180830 12/30/2009 (2) CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1
t, ONE CIVIC SQUARE HENRY SCHEIN INC
CARMEL, INDIANA 46032 DEPT CH 10241 CHECK AMOUNT: $1,858.22
PALATINE IL 60055 -0241
CHECK NUMBER: 180830
CHECK DATE: 12/30/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
.102 4239011 8229291 -01 1,858.22 SPECIAL DEPT SUPPLIES
H ENRY SCE EIV
SHIP TO:
Medical Matrx Carmel Fire Department MI
INVOICE 540 W 136 St
Station 46 Michael Kaufmann
Carmel,IN 46032 -8806
135 Duryea Road, Melville, NY 11747
r
0100001308571 08229291 ],1001,0000001858221208096 BILL TO:
Carmel Fire Dept MI
2 Civic Sq
Carmel, IN 46032 -7543
Carmel Fire Dept MI
2 Civic Sq BILL TO INVOICE TOTAL
Carmel, IN 46032 -7543
1308571 1858.22
INVOICE# INVOICE DATE
8229291 -01 12/08/09
CUSTOMER PO# SHIP ro
(MARK 12 -08 -09 181'7102
WHSE DEA# Fed ID: 11- 3136595
f
This order ias been processed by our NORTHEAS D.C.
41 WEAVER ROAD
DENVER, A 1751_7
v1ARK HUIETT 317- 571 -2663
TOTAL ORDER FOR THIS LOCATION 1945.62
1 120 -8808 EA COMBITUBE ROLL -UP KIT 41FR 10 10 41.50 415.00 11
2 499 -9696 EA THE BAG II ADULT 12 12 9.55 114.60 13
HIS PRODUCT IS BEING SHIPPED FROM OUR MIDWES DISTR BUTION CENTER.
3 497 -3779 EA THE BAG II INFANT 12 12 9.S5 114.60 13
THIS PRODucr IS BEING SHIPPED FROM OUR MIDWES DISTR BUTIO CENTER.
4 499 -3778 EA THE BAG II PEDI 12 12 9.55 114.60 12
HIS PRODUCU IS BEING SHIPPED FROM OUR MIDWES DISTR BUTIO CENTER.
5 826 -9995 EA OXYGEN MASK NON REBREATH INFANT 20 B 0.00 0.00
ITEM BACK O DERED, WILL FOLLOW SHORTLY
6 499 -0380 PU EA FS 02 MASK H CONC W /RESER CHILD 20 20 1.29 25.80 11
7 890 -6868 3 /PK LIFEPAK 12 PAPER EKG 18 18 10.79 194.22 11
8 107 -0530 100 /BX PURPLE NITRILE PF GLOVE LARGE 50 50 C 8.50 425.00 5
ASE GOOD ITEM, MAY BE SHIPPED SEPARATELY.
ILL To INVOICE4 CUSTO MER PC# I ITEM STATUS KEY REM KEY
1308571 8229291-01 MARK 12-08-09 H Backordered: Item will follow SK school Kit
HIP T INVOICE DATE BORE U Discontinued: Item no longer available NC No Charee
F- Special Schein Free Goods
M Manufacturer will ship Item directly to you
1817102 12/08/09 14 P Prescription Drug: Return Authorization Required
R Refrigerated Item: May be shipped separately
ItIVOICE TOTAL P Special Schein Pricing
U Temporarily unavailable: please reorder
1858.22 1 OF 2 T Taxable Ilea, Continued on Next Page
WHSE DEA# Fed ID: 1 1 -3136595
A G",
I Wn 146"
A
N -..y 1 SRI'
9 3107 -0540 90/BX PURPLE NITRILE PF GLOVE X-LARGE 50 50 C 8.50 425.00 10
CASE GOOD ITEM, MAY BE SHIPPED SEPARATELY.
10 1 496-2369 100/BX LANCET SURGILANCE ORANGE 21G 3 3 9.80 29.40 11
IF YOU ARE ?ARTICIPATING IN A DISCOUNT PROGRAM (E.G., POINIS, GIFTS OR O'HER
SPECIAL AWAZDS ("DISCOUNT")), WITH THIS PURL SE YOU HAVE EARNED A CREDI TOWARD
GOODS OR SERVICES, RECEIVABLE OR REDEEMABLE :N ACCOZDANCE WITH DISCOUNT PROGRAM
RULES. UPOq DISCOUNT RECEIPT OR REDEMPTION, —OU ARE RECEI OR WILL RCEIVE
OTICE OF TIE DISCOUNT VALUE. FROM TIME TO TI E, MEDECARE, MEDICAID, TRITARE OR
THER PAYER MAY REQUEST INFORMATION REGARDING SUCH VkLUE, PND UPON ANY SITCH
EQUEST, SU VALUE MUST BE DISCLOSED AS A DI COUNT AGAINS I THE PURCHASE !3 THAT
ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE PAIN THESE RECORDS.
MERCHANDI;E TOTAL 1858.22
INVOI'E TOTAL 1858.22
PLEASE PAY WITHIN THIRTY(3 DAYS OF RE EIPT OF THIS :NVOICE. 1858.22
LEASE NOTE NEW REMIT TO ADDRESS
Please remi payments only to the following aldress:
HENRY SCHEI4 INC.
DEPT CH 10211
PALATINE, 1, 60055-0241
BILL TO INVOICEII CUSTOMER PQ# ITEM STATUS KEY REM KEY
1308571 8229291-01 MARK 12-08-09 13 Backordered: Item will follow SK School Kit
1) -I)iscnatmucd: Item no longer available NC No Charge
SHIP TO INVOICE DATE OF BOXES F pecial Schein Free Goods
M Manufacturer will ship Item directly to you
1817102 12/08/09 14 1 1 Prescription Drug: Return Authorization'Rcquircd
I, Refrigerated Item: May be shipped separately
TNVOICE TOTAL PAGE# Special Schein Pricing
U Temporarily unavailable: please reorder
1858.22 2 OF 2 T Taxable Item
A`e make every effort toma:ntain duraUnncUa
Payment by CHECK or by the HENRY SCHEIN CREDIT CARD,
catabg. however, we reoomothe right to make price adjustments in
response to manufacturers* pricoohomgeo VISA, MASTERCARD, DISCOVER and AMERICAN EXPRESS
Guaranteed Satisfaction:
or
If vou have tried a product and itisdefectivour does not perform
n�i�au�ori|y.we��||pmvideGoredi|.r�und.orexch*n it'eyou
oho�e� Simp�oa|(ouroun�meroem�e 8Odaya
Available to licensed practitioners in the US, All invoices arc
of receipt nfthe merchandise 10 arrange for the return. Fora
warranty repuirorif you were sent something you did not order,
aimp|yoaU�
Rx Products Controlled Substances:
Mat[x Medical 1~800~845^3550
Ragu!aduns i u�|imh the sale �Rxendro�m||ed
aub�em�monly 1nmg�*md.|icmnsedhee|thicampm[essiona|S,
|Y you are anevv' customer or have recently moved, please furnish
ua with a copy nf your updated nM1nregistration. For controlled
xubstenveo. furnish a copy nfyoorDEAxeUihua
shipping address, Class drugs can benrderedun|ybymail.
International Orders:
PAemse�Joim:
V;eproudly serve healthcare professionals and governments
Opened hendpieoee and equipment may Wbe returned for
throughout the wodd, To place orders nrfor inqui,iea nox A
c�di�.but�iU be repaired or replaced inouco�ano*with terms and uondi|inna. please contact our |niam�iona|Dep'�ment:
omou'u^,u'e °m a'ueo Be-fore 'vpn"i 'g h 1-OOO�46'3SSO
equipment, we SUa0eq1 that you check the shipping container
and ;ucmxyomm verify Prescri ��[ug Returns Instructions:
you ordered, Opened Computer Software
Other restrictions may also apply.
A Return Authorization inRequired for all P h i Drugs. Simply call
uurOuotomer Service Dspunmen' @1'8OU'84S-356O.
L'300
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))
8229291 -01 $1,858.22
I 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.. WARRANT N
ALLOWED 20
Henry Schein
IN SUM OF
Dept Ch 10241
Palatine, IL 60055
$1,858.22
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT
Board Members
1120 8229291 01 102 390.11 $1,858.22 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
f
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund