HomeMy WebLinkAbout203878 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