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179696 11/24/2009 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1 ONE CIVIC SQUARE HENRY SCHEIN INC CARMEL, INDIANA 46032 DEPT CH 10241 CHECK AMOUNT: $1,586.06 PALATINE IL 60055 -0241 CHECK NUMBER: 179696 CHECK DATE: 11/24/2009 DEPARTMENT ACCOUNT P O NUMBER INVOICE NU MBER AM DESCRIPTION 102 4239011 419974401 1,200.00 SPECIAL DEPT SUPPLIES 102 4239011 420243701 386.06 SPECIAL DEPT SUPPLIES WHSE DEA# Fed ID: 11- 3136595 "R DTHER PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, PND UPON ANY STCH REQUEST, SU VALUE MUST BE DISCLOSED AS A DISCOUNT kGAINS I THE PURCHASES THAT EARNED SUCH VALUE, ACCORDINGLY, YOU SHOULD REAIN THESE RECORDS. MERCHANDI;E TOTAL 386.06 INVOI7E TOTAL 386.06 PLEASE PAY WITHIN THIRTY(3)) DAYS OF RECEIPT OF THIS NVOICE. 386.06 PLEASE NOTE NEW REMIT TO ADDRESS Please remi payments only to the following aldress: HENRY SCHEI INC. DEPT CH 102 1 PALATINE, 1 60055-0241 BILL TO INVOI CE TOMER PO# ITEM STATUS KEY REM KEY 1308571 4202437-01 MARK 11 l3ackordered: Item will follow SK School Kit J Discontinued: Item no lonecr available NC No Charge SHIP TO INVOICE DATE It OF BOXES i- Special Schein Free Goods M Manufacturer will ship Item directly to you 1817102 11/05/09 2 11- Prescription Drug: Return Authorization Required R Refrigerated Item: May he shipped separately INVOICE TOTAL P�rvlf Special Schein pricing U Temporarily unavailable: please reorder Ix 386. 06 2 OF 2 T Taxable Item Alln make every effort to maintain prices for the duraflon of a Payment by CHECK or by the HENRY SCHEIN CREDIT CARD, catalog, however, me reserve the right to make price adjjstn in VISA, MASTERCARD, DISCOVER and AUERICAN EXPRESS resoonse manulmctur price chanazes Guaranteed Satisfaction. vsa or If vou have tried a Drodud and it is defective ordons not perform Biji V �'k, T 4-soum c4 c c y r satisfadody, we will provide a credil, reiund, orexchtinge: it's you,r Availab.e to license practitioners in the U3, Ali InWokces are choice," Call our custorner service- cinpartmentvih'n 33 days l thm 3n. days. of receipt of the merchandise to arrange for the return. For -a warrantu',rerlair or it you were sent something you did not order simplyc'M: Rx Products Controlled Substances: Matra Medical 1-800-845-3550 R egulations require us, to 'imilthe sail of Rx and control. 'd substancesonlvtoreg:ste:?d licensed healthcare if you are a. new customer or have recently moved, please iurnish us with a c o. of ol your update, slate registration. Fot controlled substances, lurnish a Copy of your D cehtficate verify you shipping address. Class .1 drugs car be ordered only by mail, International Orders: Vvle proudil' servie hea'thcare profess.onals an d goV rn r t me Opened handpieces, and equPment may not be returned for I returned orinquir on export throughout the world. To place orders or f 4 it i cre hat :r if be repaired or replaced ;n accordance Jth terms anu condi':,ons, please con.-tact our international Deriahmerit Beforia opening handpieces or 13 -800-841- ea ie SUgQeSt that you check, the shipping container O and Packing list to verify that y ou have received exactly at Prescription Drug Returns Instructions: you or—red.0pened Computer Software is not returnable. Other restrictions may also apply. A Return. Authorization is Required for all Prescription Dr.j(, Simply call ow Clustome. Senvic-e Depar-man' 1 -&10-845-3550. LP300 WHSE DEA# Fed ID: 11-3136595 _..__,_x� i,... ^....s,>y/i.,.,. r.m .,.sir.,s.Y. �x.k sx,wsf�'fi..A i his order as been processed by our NORTHEAS D.C. 41 WEAVER ROAD DENVER, PA 1751.7 1 203 -3856 EA SURETEMP PLUS THERM ORAL 4' CORD 4 4 225.00 900.00 1 HIS PRODUCC IS BEING SHIPPED FROM OUR MIDWES DISTR BUTIO CENTER. 2 741 -8045 EA PROBE RECTAL F /SURETEMP PLUS 4 4 68.00 272.00 1 HIS PRODUC IS BEING SHIPPED FROM OUR MID WES' DISTR BUTIO CENTER. 3 840 -2661 250 /BX PROBE COVER SURETEMP 4 4 7.00 28.00 1 HIS PRODUC IS BEING SHIPPED FROM OUR MIDWES DISTR BUTIO CENTER. LEASE NOTE 5668367 IS NOW 8402661 D UE TO MANU ACTURER NO RETURN POLICY THIS ITEM IS NOT RETU NABLE F YOU ARE PARTICIPATING IN A DISCOUNT PROG (E.G. POIN S, GIFTS OR O HER PECIAL AWARDS "DISCOUNT WITH THIS PURCHASE YOU HAVE EARNED A CREDIT TOWARD GOODS OR S RVICES, RECEIVABLE OR REDEEMABLE N ACCO DANCE WITH DISCOUNT PROGRAM RULES. UPOq DISCOUNT RECEIPT OR REDEMPTION, OU ARE RECEI ING OR WILL R CEIVE OTICE OF TIE DISCOUNT VALUE. FROM TIME TO TI E, MED CARE, MEDICAID, TRI ARE OR THER PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, D UPON ANY S CH EQUEST, SU H VALUE MUST BE DISCLOSED AS A DI COUNT kGAINSq THE PURCHASE THAT E ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN THESE RECORDS. MERCHANDI E TOTAL 1200.00 INVOI E TOTAL 1200.00 BILL TO INVOIC C USTO MER Po ITEM STATUS KEY RF_M KEY 1308 4199 MARK 13 Backordered: Item will follow SK School Kit D Discontinued: Item no longer available NC -No Charge HIP TO INVOICE DATE 4 OF BOXES P- Special Schein Prue Goods M Manufacturer will ship Item directly to you 1 11 0 5/ 0 9 1 1'- Prescription Drug: Return Authorization Required R Refrigerated Item: May be shipped separately I NVOICE T Special Schein Pricing U Temporarily unavailable: please reorder 1200. 00 1 OF 2 T- T axable Itcm Continued on Next Pa .-e SHIP TO: Matrx Medical Carmel Fire Department MI I� I v IC Station Kaufmann Carmel,IN 46032 -8806 135 Duryea Road, Melville, NY 11747 010000130857104202437110010000000386061105096 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 386.06 INVOICE# INVOICE DATE 4202437 -01 11/05/09 CUSTOMER PO# SHIP TO MARK 1817102 J WHSEDEA# Fed ID: H- 3136595 g 6 a� his order aas been processed by our NORTHEAS D.C. 41 WEAVEZ ROAD DENVER, DA 17517 RK 317-423-8784 1 373 -9613 100 /BX NAIL POLISH REMOVER PADS 6 6 3.15 18.90 2 HIS PRODUCE IS BEING SHIPPED FROM OUR MIDWES DISTR BUTIO CENTER. 2 678 -2886 6 /PK PENLIGHT DISPOSABLE 4 4 5.00 20.00 2 HIS PRODUCT IS BEING SHIPPED FROM OUR MIDWESP DISTR BUTIO CENTER. LEASE NOTE 1000592 IS NOW 6782886 3 652 -5403 2G /BX STYLET INTUBATING 14FR 1 51.50 51.50 2 HIS PRODUCE IS BEING SHIPPED FROM OUR MIDWES DISTRIBUTIOD CENTER. 4 602 -8100 EA COLLAR AD STIFNECK SELECT UNV 50 50 C 5.75 287.50 1 HIS PRODUCE IS BEING SHIPPED FROM OUR MIDWES DISTR BUTIO CENTER. ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. 5 953 -1971 10 /BX MILTEX DISPOSABL SCALPELS #11 1 1 8.16 8.16 2 HIS PRODUCE IS BEING SHIPPED FROM OUR MIDWES DISTRIBUTIOIN CENTER. F YOU ARE DARTICIPATING IN A DISCOUNT PROG (E.G. POIN S, GIFTS OR or HER PECIAL AWA DS "DISCOUNT WITH THIS PURCHASE YOU HAVE EARNED A CREDI TOWARD GOODS OR =VICES, RECEIVABLE OR REDEEMABLE N ACCO DANCE WITH DISCOUNT PROGRAM RULES. UPOi DISCOUNT RECEIPT OR REDEMPTION, OU ARE RECEI ING OR WILL RECEIVE OTICE OF T E DISCOUNT VALUE. FROM TIME TO TI E, MEDICARE, MEDICAID, TRI ARE OR BILL TO INVOICE4 CUSTOMER ITEM STATUS KEY REM KEY 1308571 4202437-01 MARK 13 Backordered: Item will follow SK School Kit D Discontinued: Item no longer available NC No Charge HIP TO INVOICE DATE OF H XE S F Special Schein Free Goods N1 Manufacturer will ship Item directly to you 1817102 11/0 2 F Prescription Drug: Return Authorization Required R Refriecrated Item: May he shipped u:parately INVOICE TOTAL PA(,Efl Special Schein Pricin_ U Temporarily unavailable: please reorder 386. 06 1 1 OF 2 T Taxable Item Continued on Next Page SHIP TO: Miitrx Medical 2 Civic Carmel Fire Dept Head Quarters MI INVOIC Carmel,IN -2584 135 Duryea Road, Melville, NY 11747 01, 00001308571041 ,99744110010000001200001105097 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 1200.00 INVOICE# INVOICE DATE 4199744 -01 11/05/09 CUSTOMER PO# SHIP TO (MARK 1308572 Please detach here and mail the above with your payment WHSE DEA# Fed ID: 11- 3136595 a Y3k?z• a ..r`�'te� •e�� PLEASE PAY WITHIN THIRTY(3 DAYS OF RECEIPT OF THIS NVOICE. 1200.00 LEASE NOTE NEW REMIT TO ADDRESS Please remi payments only to the following a dress: ENRY SCHEIq INC. DEPT CH 10211 ALATINE, I 60055 -0241 HILL TO INVOICE INVOICE4 CUSTOMER P ITEM STATUS KEY REM KEY 13 08 571 4199744-01 MARK 13 Backordered: Item will follow SK School Kit D Discontinued: It cm no longer available NC No Charge SHIP TO INVOICE DATE OF BOXES p Special Schein Free Goods M Manulacmrer will ship Item directly to you 1308572 11/05/09 1 Prescription Dnm: Return Authorization Required R Refrigerated Item: May be shipped separately Special Schein Pricing U Temporarily unavailable: please reorder 1200.00 2 OF 2 T- Taxable Item 1 92 HENRY SCHEIM� 17 Matrx Medical R S i J w, i make ever, effort to maintain prices for the duration of a Payment by CHECK or by flee HENRY SCHEI CREDIT CARS?, cataioo, howe�rer, vv'e reserve the right to make 'price a djustments id I response to manufacti rer." pr;,,,: changes f VISA, MASTERCARD, DISCOVER and AMERICAN E E` aS 1 Guaranteed Satisfaction: or If ;'ou have, tried a roduct and five or (Ives (lit D -rform r T C. z� n satisfactorily, e rl` provide a :cre:i refund, or exchange; its ,o P your h p G', C 3 t are A a, au, ;o lice s pract :ioner� it he U.Q. ail in�.oic2s choice, Sire "y cal' our customeli service. department vvi>h'n 30 Cat's ti ab t r iJU.y�aS,Ii4. k�. i >3 t� �30 ay.5. i of receipt of the merchandise to arrange for the retard. For a 'ov'arraniy rc' lair or if you were sent somet` ing you did not order, simple call; x Products Controlled Substances: atrx GNAledical 800 -845 -3550 Reg ulatio ns iaquire us to limi the sale o f Rx anu ;ontrol!ed sub s' rice o =,l,; to registered licensed llcancca!e pro essionals. you are a nevi CLStonler or t'saV.' Centiv moved, olease fu us �,dth a conyof your updated state iedinatlon. For cod rolled substances, furnish a cor y of your D A cartificau verifying your shippi address. Class li arugs can be ordercu only by mail. International Orders: P ia«s V 'V e :ro -'Iv serve he.a th,care f�ro°ess ovals and qo ernmen's Opened handDieces and equipment ma: not re returned for v u creoi hu; vvil be resnaired cr wplaced 'n accordance with throughout the won d. To place orders or for inquires on export t€ rm ar >n t :ons, nEUas� co -.act our ',memiako-r:a D o a;,i'e_rt: rTlanitfa i 9i' tE r €U n3 G hanocl:c e cu,Pme tt, vve suo es trial you check, the shipping Container and nadKirra list t verity that you hav naccive' e xactly at you ordered, Opened Computer Software is not returnable. Prescription Drug returns Instructions: Other restrictions may also apply. A Return AuthoriWa °ion is Required for all Prescription Dwas. Simpiv call our ,Customer Service Depar n,ent `.-8FI1 84u 355 �r,.a........,. .$5..�_> �,,,..�.,,wau�_ %'..,..:�wv '.....«GW..o l «.........w�.� ,r v».... _,r� r.�u._.__.._.. u,:: ,x,.._.__ 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)) 4199744 -01 $1,200.00 4202437 -01 $386.06 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 $1,586.06 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 1120 4199744 -01 102 390.11 $1,200.00 i hereby certify that the attached invoice(s), or 1120 4202437 -01 102 390.11 $386.06 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 NOV 2 3 2009 44d JTl Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund