HSI ORDERff I ORDER DATE: INVOICI IDAT E OF BOXES D Discontinued: Item no longer available NC No Charge F Special Schein Free Goods M Manufacturer will ship Item directly to you 95649787 11/03/11 11/09/11 P prescription Drug: Return Authorization Required R Refrigerated Item: May be shipped separately CUSTOMER P(j# PAGE# Special Schein pricing i U Temporarily unavailable; please reorder FMARK 1 OF 1 T Taxable Item LP300 Pay,nnent Terms: Wo make nvervo priCes for the; dmoflo:ofa Payment by CHECK or by the HENRY SCHEIN CREDIT CARD, catalog howevar,wmmnemaUm richt to make phoaudjuotments|n VISA, MASTERCARD, DISCOVER and AMERICAN EXPRESS response tomanufaoumo`;hceuhan0no Guaranteed Satisfaction: or Kynu have <,iada�mduo�endi�isd*�o|ivoordnonn�podurm Bill Your Order To Your Oper, Account oabu�u�nh|y.wnwii||pmvidee credit, refund, n/sxnhan0e it's your Avaiab to licensed practitionors i n the US. A", invoices art) xhoioo, Simp'v to nwkmd N ':f' 30dann ayab with 30 days, 0 arrange for the rotum. For warranty repair urd you were sent aomothinQ you did not order, a|My|y:a||: Rx Products Controlled Substances: M8trx Medical 1~800-845~3550 Regulati N limit 'he oainofRx and controlled uobo�mmaon|y��0i�amd healthcare professionals. I you are a new customer or h h us with a copy of your updated state r g For con4olled substances, fu:mish a copy of your DEA certificate, verifying youir shipping address. Class 11 druias can be orderod only by International Orders: Please Note: Yvopm' �di h it�campm(eaniuna!sandgnvpmmon|s 0pauedhandp� n\m m ueaundoquipmeaynu(hotumadfnr thmughuui the wudd Tnp|anon�amn/brinqui,iannnoxpo� nrodit bu'wiUbnrepaiedormp|aoodinacno�ancowi|h tp.mm and oonditionn Please cun��nu/|n|am�inoe|Depa�mo�: manufacturer weremheo,Bofnmopening handP|eoonor ;-800-845-35117,0 eqoipmon1 we stuggest that check lh shipping i and pooking{io�Nvnr|��youn��moo|vaUoxosUywk� Prescription Drug Returns Instructions: �mn�e/od1�panndCom ba Software iancdro�urnab|e. Other restrictions may also apply. A Return AuiihnrizuUoninRoquiredio/ all Prescription Drugs. 6|mp|yoa|| nur Customer Service Dopo�Men 1- 80- 8.4 5 0. HSI ORDER ORDER DATE DUE DATE 95805767 1 11/09/11 12/09/11 WHSE DEA# RHO] 62494 Fed ID: 1 1 .e e P M er s•e r ee� his order has been processed by our MIDWEST D.C. 5315 WES 74TH 3TREET INDIANAP LIS,IN 46268 MIDWEST D.C. State Lic 23 00304 1 459 -3636 EA SURETEMP PLUS ORAL PROBE 4' CORD 1 1 67.71 67.71 1 F YOU ARE ARTICIPATING IN A DISCOUNT PROG (E.G. POIN S, GIFTS OR OTHER PECIAL AWA DS "DISCOUNT WITH THIS PURL SE YOU HAVE EARNED A CREDI TOWARD GOODS OR S RVICES, RECEIVABLE OR REDEEMABLE N ACCO DANCE WITH DISCOUNT PROGRAM RULES. UPO4 DISCOUNT RECEIPT OR REDEMPTION, OU ARE RECEI OR WILL RECEIVE OTICE OF T E DISCOUNT VALUE. FROM TIME' TI E, MEDICARE, MEDICAID, TRI ARE OR THER PAYER MAY REQUEST INFORMATION REGARDING SUCH V UE, PND UPON ANY S CH EQUEST, SU H VALUE MUST BE DISCLOSED AS A DI COUNT GAINSI THE PURCHASE THAT ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN TH SE RECORDS. MERCHANDI E TOTAL 67.71 I nvoice Date 30 days 67.71 LEASE NOTE NEW REMIT TO ADDRESS P lease remi payments only to the following a dress: H ENRY SCHEIJ INC. D EPT CH 10211 ALATINE, I 60055 -0241 BILL, TO SHIP TO T INVOICE AMOUNT ITEM STATUS KEY REM KEY 1308571 1308572 727315 -01 67.71 11 Backordered: Item will follow SK School Kit D Discontinued: Item no longer available NC -No Charge H I ORDER# ORDER DATE INVOICE DATE OF BOXES 1' Special Schein Free Goods 11/09/11 1 M Manufacturer will ship Item directly to you 958 0 5767 11/ 09/11 1'- Prescription Drug: Return Authorization Required CUS TOMER PO# PAGE# R Refrigerated Item: May be shipped separately Special Schein Pricing U Temporarily unavailable: please reorder MARK 2 1 OF 1 T Taxable Item LP300 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 defective or does not perform Bill Your Ord To Your Open count 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. 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 11 drugs can be ordered only by mail. International Orders: Please Note: 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 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. 77 7 =,gg5R37- g e 'ova 3 1 Q "Im 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)) 727224 $2,332.72 727315 $67.71 565469 I I $291.00 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 $2,691.43 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO. I ACCT #/TITLE AMOUNT Board Members 1120 j 727224 j 102 390.11 j $2,332.72 1 hereby certify that the attached invoice(s), or 1120 727315 102- 390.11 $67.71 bill(s) is (are) true and correct and that the 1120 I 565469 1 102 390.11 I $291.00 materials or services itemized thereon for which charge is made were ordered and received except NOV 2'1 2011 Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund