178187 10/14/2009 F CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1
ONE CIV:C SQUARE HENRY SCHEIN INC CHECK AMOUNT: $5,156.64
CARMEL, INDIANA 46032 DEPT CH 10241
PALATINE IL 60055 -0241
CHECK NUMBER: 178187
CHECK DATE: 10114/2009
D EPARTMENT ACCOUNT PO NUMBER INVOICE NU MBER AMOUNT DESCRIPTION
102 4239011 8336047 -01 1,820.32 SPECIAL DEPT SUPPLIES
102 4467006 8337,222 -01 2,938.49 EMS EQUIP
102 4239011 8337222 -02 397.83 SPECIAL DEPT SUPPLIES
y
WHSE DEA# Fed ID: 11- 3136595
r
E
y„
his order as been processed by our MIDWEST D.C.
5315 WEST 74TH 3TREET
INDIANAP LIS,IN 46268
RK SUPPLI S FOR STATION
17 -571 -266
1 555 -5396 PU EA PROTECTIV ACUVNC SFT OATH 20X1.25 149 149 2.67 397.83 1
HIS PRODUC IS BEING SHIPPED FROM OUR MIDWES DISTREBUTIOD CENTER.
F YOU APE ARTICIPATING IN A DISCOUNT PROGRAM (E.G. POIN S, GIFTS OR 0 HER
3 PECIAliA,e,A DS� ("DISCOUf:^"`)) WITH THIS' PURC SE' -YOU HAVE RNED.A CREDI TOWARD.
GOODS OR SERVICES, RECEIVABLE OR REDEEMABLE N ACCO DANCE WITH DISCOUNT PROGRAM
RULES. UPON DISCOUNT RECEIPT OR REDEMPTION, ''OU ARE RECEI ING OR WILL RECEIVE
OTICE OF THE DISCOUNT VALUE. FROM TIME TO TIME, MEDICARE, MEDICAID, TRI ARE OR
THER PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, PND UPON ANY S CH
EQUEST, SU H VALUE MUST BE DISCLOSED AS A DI COUNT AGAINSq THE PURCHASE THAT
E ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN THESE RECORDS.
14 2 HENRY CHEIN,INC. DISTRIBUTES THIS DRUG PRODUCr AS Ak AUTHORIZED
ISTRIBUTOR OF RECORD FOR THE MANUFACTURER.
MERCHANDI E TOTAL 397.83
INVOI E TOTAL 397.83
PLEASE PAY WITHIN THIRTY(3 DAYS OF RECEIPT OF THIS NVOICE. 397.83
BILL TO INVOICEff CJSTOMER PQ# ITEM STATUS KEY REM KEY
1308571 8337222-02 MARK B- Backordered: Item will follow SK School Kit
D Discontinued; Item no longer available NC -No Charge
HIP TO INVOICE DATE It OF BOXES F- Special Schein Free Goods
M Manufacturer will ship Item directly to you
1817102 10/01/09 1 P Prescription Drug: Return Authorization Required
R Refrigerated Item: May be shipped separately
INVOICE T TAL PAGE Special Schein Pricing
U Temporarily unavailable: please reorder
397.83 l OF 2 T- Taxable Item Continued on Next Page
L
WHSE DEA# Fed ID: 11- 3136595
his order las been processed by our NORTHEAST D. C.
41 WEAVER ROAD
DENVER, A 1751.7
QUIPMENT MARK 317 -571 -2663
1 180 -7538 EA LITTMANN CARDIOLOGY III BURGUM 4 4 139.00 556.00 7
2 130-3957 KIT SYSTEM 5 MULTICUFF BP KIT BLUE 4 4 105.58 422.32 7
3 499 -0650 EA BREATHSAVER ULTRA ROYBLUE 2 2 230.65 461.30 5
AD 7 AGE C- P.RE'`?�IT
5 666 -2575 EA SHARPS CONTAINER 2GAL 60 60 C 3.11 186.60 3
ASE GOOD I EM, MAY BE SHIPPED SEPARATELY.
OUR ORDER 71654866 HAS BEEN SPLIT INTO MULTI LE SHI DMENTS. CERTAIN ITEM WILL
E SHIPPED 3EPARATELY. YOU WILL BE BILLED FOR THESE ITEMS HEN THEY ARE HIPPED.
F YOU ARE ARTICIPATING IN A DISCOUNT PROGRAM (E.G. POIN S, GIFTS OR OTHER
PECIAL AWA DS "DISCOUNT WITH THIS PURCHASE YOU HAVE EARNED A CREDI TOWARD
GOODS OR SERVICES, 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
THER PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, D UPON ANY S T CH
EiLL `6
INVOICE; CUSTOMER ITEM STATUS KEY REM KEY
1308571 8336047-01 EQUIPMENT B Backordered; Item will follow SK School Kit
HIP T INVOICE D Discontinued: Item no longer available NC No Charge
F- Special Schein Free Goods
M Manufacturer will ship Item directly to you
1308572 9/22/09 7 P-
Prescription Drug; Return Authorization Required
R Refrigerated Item: May be shipped separately
INVOICE TOTAL P Special Schein Pricing
U Temporarily unavailable: please reorder
182 0 3 2 1 OF 2 T Taxable Item Continued on Next Page
WHSE DEA# Fed ID: 11- 3136595
wp gm, Ng 6-mong
REQUEST, SU H VALUE MUST BE DISCLOSED AS A DISCOUNT AINSq THE PURCHASE THAT
EARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RETAIN TH SE RECORDS.
MERCHANDI E TOTAL 1820.32
INVOI E TOTAL 1820.32
PLEASE PAY WITHIN THIRTY(3 DAYS OF RECEIPT OF THIS NVOICE. 1820.32
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 INVOICE# CUSTOMER ITEM STATUS KEY REM KEY
1308571 8336047-01 EQUIPMENT B Backordered; Item will follow SK school Kit
IP T INVOICE F BOXES D Discontinued; Item no longer available NC No Charge
F Special Schein Free Goods
M Manufacturer will ship Item directly to you
1308572 9/22/09 7 P- Prescription Drug: Return Authorization Required
R Refrigerated Item: May be shipped separately
INVOICE PAGE Special Schein Pricing
U Temporarily unavailable; please reorder
1820.32 2 OF 2 j T Taxable Item
LP300
Payment 'erms:
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
v��'-v �a i r m
Guaranteed Satisfaction: R i :l'
If you have tried a product and it is defective or does not perform or I
satisfactorily, we will provide a credit, refund, or exchange, its your ill Your Order To Y our Open Account
choice. Simply call our customer service department within 30 days Available to licensed practitioners in the U.S. All invoices are
of receipt of the merchandise to arrange for the return. For a payable within 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 11 drugs can be ordered only by mail.
International Orders:
P No
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:
1-800-845-3550
equipment, we suggest that you check the shipping container
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 call
our Customer Service Department 1- 800 845 -3550.
WHSE DEA# Fed ID: 11- 3136595
s et �t•S`��i fy"° M IN
P his order has been processed by our NORTHEAS D.C.
41 WEAVER ROAD
DENVER, A 175L7
1
vIA RK SUPPLI S FOR STATION
17 -571 -266
1 220 -1398 3 /ST BODY STRAP SET DISP YELLO W 193 193 4.86 937.98 6
2 220 -1398 3 /ST BODY STRAP SET DISP YELLO W 5 5 4.86 24.30 15
HIS PRODUC IS BEING SHIPPED FROM OUR WEST COAST D=RIRUr1ION CENTER.
3 1-44 1` EA" EL ARE PLUS' "FCAtd LCOH CD 90Z x "'49 48' C 7;50 3 60.00 i2w_
ASE GOOD I EM, MAY BE SHIPPED SEPARATELY.
4 107 -2953 50 /BX SURGICAL MOLDED MASKS BLUE 80 80 5.77 461.60 9
HIS PRODUcr IS BEING SHIPPED FROM OUR MIDWES DISTR BUTIO CENTER.
5 107 -2953 50 /BX SURGICAL MOLDED MASKS BLUE 80 80 5.77 461.60 12
HIS PRODUCU IS BEING SHIPPED FROM OUR WEST C AST DI TRIBU ION CENTER.
6 107 -2953 50 /BX SURGICAL MOLDED MASKS BLUE 40 40 5.77 230.80 5
7 153 -6483 RX 250ML /BT STERILE WATER FOR IRRIG 48 48 C 1.23 59.04 4
ASE, GOOD I EM, MAY BE SHIPPED SEPARATELY.
14 2 PEDIGR E ITEM.
bC:0033800 402
BI T O INV OICE ITEM STATUS KEY REM KEY
1308571 8337222-01 MARK B Backordered: Item will follow SK School Kit
HIP T INVOICE D F BOXES D Discontinued: Item no longer available NC- No Charge
P Special Schein Free Goods
M Manufacturer will ship Item directly to you
1817102 9/22/09 is Y- Prescription Drug: Return Authorization Required
R Refrigerated Item: May be shipped separately
INVOICE T L PAGE# Special Schein Pricing
U Temporarily unavailable: please reorder
2938.49 1 OF 2 T- Taxable Item Continued on Next Page
L
WHSE DEA# Fed ID: 11- 3136595
OWN P
w
8' 555 -5396 PU EA PROTECTIV ACUVNC SFT OATH 20X1.25 250 101 2.67 269.67 11
ARTIAL SHI MENT WILL SHIP AND INVOICE WHEN AVAILABLE.
HIS PRODUCT IS BEING SHIPPED FROM OUR MIDWEST DISTR BUTIO CENTER.
9` 555 -5396 PU EA PROTECTIV ACUVNC SFT CATH 20X1.25 50 50 2.67 133.50
HIS PRODUCT IS BEING SHIPPED FROM OUR MIDWES DISTRIBUTIOIN CENTER.
F YOU ARE ARTICIPATING IN A DISCOUNT PROGRAM (E.G. POIN S, GIFTS OR OTHER
PECIAL AWARDS "DISCOUNT WITH THIS PURCHASE YOU HAVE EARNED A CREDI TOWARD
GOODS OR S RVICES, RECEIVABLE OR REDEEMABLE N ACCO DANCE WITH DISCOUNT PROGRAM
RULES. UPO DISCOUNT RECEIPT OR REDEMPTION, OU ARE RECEI ING OR WILL RECEIVE
OTICE OF .T E DISCOUNT VALUE. FROM TIME TO TIME, MED CARE, MEDICAID, TRI ARE OR
THEIR PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, TND UPON ANY S CH
REQUEST SU HWALUE:MUST "BE.DISCLOSED AS A-
MUST COUNT- GAINS.,THE,PURCHASE ;,THAT,
ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN TH SE RECORDS.
2 HENRY CHEIN,INC. DISTRIBUTES THIS DRUG PRODUCE AS AUTHORIZED
ISTRIBUTOR OF RECORD FOR THE MANUFACTURER.
MERCHANDI E TOTAL 2938.49
INVOI E TOTAL 2938.49
PLEASE PAY WITHIN THIRTY(3 DAYS OF RECEIPT OF THIS NVOICE. 2938.49
LEASE NOTE NEW REMIT TO ADDRESS
Please remi payments only to the following a dress:
HENRY SCHEI4 INC.
DEPT CH 10211
ALATINE, I 60055 -0241
B ILL TO INV I E R PO# ITEM STATUS KEY REM KEY
1308571 8337222-01 MARK 13 Backordered; Item will follow SK School Kit
D Discontinued; o Item Good longer av NC No Charge
S HIP F BOXES Special
M Manufacturer will ship Item directly to you
1817102 9/22/09 15 P- Prescription Drug: Return Authorization Required
R Refrigerated Item: May be shipped separately
INVOICE L PAGE Special Schein Pricing
U Temporarily unavailable: please reorder
2938.49 2 OF 2 T Taxable Item
LP300
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
satisfactorily, we wil! provide a credit, refund, or exchange; it's our
Bill Order To Yo ur Open Account
y p it your
choice. Simply call our customer service department within 30 days Avai °:.able to licensed practitioners in the US, All invoices are
payable within 30 days.
of receipt of the merchandise to arrange for the return. For a
war. ranty repair or if you were sent something you did not order
simly 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 11 drugs can be ordered only by mail.
International Orders:
Please Not
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 handpiecas or terms and conditions, please contact our International Department:
1-800-845-3550
equipment, we suggest that you check the shipping container
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 call
our Customer Service Department 1- 800 -845 -3550.
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))
8337222 -01 $2,938.49
8336047 -01 $1,820.32
8337222 -02 $397.83
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
$5,156.64
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1120 8337222 -01 102- 670.06 $2,938.49 1 hereby certify that the attached invoice(s), or
1120 8336047 -01 102 390.11 $1,820.32 bill(s) is (are) true and correct and that the
1120 8337222 -02 102 390.11 $397.83
materials or services itemized thereon for
which charge is made were ordered and
received except
OCT 12 2009
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund