177692 09/29/2009 a CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1
ONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: $935.27
CARMEL, INDIANA 46032 DEPT CH 10241
.roN PALATINE IL 60055 -0241 CHECK NUMBER: 177692
CHECK DATE: 9/29/2009
DEPA RTMENT AC PO NUM INVOICE NUMB I AM D
102 4239011 7624544 -01 486.00 SPECIAL DEPT SUPPLIES
102 4239011 8840700 -01 449.27 SPECIAL DEPT SUPPLIES
WHSE DEA# Fed ID: 11- 3136595
r- s
RK 317-423-8784
HANK YOU JULIE 1- 800 845 -3550 X328
1 220 -1398 3 /ST BODY STRAP SET DISP YELLO W 100 100 4.86 486.00
OUR ORDER 70899890 HAS BEEN SPLIT INTO MULTI LE SHI MENTS. CERTAIN ITEM WILL
E SHIPPED 3EPARATELY. YOU WILL BE BILLED FOR THESE ETEMS VHEN THEY ARE HIPPED.
F YOU ARE ARTICIPATING IN A DISCOUNT PROGRAM (E.G. POIN S, GIFTS OR OTHER
PECIAL AWARDS "DISCOUNT WITH THIS PURC SE YOU HAVE EARNED A CREDI TOWARD
GOODS OR SERVICES, RECEIVABLE OR REDEEMABLE IN ACCORDANCE WITH DISCOUNT PROGRAM
R LES`:`UPOd`DISCOUNT RECEIPT OR REDEMPTION, OU ARE RECEIVING OR WILL R110EIVE
OTICE OF T E DISCOUNT VALUE. FROM TIME TO TI E, MED CARE, 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 AGAINSI THE PURCHASES THAT
EARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN THESE RECORDS.
2 HENRY 3CHEIN,INC. DISTRIBUTES THIS DRUG PRODUCC AS Al AUTHORIZED
ISTRIBUTOR OF RECORD FOR THE MANUFACTURER.
MERCHANDI E TOTAL 486.00
INVOI E TOTAL 486.00
PLEASE PAY WITHIN THIRTY(3 DAYS OF RECEIPT OF THIS NVOICE. 486.00
BILL TO INVOICE# T P0#
ITEM STATUS KEY REM KEY
1308571 7624544-01 MARK n Backordered; hem will follow SK school Kit
SH IP INVOICE DATE F BOXES D Discontinued: Item no longer available NC -No Charge
F special Schein Free Goods
M Manufacturer will ship Item directly to you
1817102 9/16/09 P Prescription Drug: Return Authorization Required
INVO ICE TOTAL p E R Refrigerated Item; May be shipped separately
Special Schein Pricing
U Temporarily unavailable; please reorder
486. 0 0 1 OF 2 T Taxable hem Continued on Next Page
LP300
wnsa DEA# Fed ID: 11-313659
This order has been processed by our NORTHEAS" D.C.
41 WEAVER ROAD
DENVER, )A 175L7
317-571-266� MARK
3 101-2406 EA OXYGEN HOSE CONNECT FIT PLASTIC 12 12 0.99 11.88 1
IF YOU ARE PARTICIPATING IN A DISCOUNT PROGRAIq (E.G. POINrIS, GIFTS OR OTHER
SPECIAL AWAZDS ("DISCOUNT")), WITH THIS PURC SE YOU HAVE EARNED A CREDI TOWARD
GOODS OR SERVICES, RECEIVABLE OR REDEEMABLE N ACCORDANCE WITH DISCOUNT PROGRAM
RULES. UPO4 DISCOUNT RECEIPT OR REDEMPTION, OU ARE RECEI%ING OR WILL RICEIVE
�TOTICE OF TiE DISCOUNT VALUE. FROM TIME TO TI E, MEDECARE, MEDICAID, TRITARE OR
DTHER PAYER MAY REQUEST INFORMATION REGARDING SUCH V�.LUE, TND UPON ANY STCH
REQUEST, SU VALUE MUST BE DISCLOSED AS A DI 3COUNT GAINSrI THE PURCHASEX THAT
EARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE THESE RECORDS.
MERCHANDI E TOTAL 449.27
INVOI E TOTAL 449.27
BILL TO INVOICE# CUSTOMER PO# ITEM STATUS KEY �REM K�EY
1308571 8840700-01 MARK 11 Backordercd: Item will follow SK School Kit
1) Discontinued: Item no lonoer available NC No Char
SHIP TO INVOICE DATE OF BOXES F- Special Schein I Goods
M Manufacturer will ship Item diocctl� to you
1308572 9/09/09 2 Prescription Dmg: Return Authorization Required
iZ Reiriacrated Item: May be shipped separately
TNVOICE TOTAL PAQEJ4 Special Schein Pricin
C ontinued on Ne P a2e
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))
8840700 -01 $449.27
7624544 -01 $486.00
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. WARR ANT N
ALLOWED 20
Henry Schein
IN SUM OF
Dept Ch 10241
Palatine, IL 60055
$935.27
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT #!TITLE AMOUNT Board Members
1120 8840700 -01 102 390.11 $449.27 1 hereby certify that the attached invoice(s), or
1120 7624544 -01 102 390.11 $486.00 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
C9
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund