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177237 09/15/2009 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1 ONE CIVIC SQUARE HENRY SCHEIN INC 0 CHECK AMOUNT: $3,290.76 CARMEL, INDIANA 46032 DEPT CH 10241 PALATINE IL 60055 -0241 CHECK NUMBER: 177237 CHECK DATE: 9/15/2009 DEPA RTMENT ACCO PO NUMBER INVOICE NUM AMOUNT DESCRIPTION 102 4239011 7623818 -01 2,883.68 SPECIAL DEPT SUPPLIES 102 4239011 8293406 -01 319.60 SPECIAL DEPT SUPPLIES 102 4239011 8636527 -01 87.48 SPECIAL DEPT SUPPLIES i WHSE DEA# Fed ID: 11- 3136595 rM. 143 ..>aJ 'LI MISS, his order aas been processed by our NORTHEAS D.C. 41 WEAVER ROAD DENVER, A 175L7 OLD ORDER OR MARK HULET 1 565 -1031 100 /BX NITRILE PF GLOVE BLACK LARGE 20 20 C 7.99 159.80 2 ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. 2 565 -0811 100 /BX NITRILE PF GLOVE BLACK X -LARGE 20 20 C 7.99 159.80 4 ASE GOOD ITEM, MAY BE SHIPPED SEPARATELY. 'F YCU ARE ARTICIPATING IN A DISCOUNT PROG. (E.G. POIN S, GIFTS OR OTHER PECIAL AWA DS "DISCOUNT WITH THIS PURL SE YOU HAVE EARNED A CREDI TOWARD GOODS OR S RVICES, RECEIVABLE OR REDEEMABLE IN ACCO DANCE WITH DISCOUNT PROGRAM RULES. UPO4 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 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 AGAINS THE PURCHASEI THAT EARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN TH SE RECORDS. /F: HOLD F R MARK HULET MERCHANDI E TOTAL 319.60 INVOI E TOTAL 319.60 PLEASE PAY WITHIN THIRTY(3 DAYS OF RECEIPT OF THIS INVOICE. 319.60 BILL TO INVOICE# CUSTOMER PO# ITEM STATUS KEY REM KEY 1308571 8293406-01 MARK n- nackordered: Item will follow SK School Kit D Discontinued: Item no longer available NC No Chart SH IP E DATE BOXES P Special Schein free Goods M Manufacturer will ship Item directly to you 1308572 8/26/09 4 1'- Prescription Drug: Return Authorization Required R Refrigerated Item: May be shipped separately 5 Special Schein Pricing U Temporarily unavailable: please reorder 319.60 1 OF 2 T Taxable Item Continued on Next Page WHSE DEA# Fed ID: 11- 3136595 a This order has been processed by our NORTHEAS D.C. 41 WEAVER ROAD DENVER, A 175 L7 RK 317-423-8784 HANK YOU JULIE 1- 800 845 -3550 X328 1 602 -8100 EA COLLAR EXTRIC. STIFFNECK ADJ. 100 100 C 5.75 575.00 2 ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. 2 879 -8581 30 /PK MEDI -TRACE SNAP FOAM ELEC 530ECG 80 80 4.75 380.00 17 890 -68868 3 /PK LIFEPAK 12 PAPER EKG i8 i8 ii.i0 199.86 16 4 360 -1359 EA SAM SPLINT ORANGE /BLUE 36X4.25 25 25 6.76 169.00 17 5 107 -0530 100 /BX PURPLE NITRILE PF GLOVE LARGE 60 60 C 8.50 510.00 8 ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. 6 153 -2007 20 /RL BIOHAZARD BAG 14.5X19 RED 3GAL 10 10 C 1.99 19.90 9 ASE GOOD ITEM, MAY BE SHIPPED SEPARATELY. 7 891 -3037 U 50 /CA IV PREP KIT W/ TEGADERM 6 6 C 61.97 371.82 15 ASE GOOD ITEM, MAY BE SHIPPED SEPARATELY. 8 507 -8362 ZX 100 /BX NACL PREFILL SYRINGE 2 2 47.50 95.00 19 142 PEDIGREE ITEM. .TDC:6380701)010 BILL INVOICE# CUSTOMER e ITEM STATUS KEY REM KEY 13 08571 7 6 2 3 818 01 MARK B Backordered: Item will follow SK School Kit S HIP TO INVOICE DATE OF 13OXES D Discontinued: Item no longer available NC No Charge F Special Schein Free Goods M Manufacturer will ship Item directly to you 1817102 8/ 2 4/ 0 9 20 P- Prescription Drug: Return Authorization Required R Refrigerated Item: May be shipped separately INVOICE TOTAL PAGE# Special Schein Pricing U Temporarily unavailable: please reorder 2883.68 1 OF 3 T- Taxable hem Continued on Next Page NAIHSE DEA# Fed ID: 11 -3136595 q a his order as been processed by our NORTHERS D.C. 41 WEAVER ROAD DENVER, )A 1751-7 1 220-1398 3/ST BODY STRAP SET DISP YELLO W 18 18 4.86 87.48 1 IF YOU ARE DARTICIPATING IN A DISCOUNT PROGRAJI (E.G. POINI S, GIFTS OR 0 HER PEC IAL AWAZDS ("DISCOUNT")), WITH THIS PURCH SE YOU HAVE EARNED A CREDI TOWARD GOODS OR S ERVICES, RECEIVABLE OR REDEEMABLE N ACCOZDANCE WITH DISCOUNT PROGRAM RULES. UPO4 DISCOUNT RECEIPT OR REDEMPTION, OU ARE RECEI%ING OR WILL RECEIVE 110TICE OF T DISCOUNT VALUE. FROM TIME TO TI E, MEDECARE, MEDICAID, TRI('ARE OR DTHER PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, T-ND UPON ANY STCH :ZEQUEST, SU VALUE MUST BE DISCLOSED AS A DI COUNT GAINS q THE PURCHASE THAT EARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE THESE RECORDS. MERCHANDI E TOTAL 87.48 INVOI E TOTAL 87.48 PLEASE PAY WITHIN THIRTY(3)) DAYS OF RECEIPT OF THIS NVOICE. 87.48 PLEASE NOTE NEW REMIT TO ADDRESS lease remi payments only to the following aldress: ENRY SCHEI4 INC. EPT CH 102 1 ALATINE, 1, 60055-0241 BILL TO IYVOICF# CUSTOMER PO# ITEM STATUS KEY FE�MKEY� 1308571 8636527-01 MARK 13 Backordered: Item will follow SK School Kit J Discontinued: item no lonLer available NC No Charuc SHIP TO INVOICE DATE 4 OF BOXES i: Special Schein Free Goods NI Manufacturer will ship Item directly to vou 1817102 8/28/09 1 11 Prescription DRIB: Remrn Amhon/Anion Required R Rctri Item: May be shipped separately INVOI('E TOTAL PA(,E# I Special Schein Vficoo U Temporarily unavailable: please reorder 87.48 1 OF 1 T Taxable Item We make event effor to maintain orices for the duration o" a I Payment by CHECK or by the HENRY SCHEIN PLATINUM 9USINESS Cataloo, howevert Wp reserve the right to make price adjustments in CARD, VISA, MASTERCARD� DISCOVER and AMERICAN EXPRESS .3 iges Guaranteed Satisfaction: OF` or If vou have tried a product and it is detective or does not perform Bill Your Order To Your Open Accoutnt Available to licensed pracfitioners in the 'j,S, All invoices are choice. Simpiv call our cuslomer service department within 30 days pa within 30 days. of receipt ol the merchandise to arrange. for the return, For a rl warranty repair o r if you olere sent something youl did not order, simply call: Rx Products Controlled Substances: Matrx Medical 1-800-845-3550 Regulations require usN limit the saieofRxand controlled subotanononnly to registered, licensed heaUhoore profess |l you are a new customer or have recently mnvod.p|mmofurnish usw|1hucopyof your updated state registration. For controlled oubstoncoo.furnish aonpyof your OEAxedihoa\o. verifying your shipping address. C|ass||dmgo can be orderer! only bymail, International Orders: P/emseNote: VVopmud|y serve healthcare Professionals and govarnments Opened handpeuex and equipment may not ba returned for �hrnughou�\he�udd� Tnp|aoen�emo/ for inquiries no U uredii. but wi||be repaired n/rep\anedin accordance with terms and uondiUon«. please contact our international Dep omov/m.m/e/ wm.ox: n Before opening h a 1'800-845-3560 equipment, vv!e suggest that vou cheeck the shipping container and Packing list m":x/ �*�yw/uu n Drug Returns Instructions: you o� mdO dC �orSohwueiunotndurnab}e. Other restrictions may also apply. A Return Authorization iaReauimd for ail Prescription Drugs. Simply call ourCustomor Service Departnen' @1-80O-84S-3 Lpa00 ENRY CHEIN i cal SHIP TO: Carmel Fire Department MI INVOICE Station Kaufmann 135 Duryea Road, Melville, NY 11747 Carmel, IN 46032 -8806 010000130857107623818110010000002883680824090 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 2883.68 I NvOICE# INVOICE DATE 7623818 -01 8/24/09 CUSTOMER PQ# SHIP TO MARK 1817102 WHSEDEA# Fed ID: H- 3136595 WWII 00 i- Yl i i r d s G y 9 O ,6 tly R 9 555 -5396 PU EA PROTECTIV ACUVNC SFT OATH 20X1.25 50 50 2.70 135.00 20 HIS PRODUCT IS BEING SHIPPED FROM OUR MIDWES DISTREBUTIOIN CENTER. 10 555 -1166 U EA PROTECTIV ACUVNC SFT CATH 18X1.25 50 50 2.70 135.00 20 HIS PRODUCP IS BEING SHIPPED FROM OUR MIDWES DISTR BUTIO CENTER. 11 499 -0538 U EA ROBERTAZZI NASO AIRWAY 24FR 10 10 2.29 22.90 18 12 499 -0539 PU EA ROBERTAZZI NASO AIRWAY 26FR 10 10 2.29 22.90 17 13 826 -2056 EA NASOPHARYNGEAL AIRWAY 28 FR 10 10 2.29 22.90 17 14 826 -5078 EA NASOPHARYNGEAL AIRWAY 30 FR 10 10 2.29 22.90 17 15 499 -5009 EA ET TUBE CUFFED 6.5 20 20 1.15 23.00 18 16 878 -8721 EA ALCARE PLUS FOAM ALCOH OD 90Z 24 24 C 7.44 178.56 16 ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. OUR ORDER 70899890 HAS BEEN SPLIT INTO MULTI 3 LE SHIPMENTS. CERTAIN ITEM WILL E SHIPPED 3EPARATELY. YOU WILL BE BILLED FOR THESE ITEMS IvHEN THEY ARE HIPPED. F YOU ARE PARTICIPATING IN A DISCOUNT PROG (E.G. POIN S, GIFTS OR OTHER PECIAL AWA DS "DISCOUNT WITH THIS PURL SE YOU HAVE EARNED A CREDI TOWARD GOODS OR SERVICES, RECEIVABLE OR REDEEMABLE IN ACCO DANCE WITH DISCOUNT PROGRAM RULES. UPO4 DISCOUNT RECEIPT OR REDEMPTION, YOU ARE RECEI ING OR WILL RECEIVE OTICE OF TIE DISCOUNT VALUE. FROM TIME TO TIME, MED CARE, MEDICAID, TRI ARE OR RILL TO INVOICE# CUSTOMER PQ# ITEM STATUS KEY REM KEY 1308571 7623818-01 MARK R Rackordemd: Item will follow SK School Kit SH IP INVOICE F E D Discontinued: Item no longer available NC- No Charge P Special Schein Free Goods M Manufacturer will ship Item directly to you 1817102 8/24/09 20 P- Prescription Drug: Return Authorization Required R Refrigerated Item: May be shipped separately INVOICE TOTAL PAQE# Special Schein Pricing U Temporarily unavailable: please reorder 2883.68 2 OF 3 T- Taxable Item Continued on Next Page ENRY SCHEN SHIP TO: a INVO Carmel Fire Department MI 54 0 W 13 6 S t Station 46 Michael Kaufmann 135 Duryea Road, Melville, NY 11747 Carmel, IN 46032 -8806 010000130857107 6238181100110000002883680824090 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 2883.68 INVOICE4 NVOICE DATE 7623818 -01 8/24/09 CUSTOMER PO# SHIP TO MARK 1817102 Please detach here and mail the above with your payment WHSE DEA# Fed ID: 11- 3136595 x 66 ,r ✓4r &�-�d .nee u�i. d _,y Cis p'�, 8 ,er�n. THER PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, PND UPON ANY STICH R EQUEST, SU H VALUE MUST BE DISCLOSED AS A DISCOUNT AGAINSI THE PURCHASE THAT E ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN THESE RECORDS. 2 HENRY CHEIN,INC. DISTRIBUTES THIS DRUG PRODUCP AS AUTHORIZED ISTRIBUTOR OF RECORD FOR THE MANUFACTURER. MERCHANDZ E TOTAL 2883.68 INVOI E TOTAL 2883.68 PLEASE PAY WITHIN THIRTY(3 DAYS OF RECEIPT OF THIS NVOICE. 2883.68 LEASE NOTE NEW REMIT TO ADDRESS Please remi payments only to the following a dress: HENRY SCHEI INC. DEPT CH 102 1 ALATINE, I 60055 -0241 BILL TO INVOIC CLISTOMER PO4 ITEM STATUS KEY REM KEY 1308571 7623818-01 MARK 13 13ackordered: Item will follow SK School Kit NV I E ATE F B D Discontinued: Item no longer a NC No Charee SHI TO F Special Schein Free Goods M Manufacturer will ship Item directly to you 1817102 8/24/09 20 P- Prescription Drug: Return Authorization Required TNVOTQE TOTAL R Refrigerated Item: Mav be shipped separately Special Schein Pricing U Temporarily unavailable: please reorder I 2883.68 3 OF 3 T- Taxable Item H ENRY CHEIN f T ERM S SA LE m Matrx J y We make ever; effort to maintain prices for the duration of a Payment by CHECK or by the HENRY SCHEIN PLATINUM BUSINESS catalog, however, we reserve the right to make price adjustments in CARD, VISA, MASTERCARZ3, DISCOVER and AMERICAN EXPRESS response to manufacturers price changes YppBW N Guaranteed Satisfaction: or It you have tried a product and it is detective or does not perform Bili w t Order To Yo Open Ac l nzi unt satisfactorily, we 'Trill provide a credit, refund, or exchange; its your Availa ie to license practitioners in the US, All invoices are choice. Simply Cali our customer service department within 30 days a aole r thin 30 nays, of receipt of the merchandise to arrange for the return. For a p s warranty repair or if you were sent something you did not order, simply call: Rx Products Controlled Substances: Matra Medical 1 -800 -845 -3550 Regulations require us to limit the sale of Rx and controlled substances only to registered, licensed healthcare professionals. f you area new customer or have re=cently moved please fume sh us v'Ith a COuy t your updated State registration. For controlled substances, furnish a copy of your DcA certificate, verifying your shipping address. Glass it drugs can be orderer: only by mail. International Orders: P;eave oI We Droudlv serve healt "care Professionals, and ao ernment Opened handpieces and equipment may not be returned for throughout the Y:orid. To place orders or for inquiries on export Credit but tirtlill be repaired or replaced in accordance with terms and c ?nrPhons, l nha5e Contact our In ternational Department: manufacturer vvar,amies. Be rfo "e opening haindpleces or equipm ;R'e Suggest that you h- K the shipping container i -800-845 and packing list to verity that you have received exactly what Prescription Drub Returns Instructions: you ordered.Opened Computer Software is not returnable. Other restrictions may also apply. t R A Return Authorization is Required for all Press ,p t icn Drugs. Simply call our Customer Service Department @1- 833 -845 -3553. T 11, EZ-11NI N-47"A I 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)) 8636527 -01 $87.48 7623818 -01 $2,883.68 8293406 -01 $319.60 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 $3,290.76 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 1120 8636527 -01 102- 390.11 $8748 1 hereby certify that the attached invoice(s), or 1120 7623818 -01 102 390.11 $2,883.68 bill(s) is (are) true and correct and that the 1120 8293406 -01 102 390.11 $319.60 materials or services itemized thereon for which charge is made were ordered and received except SEP 14 2009 m Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund