HomeMy WebLinkAbout204573 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