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Home My WebLink About204573 12/13/2011 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1 ONE CIVIC SQUARE HENRY SCHEIN INC CARMEL, INDIANA 46032 DEPT CH 10241 CHECK AMOUNT: $78.19 PALATINE IL 60055 -0241 CHECK NUMBER: 204573 CHECK DATE: 12/1312011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 102 4239011 1302422 -02 78.19 SPECIAL DEPT SUPPLIES H ENRY CHEW" E� SHIP TO /SOLD TO: Du INV OIC E Carmel Fire Dept Head Quarters MI 135 Du ea Road, Melville, NY 11747 2 civic s Carmel,IN 46032 -2584 0100001, 30857101302422 110020000000078191130112 BILL TO: Carmel Fire Dept MI 2 Civic Sq Carmel, IN 46032 -7543 Carmel Fire Dept MI 2 Civic Sq HILL TO SHIP TO INVOICE AMOUNT Carmel, IN 46032 -7543 1308571 1308572 78.19 INVOICE# INVOICE DATE 1302422 -02 11/30/11 CUSTOMER PO IN ENRY SCHEIN@ t E RMS O F EMS M.,_,,,,- .�....r., MARK _.r�.. i Please detach here and mail the above with your payment J HSI ORDERN ORDER DATE DUE DATE L 96146871 11/23/11 12/29/11 WHSE DEA# RH0162494 Fed ID: 1 1-3136595 n his order as been processed by our MIDWEST C. 5315 WES 74TH TREET INDIANAP LIS,IN 46268 MIDWEST D.C. State Lic 23 00304 1 499 -2113 EA LSU BATTERY NS 1 1 78.19 78.19 1 F YOU ARE PARTICIPATING IN A DISCOUNT PROG (E.G. POIN S, GIFTS OR 0 HER PECIAL AWA DS "DISCOUNT WITH THIS PURCHASE YOU HAVE EARNED A CREDI TOWARD GOODS OR S RVICES, RECEIVABLE OR REDEEMABLE N ACCORDANCE 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, MED CARE, MEDICAID, TRI ARE OR THER PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, ZND 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 THESE RECORDS. MERCHANDI E TOTAL 78.19 I nvoice Date 30 days 78.19 LEASE NOTE NEW REMIT TO ADDRESS P lease remi payments only to the following a dress: ENRY SCHEI INC. D EPT CH 102 1 ALATINE, I 60055 -0241 BILL TO qHIP INVOICE# INVOICE AMI.T ITEM STATUS KEY REM KEY 308571 13 0 8 5 7 2 1302422-02 78.19 B HacAnrdercd: Item will fnuow sK School Kit I I ORDER ORDER DATE INVOICE DATE OF H XE 1) Discontinued: Item no longer available NC No Charge P tipecial Schein Free Goods 6146871 11/23/11 11/30/1 1 M Manufacturer will ship Item directly to you P- Prescription Drug: Return Authorization Required C USTOMER P PA R Refrigerated Item: May be shipped separately tipecial Schein Pricing MARK U Temporarily unavailable: please reorder 1 OF 1 T Taxablelmm 300 We make every effort tomaintain prices for the dumhon of Payment by CHECK or by the HENRY SCHEIN CREDIT CARD, catalog, however, wmreaamethe right to make price adjustments in VISA, MASTERCARD, DISCOVER and AMERICAN EXPRESS response tn manufacturers' price changes Guaranteed Satisfaction: or U you have tried a product and i1in detective ur does not perform Bill Your Order To Your Open Account oaho(odnri|y.we will pmvideenmUiL ndund.o,oxchangnjt'eyour Available to licensed practitioners in the US. All invoices are oh�ce�Simdy call our customer service de Imnntwkin30deye -ayable within 30 days. o f receipt nf the merchandise tn arrange for the return. Fora wor�nty repair mrit you were sent something you did nNn�er. simply call: Rx Products Controlled Substances: M8trxMedica! 1'800-845-3550 Regulations require uo1nlimit the sale ofRx and controlled substances only N registered, licensed healthcare professionals. U you are a new Customer nr have recently moved, please furnish us with u cc py of your updated state registration. Foroon!m||od substances, fumisha copy of your DEA certificate, verifying your nhippingaddrena. Class Udmgs can be ordered only bymaii, International Orders: PicoaNr�: VVe proudly serve healthcare prof eoaionalsandgovernments Opened hand ieces and equipment may not be returned for throughout the world. To place orders or for inquiries onexport credit, but will be repaired nr replaced in accordance with terms and conditions, please contact our International DepaUment: manufacturer warranties. Before opening haodPincex»' 1'880'846'3550 equipment, wasuggest that you check the shipping container and packing list \n verily that you have received exactly what Prescription Drug Returns Instructions: youomomd/JpnnedCom tor Software in not returnable. Other restrictions may also apply. A Return Authorization io Required for a||Prescrip Drugs. Simply call 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)) 1302422 -02 I I $78.19 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. WAR NO. ALLOWED 20 Henry Schein IN SUM OF Dept Ch 10241 Palatine, IL 60055 $78.19 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO. I ACCT #/TITLE I AMOUNT Board Members —x 1120 I 1302422 -02 1 102- 390.11 I $78.19 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 DEC '1 1 2 2011 1. p 7 b ®v U Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund