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Home My WebLink About205868 01/31/2012 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1 ONE CIVIC SQUARE HENRY SCHEIN INC o CARMEL, INDIANA 46032 DEPT CH 10241 CHECK AMOUNT: $3,471.06 PALATINE IL 60055 -0241 CHECK NUMBER: 205868 CHECK DATE: 1/31/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 102 4239011 9546225 -01 725.48 SPECIAL DEPT SUPPLIES 102 4239011 9547697 -01 2,745.58 SPECIAL DEPT SUPPLIES Please detach here and mail the above with your payment HSI ORDER# ORDER DATE DUE DATE 97132969 01/10/12 02/09/12 WHSE DEA# RHO162494 Fed ID: 11-3136595 HIS PRODUCT IS BEING SHIPPED FROM OUR NORTHEAST DISTRIBUTION CENTER. ASE GOOD ITEM, MAY BE SHIPPED SEPARATELY. 11 857 -2647 EA NASAL AIRWAY LF 20FR 12 12 2.29 27.48 15 F YOU ARE DARTICIPATING IN A DISCOUNT PROGRAM (E.G. POIN S, GIFTS OR OTHER PECIAL AWA DS "DISCOUNT WITH THIS PURCHASE YOU HAVE EARNED A CREDI TOWARD GOODS OR SERVICES, RECEIVABLE OR REDEEMABLE IN ACCO DANCE WITH DISCOUNT PROGRAM RULES. UPOq DISCOUNT RECEIPT OR REDEMPTION, OU ARE RECEI ING OR WILL RECEIVE OTICE OF T E DISCOUNT VALUE. FROM TIME TO TIME, MEDICARE, MEDICAID, TRI ARE OR THER PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, PND UPON ANY S CH EQUEST, SU H VALUE MUST BE DISCLOSED AS A DI COUNT AGAINSI THE PURCHASES THAT ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN THESE RECORDS. HENRY 3CHEIN, INC. HAS PURCHASED THE SPE IFIC UNIT OF THE PRESCRIPT ON DRUG DIRECTLY F OM THE MANUFACTURER. MERCHANDI E TOTAL 2745.58 Invoice Date 30 days 2745.58 LEASE NOTE NEW REMIT TO ADDRESS Please remi payments only to the following a dress: HENRY SCHEI4 INC. DEPT CH 10211 ALATINE, I 60055 -0241 HILL TO SHIP TO INVOICE INVOICE# INVOICE AMOUNT ITEM STATUS KEY REM KEY 1308571 1817102 9547697 -01 2745.58 13- Backordered: Item will follow SK School Kit D Discontinued: Item no longer available NC- No Charge H Z DER E DA INVOICE DATE B P- Special Schein Free Goods 10 12 1/10/12 1$ M Manufacturer will ship Item directly to you 97132969 01 P- Prescription Drug: Return Authorization Required CUSTO R Refrigerated Item: May be shipped separately Special Schein Pricing U Temporarily unavailable: please reorder MARK 2 OF 2 T Taxable Item LP300 Pays erat 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 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. 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 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. HSI ORDER ORDER DATE DUE DATE 97137542 01/10/12 02/09/12 WHSE DEA# RHO162494 Fed ID: 11-3136595 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 RK 317-57.-2663 1 935 -6155 50 /PK BLUE SENSOR SP ELECTRODES 4 4 11.77 47.08 1 2 499 -0652 EA PENLIGHT METALITE 1 1 2.40 2.40 1 3 777 -5610 EA STETH LITTMANN CARDIO 111D 27" 4 4 169.00 676.00 1 F YOU ARE ARTICIPATING IN A DISCOUNT PROG (E.G. POINIIS, GIFTS OR OTHER PECIAL AWA DS "DISCOUNT WITH THIS PURL SE YOU HAVE EARNED A CREDI TOWARD GOODS OR S RVICES, RECEIVABLE OR REDEEMABLE IN ACCO DANCE WITH DISCOUNT PROGRAM RULES. UPO4 DISCOUNT RECEIPT OR REDEMPTION, IOU ARE RECEI ING OR WILL RECEIVE OTICE OF TIE DISCOUNT VALUE. FROM TIME TO TI E, MED CARE, MEDICAID, TRI ARE OR THER PAYER MAY REQUEST INFORMATION REGARDING SUCH VALUE, PND UPON ANY S CH REQUEST, SU H VALUE MUST BE DISCLOSED AS A DI COUNT AGAINSI THE PURCHASE THAT EARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN THESE RECORDS. MERCHANDI E TOTAL 725.48 Invoice Date 30 days 725.48 BILL TO SHIP T O INVOICE# INVOICE AMOUNT ITEM STATUS KEY REM KEY 1308571 1308572 9546225 -01 725.48 D backordered: Item will follow sx- tichool xd D Discontinued: Item no longer available NC No Chargc H I DER DER DA INVOICE ATE BOXES I- Special Schein free Goods M Manufacturer will ship Item directly to you 97137542 01/10/12 1/10/12 1 P Prescription Drug: Return Authorization Required CUSTOM PO# P E R Refrigerated Item: May he shipped separately Special Schein Pricing U Temporarily unavailable: please reorder MARK 1 OF 2 T Taxable Item Continued on Next Page LP300 0 H ENRY SCHEIN EMS SHIP TO /SOLD TO: Carmel Fire Dept Head Quarters MI 135 Duryea Road, Melville, NY 11747 2 2 Civic Sq Carmel,IN 46032 -2584 010000130857109546225110010000000725480110123 BILL TO: Carmel Fire Dept MI 2 Civic Sq Carmel, IN 46032 -7543 Carmel Fire Dept MI 2 Civic Sq BILL TO SHIP TO INVOICE AMOUNT Carmel, IN 46032 -7543 1308571 1308572 725.48 INVOICE# INVOICE DATE 9546225 -01 1/10/12 CUSTOMER PO MARK Please detach here and mail the above with your payment HSI ORDER ORDER DATE. DUE DATE 97137542 01/10/12 02/09/12 WHSE DEA# RH0162494 Fed ID: 11- 3136595 LEASE NOTE NEW REMIT TO ADDRESS P lease remi payments only to the following address: H ENRY SCHEII INC. DEPT CH 10211 ALATINE, I 60055 -0241 I 13 ILL TO SHIP TO IUVOICRO INVO AMOUNT ITEM STATUS KEY REM KEY 1308571 1308572 9546225 -01 725.48 B- Backordered: Item will follow SK School Kit HSI O RDER# ORDER DATE INVOICE DATE BOXES D Discontinued: Item no longer available NC -No Charge F Special Schein free Goods 10 12 1/10/12 1 M Manufacturer will ship Item directly to you 9 713 754 2 O 1 P Prescription Drug: Return Authorization Required CUSTOMER P P R Refrigerated Item: May be shipped separately 1��rtrtT� Special Schein Pricing i•tt'1RK U Temporarily unavailable: please reorder 2 OF 2 T Taxable Item '300 HEN RY SCHEIN" EMS TERMS OF SALE 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: or If you have tried a product and it is defective or does not perform Bill Your Order To Your Open Account 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 II 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 terms the world. To place orders or for inquiries on export terms and conditions, please contact our International Department: manufacturer warranties. Before opening handpieces or 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 thugs. Simply calf our Customer Service Department 1- 800 -845 -3550. NHENRYSCHEIN@ SHIP TO /SOLD TO: EMS Carmel Fire Department MI 135 Duryea Road, Melville, NY 11747 INVOICE 54o W St Station n 4 46 Michael Kaufmann Carmel,IN 46032 -8806 010000130857109547697110010000002745580110125 BILL TO: Carmel Fire Dept MI 2 Civic Sq Carmel, IN 46032 -7543 Carmel Fire Dept MI 2 Civic S q BILL TO I SHIP TO I INVOICE AMOUNT Carmel, IN 46032 -7543 1308571 1817102 2745.58 INVOICEff INVOICE DATE 9547697 -01 1/10/12 CUSTOMER PO MARK HSI ORDER# I ORDER DATE DUE DATE 97132969 01/10/12 02/09/12 WHSE DEA# RHO] 62494 Fed ID: 11-3136595 e o c 00 11 M aa'e r ec 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 1 107 -0530 100 /BX PURPLE NITRILE PF GLOVE LARGE 60 60 C 8.25 495.00 6 ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. 2 555 -5396 PU EA PROTECTIV ACUVNC SFT CATH 20X1.25 150 150 2.73 409.50 12 3 555 -1166 PU EA PROTECTIV ACUVNC SFT CATH 18X1.25 100 100 2.73 273.00 13 4 499 -5379 EA BURN SHEET 60 1 IX90" 50 50 C 2.69 134.50 7 ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. 5 220 -1398 3 /ST BODY'STRAP SET DISP YELLOW 200 200 5.10 1020.00 13 6 153 -3144 20 /RL BIOHAZARD BAG 11X14.25RED 1GAL 40 40 1.50 60.00 12 7 153 -2007 20 /RL BIOHAZARD BAG 14.5X19 RED 3GAL 40 40 C 1.98 79.20 11 ASE GOOD ITEM, MAY BE SHIPPED SEPARATELY. 8 507 -8362 100 /BX NACL PREFILL SYRINGE 10ML ST 2 2 38.00 76.00 12 1 4N PEDIGR E ITEM. DC:6380701 010 9 890 -6800 EA SHARPS SHUTTLE SINGLE USE P2 100 100 1.57 157.00 13 10 499 -0813 24 /CA INSTANT SUMMER HOT 2 2 C 6.95 13.90 17 BII, INV E AM ITEM STATUS KEY REM KEY 1308,7 1 1817102 9547697-01 2 7 4 5. 58 B- Backordered: Item will follow SK School Kit R D AT NV A BOXES D Discontinued: Item no longer available NC No Charge 1' Special Schein free Goods 97132969 01/10/12 1/10/12 1$ D4 Manufacturer will ship Item directly to you P 1'rescription Drug: Return Authorization Required R Refrigerated Item: May be shipped separately Special Schein Pricing U Temporarily unavailable: please reorder MARK 1 OF 2 T Taxable Item Continued on Next Page 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)) 9547697 -01 $2,745.58 9546225 -01 $725.48 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 N WARRA NO. ALLOWED 20 Henry Schein IN SUM OF Dept Ch 10241 Palatine, IL 60055 $3,471.06 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO. ACCT #!TITLE I AMOUNT Board Members 1120 9547697 -01 j 102 390.11 j $2,745.58 1 hereby certify that the attached invoice(s), or 1120 9546225 -01 102 390.11 $725.48 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 Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund