180446 12/16/2009 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1
ONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: $491.25
CARMEL, INDIANA 46032 DEPT CH 10241
PALATINE IL 60055 -0241 CHECK NUMBER: 180446
CHECK DATE: 12/16/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 4467006 8336340 -01 461.30 EMS EQUIP
102 4467006 9199545 -01 29.95 EMS EQUIP
WH t Sii DEA# Fed ID: 11- 3136595
r M ,,m
QUIPMENT MARK 317 -571 -2663
1 499 -3262 EA ULTRA BREATHSAVER "D" BAG RED 2 2 230.65 461.30
RODUCT IS EING SHIPPED TO YOU DIRECTLY FROM THE MA.RUFACTLRER.
OUR ORDER 71654866 HAS BEEN SPLIT INTO MULTIPLE SHIPMENTS. CERTAIN ITEM WILL
E SHIPPED 3EPARATELY. YOU WILL BE BILLED FOR THESE ITEMS 1AHEN THEY ARE HIPPED.
F YOU ARE PARTICIPATING IN A DISCOUNT PROGRAM (E.G. POIN S, GIFTS OR O HER
PECIAL AWA DS "DISCOUNT WITH THIS PURCH SE YOU HAVE EARNED A CREDI TOWARD
GOODS OR SERVICES, RECEIVABLE OR REDEEMABLE N ACCO DANCE WITH DISCOUNT PROGRAM
kbLES. DISCOUNT RECEIPT OR REDEMPTION, 'CU ARE RECEI ING OR U:ILL RECEIVE
OTICE OF TIE DISCOUNT VALUE. FROM TIME TO TI E, MEDICARE, MEDICAID, TRI ARE OR
THER PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, D UPON ANY S CH
REQUEST, SUM VALUE MUST BE DISCLOSED AS A DI COUNT kGAINS1 THE PURCHASE THAT
EARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN THESE RECORDS.
MERCHANDI E TOTAL 461.30
INVOI E TOTAL 461.30
PLEASE PAY WITHIN THIRTY(3 DAYS OF RECEIPT OF THIS NVOICE. 461.30
LEASE NOTE NEW REMIT TO ADDRESS
Please remi payments only to the following a dress:
HENRY SCHEIN INC.
EPI CH 102 11
ALATINE, 11 60055 -0241
BILL TO INVOICE14 CUSTOMER PO4 ITEM STATUS KEY REM KEY
1308571 8336340-01 EQUIPMENT B Backordered: Item will follow SK School Kit
1) Discontinued: Item no longer available NC No Charge
S HIP TO INVOICE DATE OF BOXES 1' Special Schein Free Goods
M Manufacturer will ship Item directly to you
1308572 10/27/09 P- Prescription Drug: Return Authorization Required
R Refrigerated Item: May be shipped separately
INVOICE TOTAL PAGE Special Schein Pricing
U Temporarily unavailable: please reorder
461. 3 0 1 OF 1 T- Taxable Item
L
Payimnfferrns:
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 detective or does not perform or
Bill Your Order To Your Open Account
satisfactorily, we will provide a credit, refund, or exchange; it's your
choice. Simply call our customer service department within 30 days Available t li censed practitioners in the U.S. All invoices are
of receipt of the merchandise to arrange for the return. Fora payable wit 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.
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 H drugs can be ordered only by mail.
International Orders:
Please ftte:
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:
equipment, we suggest that you check the shipping container 1-800-845-35 0
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 calf
our Customer Service Department 1- 800 -845 -3550.
WHS[? DEA# Fed ID: 11- 3136595
y a
a S,t a c ,t rA Fes' ✓r >t, a v: i.,.t sa c e:.. F....
his order ias been processed by our NORTHEAS D.C.
41 WEAVEIZ ROAD
DENVER, PA 175L7
v1ARK 317-423-8784
1 777 -2946 5 /PK DIAPHR RIM LTMN ASMB LARGE 1 1 29.95 29.95 1
OUR ORDER 73178944 HAS BEEN SPLIT INTO MULTI LE SHI MENTS. CERTAIN ITEM WILL
E SHIPPED 3EPARATELY. YOU WILL BE BILLED FOR THESE ITEMS HEN THEY ARE HIPPED.
F YOU ARE DARTICIPATING IN A DISCOUNT PROG I (E.G. POIN S, GIFTS OR OTHER
PECIAL AWA S "DISCOUNT WITH THIS PURL SE YOU HAVE EARNED A CREDI TOWARD
GOODS OR SERVICES, RECEIVABLE OR REDEEMABLE N ACCORDANCE WITH DISCOUNT PROGRAM
RULES. UPO4 DISCOUNT RECEIPT OR REDEMPTION, IOU ARE RECEI ING OR WILL RECEIVE
OTICE OF T E DISCOUNT VALUE. FROM TIME TO TI E, MEDICARE, MEDICAID, TRI ARE OR
THER PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, PND UPON ANY S CH
REQUEST, SU H VALUE MUST BE DISCLOSED AS A DI COUNT kGAINSq THE PURCHASE THAT
EARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN THESE RECORDS.
MERCHANDI E TOTAL 29.95
INVOI E TOTAL 29.95
PLEASE PAY WITHIN THIRTY(30) DAYS OF RECEIPT OF THIS INVOICE. 29.95
BILI, TO INVOICE# CUSTOMER PQ# ITEM STATUS KEY REM KEY
1308571 919954S-01 MARK B- Backordered: Item will follow SK School Kit
D Discontinued: Item no longer available NC No Charge
SHIP 0 INVOICE DATE OF BOXES P- Special Schein I:we Goods
M Manufacturer will ship Item directly to you
1308572 12/01/09 1 P Prescription Drug: Return Authorization Required
R Refrigerated Item: May be shipped separately
INVOICE TOTAL PACE4 Special Schein Pricing
U Temporarily unavailable: please reorder
29.95 1 OF 2 T- Taxable Item Continued on Next Page
Prescribed by State Board of Accounts City Form No. 201 Qev. 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))
9199545 -01 $29.95
8336340 -01 $461.30
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
VOWPER_NO. WARRANT NO.
ALLOWED 20
Henry Schein
IN SUM OF
Dept Ch 10241
Palatine, IL 60055
$491.25
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1120 9199545 -01 102 670.06 $29.95 1 hereby certify that the attached invoice(s), or
1120 8336340 -01 102 670.06 $461.30 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 14 2009
u
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund