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Home My WebLink About204249 12/06/2011 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1 ONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: $81.23 CARMEL, INDIANA 46032 DEPT CH 10241 PALATINE IL 60055 -0241 CHECK NUMBER: 204249 CHECK DATE: 1216/2011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 102 4239011 15500338 -1.77 SPECIAL DEPT SUPPLIES 102 4239011 823912 -01 83.00 SPECIAL DEPT SUPPLIES HSI ORDER# ORDER DATE DUE DATE 95899523 11/14/11 12/14/11 WHSE DEA# RHO] 62494 Fed ID: 11-3136595 ,3x" F i, y 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 1 555 -4218 PU EA JELCO IV CATHETER 14GX1" 100 100 0.83 83.00 1 F YOU ARE DARTICIPATING IN A DISCOUNT PROGRAM (E.G. POIN S, GIFTS OR OTHER PECIAL AWARDS "DISCOUNT WITH THIS PURL SE YOU HAVE RNED A CREDI TOWARD GOODS OR S RVICES, RECEIVABLE OR REDEEMABLE IN ACCO DANCE WITH DISCOUNT PROGRAM RULES. UPOI DISCOUNT RECEIPT OR REDEMPTION, OU ARE RECEI VING OR WILL RECEIVE OTICE OF T E 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 REQUEST, SU H VALUE MUST BE DISCLOSED AS A DI COUNT GAINSq THE PURCHASE THAT EARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN THESE RECORDS. MERCHANDI E TOTAL 83.00 Invoice Date 30 days 83.00 LEASE NOTE NEW REMIT TO ADDRESS lease remi payments only to the following a dress: ENRY SCHEI4 INC. DEPT CH 10211 ALATINE, 2 60055 -0241 BILL x TO INVOICE# INVOICE ITEM STATUS KEY REM KEY 1308571 1308572 823912 -01 83.00 H Backordcred:Itemwill follow SK School Kit H DER DE DATE INVOICE DATE F BOXES D Discontinued: Item no longer available NC -No Charge P- Special Schein Hcc Goods 11/14/11 1 M Manufacturer will ship Item directly to you 9 5 8 9 9 5 2 3 11/14/11 P Prescription Drug: Return Authorization Required CUS TOMER PO# R Refrigerated Item: May be shipped separately Special Schein Pricing U Temporarily unavailable: please reorder MARK 1 OF 1 T Taxable Item LP300 1 &b�£RA4a£PS !4 €I££eiv 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, we will provide a credit, refund, or exchange; its 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 11 drugs can be ordered only by mail. International Orders: Pl ease 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. xg� YHIiG N I.KEUll H mow': 1t-A 0f 1 Account 1 5558844 Ea Protectiv Plus IV Cathete 149X1.25" 1`a 827224 1.77 1.77 fi 11/14/11 Order 8098792 1.000*"", MPRK,r Credit.amount 1.77 Sub Net „Total 1.77 Total C redzt y 1.77 th tea: y f ACCOUNT TOTAL CREDIT 1308571 1.77 CREDIT MEMO CREDIT MEMO DATE 15500338 11/14/11 PAE CREDIT APPLIED TO 1 01 f 1 Account LP300 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)) 15500338 ($1.77) 823912 -01 $83.00 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. WARRAN NO. ALLOWED 20 Henry Schein IN SUM OF Dept Ch 10241 Palatine, IL 60055 $81.23 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO. I ACCT #/TITLE I AMOUNT Board Members 1120 823912 -01 j 102 390.11 j $83.00 1 hereby certify that the attached invoice(s), or 1120 15500338 102 390.11 ($1.77) bill(s) is (are) true and correct and that the materials or services itemized thereon for which charge is made were ordered and received excentr 7— v t v c Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund