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Home My WebLink About180113 12/08/2009 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1 r ONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: $1,106.72 CARMEL, INDIANA 46032 DEPT CH 10241 oM PALATINE IL 60055 -0241 CHECK NUMBER: 180113 CHECK DATE: 12/8/2009 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 102 4239011 919949001 132.00 SPECIAL DEPT SUPPLIES 102 4239011 920067501 974.72 SPECIAL DEPT SUPPLIES IA✓HSE:DEA# Fed ID: 11-3136595 WE, A OW MN RN his order as been processed by our NORTHEAS" D.C. 41 WEAVER ROAD DENVER, PA 175L7 VIARK 317-423-8784 1 206-8985 EA WALL HOLDER F/690 THERMOM 4 4 33.00 132.00 1 OUR ORDER 73178944 HAS BEEN SPLIT INTO MULTI )LE SHI:)MENTS. CERTAIN ITEM WILL E SHIPPED SEPARATELY. YOU WILL BE BILLED FOR THESE ITEMS 1 THEY ARE HIPPED. IF YOU ARE )ARTICIPATING IN A DISCOUNT PROGRAII (E.G. POINIS, GIFTS OR OTHER SPECIAL AWARDS "DISCOUNT WITH THIS PURL SE YOU HAVE EARNED A CREDI TOWARD GOODS OR SLRVICES, RECEIVABLE OR REDEEMABLE :N ACCORDANCE WITH DISCOUNT PROGRAM RULES. UPON DISCOUNT RECEIPT OR REDEMPTION, IOU ARE RECEI%ING OR WILL RECEIVE OTICE OF TIE DISCOUNT VALUE. FROM TIME TO TI E, MEDICARE, MEDICAID, TRITARE OR DTHER PAYER MAY REQUEST INFORMATION REGARDING SUCH VkLUE, TND UPON ANY STCH REQUEST, SU VALUE MUST BE DISCLOSED AS A DI COUNT GAINS I THE PURCHASE:; THAT EARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE'AIN THESE RECORDS. MERCHANDI;E TOTAL 132.00 INVOI'E TOTAL 132.00 PLEASE PAY WITHIN THIRTY(3)) DAYS OF RECEIPT OF THIS NVOICE. 132.00 BILL TO INVOICE# CUSTOMER PO# REM KEY_� ITEM STATUS KEY REM 1308571 9199490-01 MARK If Backordered: Item will follow SK _School Kit Discontinued: item no longer available NC N( Charge SHIP T INVOICE DATE OF BOXES Special Schein Free Goods N4 Manufacturer will ship Item directly to you 1308572 11/17/09 1 11 prescription Drug: Return Authorization Required R Refrigerated Item: May he shipped separately INVOICE TOTAL PA(-,E# Special Schein pricin U Temporarily unavailable: please reorder 132. 00 OF 2 T Taxable Item Continued on Next Pale WHSE -DEA# Fed ID: 1 1-313 6595 e 6 k 8'1 .�'"#4�"3� Y 8 ✓s.,'L ��'!n g k k k 'SIg/ F f his order ias been processed by our NORTHEAS D.C. 41 WEAVEZ ROAD DENVER, A 1751.7 8016609 10 /BX ANGI CATH 14X3 -1/4 PINK BD BEC ON- DICKINSON 382268 (888) 237-!762 38.00 .MARK 1 507 -8362 kX 100 /BX NACL PREFILL SYRINGE 3 3 40.00 120.00 2 HIS PRODUC 7 IS BEING SHIPPED FROM OUR MIDWES. DISTR BUTIO CENTER. N PEDIGREE ITEM. DC:6380701 010 2 555 -1166 PU EA PROTECTIV ACUVNC SFT CATH 18X1.25 100 100 2.70 270.00 2 HIS PRODUCU IS BEING SHIPPED FROM OUR MIDWES DISTR BUTIO CENTER. 3 499 -0472 PU EA MECONIUM ASPIRATOR 20 20 4.10 82.00 1 4 499 -0671 PU EA MASK INF MED CONC TUBING 7' 12 12 2.81 33.72 1 5 220 -1398 3 /ST BODY STRAP SET DISP YELLO W 100 100 4.69 469.00 1 F YOU ARE DARTICIPATING IN A DISCOUNT PROG (E.G. POIN S, GIFTS OR OTHER PECIAL AWA DS "DISCOUNT WITH THIS PURL SE YOU HAVE ARNED A CREDIT TOWARD 13 ILL TO INVOICElf CUSTOMER P ITEM STATUS KEY REM KEY 1308571 9200675-01 MARK 13 Backordered: Item will follow SK School Kit Discontinued: Item no longer available NC No Charge INVOIC SHIP TO DATE 4 OF BOXES P- Special Schein Frec Goods M Manufacturer will ship Item directly to you 1817102 11/17/09 2 P Prescription Drug: Return Authorization Required R Refrigerated Item: May be shipped separately INVOICE TOTAL PACE#, S Special Schein Pricing U Temporarily unavailable: please reorder 974.72 1 OF 2 T Taxable Item Continued on Next Pale HENRY SCHEIN SHIP TO: Carmel Fire Department MI I NV OIC E Station Kaufmann 135 DuryealRoad, Melville, NY 11747 Carmel, IN 46032 -8806 0100001308571 09200675110010000000974721 117096 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 974.72 INVOICE# INVOICE DATE 9200675 -01 11/17/09 CUSTOMER PO# SHIP TO MARK t 1817102 Please detach here and mail the above with your payment WHSE DEA# Fed ID: 11- 3136595 tom, K digs o GOODS OR S RVICES, RECEIVABLE OR REDEEMABLE N 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, MEDICARE, MEDICAID, TRI ('ARE OR THER PAYER MAY REQUEST INFORMATION REGARDING SUCH VALUE, 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 TH SE RECORDS. N HENRY 3CHEIN, INC. HAS PURCHASED THE SPE IFIC UTIT OF THE PRESCRIPT ON DRUG DIRECTLY F OM THE MANUFACTURER. MERCHANDI E TOTAL 974.72 INVOI E TOTAL 974.72 PLEASE PAY WITHIN THIRTY(3 DAYS OF RECEIPT OF THIS NVOICE. 974.72 LEASE NOTE NEW REMIT TO ADDRESS lease remi payments only to the following a dress: ENRY SCHEI4 INC. EPT CH 10211 ALATINE, I 60055 -0241 ILL TO I INVOICE# CUSTOMER PO# ITEM STATUS KEY REM KEY 1308571 9200675-01 MARK 13 Backordered: Item will follow SK School Kit D Discontinued: Item no longer available NC No Charge SH IP E DATE B E P Special Schein free Goods M Manufacturer will ship Item directly to you 1817102 11/17/09 2 P Prescription Drug: Rcturn Authorization Required R ReOfigerated Item: Mav be shipped separately INVOICE TOTAL PA(R# Special Schein Pricing U Temporarily unavailable: please reorder 974.72 2 OF 2 T- Taxable Item 12 HENRY SCHEIN TERMS OF Il:) ALE J 1 4e make ever\ elfort to maintain hnthe duration ora Payment by CHECK or by the HENRY SCHEIN CREDIT CARD, catalog, however, we reserve the right to make price edjuaknonnm VISA, MASTERCARD, DISCOVER and AMERICAN EXPRESS response tomanufacturers'phoechanges Guaranteed Satisfaction: or U you have tried a product and i1io detective or does not perflonn Bill Your Order To Your Open Account satisfactorily, we will provide a credit, refund, or e it's you choice, Simply call our customer service department withio3Odayo payable within 30 days. oi rece Fora warranty repair urifynuwereonntoomethingyoudidnotordor, uimp|yoaU� RxProducts Controlled Substances: M8trx Medical 1-800-845'3550 Regulafions require us blimit the sale ofRx and controlled substan on|yN registered, licensed heakhmaepmfcmsono|a Uyou are a new customer or have reoendy moved, p|eooefumish ua with a copy of your updated state registration. For controlled substances, furnish a copy o/ your DEA certificate, verifying your shipping address. Class drugs can be ordered only bymail. International Orders: Phemno067tec We proudly serve healthcare pnofnsninnaln and governments returned thnughouthowo,|d. To place orders or for inquiries onexport but wU|bo repaired or replaced inunmrdanuewith te and conditions, p|oux* contact our |nLenshona|Department moou|ac�u�rxanaodes8eoe opening hsndPiaueaor 1'800845'35 58 equipmenLwaaugg6a11halynu check the shipping container and packing list to verity that you have received exactly what Prescription Drug Returns Instructions: you u/dored0 d Computer Software is not returnable. Other restrictions may also apply. A Return Authorization iu Required for all Prescription Drugs. Simply call our Customer Service Department @1'8OO-845'355O. 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)) 9200675 -01 $974.72 9199490 -01 $132.00 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 NO. ALLOWED 20 Henry Schein, IN SUM OF Dept Ch 10241 Palatine, IL 60055 $1,106.72 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 1120 9200675 -01 102 390.11 $974.72 1 hereby certify that the attached invoice(s), or 1120 9199490 -01 102 390.11 $132.00 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 /f DEC 72009 cc l L� Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund