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Home My WebLink About206269 02/14/2012 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1 ONE CIVIC SQUARE HENRY SCHEIN INC CARMEL, INDIANA 46032 DEPT CH 10241 CHECK AMOUNT: $1,292.42 PALATINE IL 60055 -0241 CHECK NUMBER: 206269 CHECK DATE: 2/14/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 102 4239011 3387660 -01 1,165.40 SPECIAL DEPT SUPPLIES 102 4239011 4462611 -02 127.02 SPECIAL DEPT SUPPLIES MARK 1 Ilien.se deui J, hero and null the above WiIh your Payment HSI ORDER# ORDER. DATE DUE DATE 97355636 01/18/12 02/29/12 WHS8DhA# RHO162494 Fed ID: I1 3136595 rl ��a 4 ing 0 �ef d "i� T his order ias been processed by our MIDWEST P.C. 5315 WES 74TH TREET INDIANAP LIS,IN 46268 MIDWEST D.C. State Lic 23 00304 ARK 17- 571 -266 17- 428 -878 1 499 -0467 EA MATRX GLOVE CADDY 6 6 21.17 127.02 1 F YOU ARE ARTICIPATING IN A DISCOUNT PROGRAM (E.G. POIN S, GIFTS OR 0 HER FECIAL AWA DS ("DISCOUNT WITH THIS PURCHASE YOU HAVE EARNED A CREDI TOWARD GOODS OR S RECEIVABLE OR REDEEMABLE N ACCO DANCE WITH DISCOUNT PROGRAM RULES. UPON DISCOUNT RECEIPT OR REDEMPTION, IOU ARE RECEI ING OR WILL R CEIVE OTICE OF THE DISCOUNT VALUE. FROM TIME TO TIME, MEDICARE, MEDICAID, TRITIARE OR THER PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, PND UPON ANY SUCH EQUEST, SU H VALUE MUST BE DISCLOSED AS A DISCOUNT GAINS THE PURCHASES THAT ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN TH SE RECORDS. MERCHANDISE TOTAL 127.02 i nvoice Date 30 days 127.02 LEASE NOTE NEW REMIT TO ADDRESS lease remi payments only to the followi.na a dress: ENRY SCHEII INC. EPT CH 102 1 ALATINE, I 60055 -0241 HILL To SHIP TO INVOICE# INVOICE AMOUN I "I'FN1 STATUS KEY REM KF,Y 1308571 1308572 4462611 -02 127.02 li- il.,A ,ndcwdl I(— ,viameow SK Seh n)lKh Disconlinucd; Item no La ntcr as:,i]ahlc H I RDER RDER DATE INVOICE DATE F S X.ES NC- No Charge F Special Schein Frcc Clouds 30 12 M hl:muiacnnn will ship Ilan di to you 97355636 01/ P Pmscnplian Drug; 12cn,rn nulhurintion Required R Rcfritcraicd Ilcnf: bh,y be shipped scparmcly CUS TOMER LOk PAGE Special Schein F&,ng lJ 'rempm'urily unavailable: please reorder MARK 1 OF 1 "r T3mll,le He,�, Pay�nerit Term,: Vlemalke every effort tomaintain prices for the duration ofa Payment by CHECK or by the HENRY SCHEIN CREDIT CARD, catalog, however, we reserve the right to make price adjustments in VISA, MASTERCARD, OISCOVER and AMERICAN EXPRESS reuponao|omuoutaduree/phuechanges Guaranteed Satisfaction: |f you have tried a product and i|ix defective or does not perform or uaha�ctori|y.wemi|[ provide 8rredii.r�und.oroxch8nge�i[oyour Available to licensed practitioners in the US, All invoices are nhoiN. Simplw call our customer senice department withi 30 days payablevMhin 30 days, of receipt of the merchandiaa�n arrange for the return, For warranty relmirord you were sent something you did not order, simply call, Rx Products Controlled Substances: ROat[xMedic8l 1-800-845~3550 Regulation's require us to|imh'hnvm|eWHx and controlled substances onhto registered, licensed healthcare professionals. U you are u new cuatnmoror have recently d please f mnh unwun a copy m your updated state registration, For controlled substances, furnish a copy nfynyrDEAoedi(inate verifying your shipping address. Class drugs can he ordered only bymo(!. International Orders: Please Note: VV proudly serve eheuUhmampm|emionn!mandgnvemmentx OpenedhaAd nUeqoipm8�may not be�humed�/ throughout the world. To place orders n/ to. inquiries onexport credit, buteUhaepalmdnr replaced inao:umunoewith terms and nmdibonu. please contact our International Depaomext: manufacturer vviunaniieo, Before openinDhandPiec*onr 1-800'846'3550 equipment, me suggest that you check the shipping con1ainar and packing list to verity that you have received exactly what Prescription Drug Returns Instructions: �mordemd1�penodCon terSod1nae|anntrm\urnab\e. Other restrictions may also apply. A RetumAuthuhzation:s Required for ail Pomohphuo Drugs. Simply Call our Customer Service OopadmeN@1'8O0'U46-3550. 1 2, 1 21 1 121 1 -11 Z- 1,11,1 1 ,15- 11' M Lm00 HSI ORDER ORDER DATE DUE DATE 97527783 01/25/12 02/24/12 WHSE DEA#i RH0162494 Fed ID: 11- 3136595 R This order ias been processed by our MIDWEST D.C. 5315 WES 74TH 3TREET INDIANAP LIS,IN 46268 MIDWEST D.C. State Lic 23 00304 v1ARK HUIETT 17 -571 -266 0 BOXES MA (E A CASE 1 338 -2276 PU 100 /CA EXTENSION SET STD BORE UL 2 2 C 224.00 448.00 2 ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. 2 338 -2276 PU 100 /CA EXTENSION SET STD BORE UL 1 1 C 224.00 224.00 4 HIS PRODUCE IS BEING.SHIPPED FROM OUR NORTHEAST DIS.RIBUT ON CENTER. ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. 3 935 -6155 50 /PK BLUE SENSOR SP ELECTRODES 40 40 11.51 460.40 3 4 499 -5079 EA STYLET W /DISTAL TIP 12FR 20 20 1.65 33.00 3 F YOU ARE DARTICIPATING IN A DISCOUNT PROG (E.G. POINTS, GIFTS OR OTHER PECIAL AWA DS "DISCOUNT WITH THIS PURCHASE 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, YOU ARE RECEI ING OR WILL RECEIVE QTICE OF T E DISCOUNT VALUE. FROM TIME TO TIME, MED CARE, EDICAID, TRI ARE OR. THER PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, D UPON ANY S17CH EQUEST, SU H VALUE MUST BE DISCLOSED AS A DISCOUNT AGAINS 10RDS. THE PURCHASE THAT EARNED SUCH VALUE, ACCORDINGLY, YOU SHOULD RE AIN THESE RE B ILL To SHIP TO I INVOICE: AMOUNT r ITEM STATUS KEY REM KEY 1308571 1817102 3387660 -01 1165.40 0- Backordered: hem illfolliow SK SchoolK,( D Di.scominued: item no longer available NC No Charge I RDER ORDER DAT INVOICE DAT F BOXES P Special Schein Pree Goods 1/25/12 4 M lldnufaciurerwillshipitemdirect lyinyou 97527783 01/25/12 V- Prescritni— Drug_ Rel—, Amhnrizatinn Required R Refrigerated Item: May N .chipped separately CUSTOMIR Poo PAGE —Special Schein Pricing U Temporarily unarailahle: please reorder MARK I OF 2 T Tasablc hem Continued on Next Page 1.P300 HENRY SHIP TO /SOLD TO: E MS Carmel Fire Department MI 135 Duryea Road, Melville, NY 11747 I NVOI CE 11747 540 W 136 St V V Station 46 Michael Kaufmann Carmel, IN 46032 -8806 0100001308571033876601 10010000001165400125],23 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 I INVOICE AMOUNT Carmel, IN 46032 -7543 1308571 1817102 1165.40 INVOICE INVOICE DATE 3387660 -01 1/25/12 CUSTOMER PO MARK Please detach here and mail the ahc)ve with your payment HSI ORDER# I ORDER DATE DUE DATE 97527783 01/25/12 02/24/12 WHSE DEA# RHO] 62494 Fed 1D: 11-3136595 MERCHANDI E TOTAL 1165.40 I nvoice Date 30 days 1165.40 LEASE NOTE NEW REMIT TO ADDRESS lease remi payments only to the following a dress: ENRY SCHEI INC. EPT CH 102 1 ALATINE, I 60055-.0241 BILL To HIP TO INVOICEff INVOICE AMOM iTFM STATUS KEY REM KEY 1308571 1817102 3387660 -01 1165.40 13- llackordcrcd: lmm- 11follow SK SchomKit H I RD R D INVOICE DATE D- Discuntinucd: Item no longer availahle NC- NoCharge F Special Schein Free Ooods 1/25/12 4 M- Manuracturcr will .chip llcm directly to you 97527783 01/25/12 P Prescription Drug: Return Authorization Required CUSTOMER P PA E R Refrigerated Item: May he shipped separately Special Schein pricing MA U Temporaniy unavailahlc: please; raxdcr RK 2 OF 2 T Taxahleltem LP300 ENS CEIN" I EMS T ERMS OF S ALE 3 yr ent Terms: We make every effort to maintain prices for the duration of a Payment by CHECK or by the HENRY SCHEIN CREDIT CARD, catalog, ho,vever, 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, vve will provide a credit, refund, or exchange; it's your Bill Your Order To Your Open Account choice. Simply call our customer service department within 30 clays Available to licensed practitioners in the US. All invoices are of receipt of the merchandise to arrange for the return, Fora payable within 36 days, warranty repair or if you were sent something you did not order simply call: Ftx 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 DER certificate, verifying your shipping address. Class II drugs can be ordered only by mail. International Orders: Pfeas No rte; Opened handpieces and equipment may not be returned for We proudly serve healthcare professionals and governments credit, b will be repaired ar replaced in accordance with throughout the world. To place orders or for inquiries on export manufacturer �Avarranties. Before opening handpieces or terms and conditions, please contact our International Department: equipment, we suggest that you check the shipping container 1 -800- 845 -3850 and packing list to verify that you have received exactly ,,chat Prescription Drug Returns Instructions: you ordered.Opened Cornputer 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. VOUCHER NO. WARRANT NO. ALLOWED 20 Henry Schein IN SUM OF Dept Ch 10241 Palatine, IL 60055 $1,292.42 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE N0. ACCT /TITLE AMOUNT Board Members 1120 4462611 -02 102 390.11 $127.02 1 hereby certify that the attached invoice(s), or 1120 3387660 -01 102 390.11 $1,165.40 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 FLU rt 3 701? Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund 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)) 4462611 -02 $1 27.02 3387660 -01 $1,165.40 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