175723 08/06/2009 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1
ONE CIVIC SQUARE HENRY SCHEIN INC
CARMEL, INDIANA 46032 DEPT CH 10241 CHECK AMOUNT: $1,670.28
PALATINE IL 60055 -0241
CHECK NUMBER: 175723
CHECK DATE: 8/6/2009
DEPARTMENT ACCOUNT PO NU I NUMBER AMOUNT DESCRIPTION
102 4239011 14223166 371.62 SPECIAL DEPT SUPPLIES
1120 4239011 309019901 907.60 SPECIAL DEPT SUPPLIES
1120 4239011 312956401 1,134.30 SPECIAL DEPT SUPPLIES
L
4 1 1 1 11 1-0 �s, L 3 i h`
1 4170688 50 /Ca Ultrasite Ext Set Std Bor 2 3274544 185.81 371.62
07/15/09 Order 6547898 1.000 MARK
Credit amount 371.62
Sub Net Total 371.62
Total Credit. 371.62
ACCOUNT TOTAL CREDIT
1308571 371.62
CREDIT MEMO CREDIT MEMO DATE
14223166 07/22/09
PAGE CREDIT APPLIED TO
1 of 1 Account
WHSE DEA# Fed ID: 11 -3136595
rhis order aas been processed by our NORTHEAS" D.C.
41 WEAVER ROAD
DENVER, ?A 175 77
CASE GOOD =M, MAY BE SHIPPED SEPARATELY.
F YOU ARE ARTICIPATING IN A DISCOUNT PROGRAM (E.G. POINrIS, GIFTS OR OTHER
PECIAL AWARDS ("DISCOUNT")), WITH THIS PURCHASE YOU HAVE EARNED A CREDI TOWARD
GOODS OR S�RVICES, RECEIVABLE OR REDEEMABLE N ACCORDANCE WITH DISCOUNT PROGRAM
RULES. UPO4 DISCOUNT RECEIPT OR REDEMPTION, YOU ARE RECEI%ING OR WILL RECEIVE
TICE OF TiE DISCOUNT VALUE�. FROM i I M_�_'T�_O I'll E, MEDICARE, MEDICAID, TRI('ARE OR
DTHER PAYER MAY REQUEST INFORMATION REGARDING SUCH VkLUE, P.ND UPON ANY STCH
REQUEST, SU VALUE MUST BE DISCLOSED AS A DI COUNT AGAINS'l THE PURCHASES THAT
EARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD REAIN THESE RECORDS.
MERCHANDI;E TOTAL 907.60
INVOI'E TOTAL 907.60
PLEASE PAY WITHIN THIRTY(3)) DAYS OF RECEIPT OF THIS 'NVOICE. 907.60
LEASE NOTE NEW REMIT TO ADDRESS
lease remi payments only to the following aldress:
EPT CH 10211
BILL TO INVOICE11 CUSTOMER PO# ITEM STATUS KEY FTREKMf_K�EY
1308571 3090199-01 MARK B Backordered: Item will follow SK School Kit J
SHIP TO INVOICE DATE OF BOXES 1) Discontinued; Item no longer available NC- No Charge
F Special Schein Free Goods
M Manufacturer will ship Item directly to you
1817102 7/14/09 4 P Prescription Drug: Return Authorization Required
R Refrigerated Item: May be shipped separately
INVOICE TOTAL PAGE# Special Schein Pricing
U Temporarily unavailable: please reorder
J 907.60 OF 1 T Ta.able Item
ayr c Terms,
We make every 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, MASTERCARD, DISCOVER and AMERICAN EXPRESS
response to manufacturers' price changes
Y Bwlm Hum
Guaranteed Satisfaction. vsA
m-
If you have tried a product and it is defective or does not perform B ill tr Order To r�r cart
satisfactorily, we will provide a credit, refund, or exchange; it's your Available to licensed practitioners in the U.S. Ail invoices arc-
choice. Simply call our customer service department within 30 days payable within 30 days.
of receipt of the merchandise to arrange for the return. For a
warranty repair or if you were sent something you did not order
simpl 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 Mote:
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:
equipment, we suggest that you check the shipping container 1- 800 845 -3550
and packing list to verify that you have received exactly what Prescription Drug Ret 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.
rf'u.,.��•. �.y _.,z� µi i
�Z
WHSE DEA# Fed ID: 11-3136595 Mu"I
Inl
1191W;T -1 I,
0M
OR M 0 5
rhis order as been processed by our NORTHEAS" D.C.
41 WEAVER ROAD
DENVER, )A 17517
317-571-266�
317--428-87 4
1 499-8458 EA NASAL CANNULA ADULT 300 300 0.38 114.00 12
HIS PRODUC IS BEING SHIPPED FROM OUR MIDWES DISTRIBUTIO]y CENTER.
2 499-6737 EA NON-REBREATHER MASK ADULT 150 150 C 0.95 142.50 9
FHIS PRODUC IS BEING SHIPPED FROM OUR MIDWES' DISTRIBUTIO CENTER.
ASE' MAY BE
3 507-0791 PU EA IV EMS SET W/ULTRA SITE 8 15DROPS 50 50 1.65 82.50 15
HIS PRODUC P IS BEING SHIPPED FROM OUR WEST COAST D=RIBU=ON CENTER.
PLEASE NOTE 4990653 IS NOW 5070791
4 507-0791 PU EA IV EMS SET W/ULTRA SITE 8 15DROPS 300 300 C 1.65 495.00 6
-ASE GOOD ICEM, MAY BE SHIPPED SEPARATELY.
5 507-0791 PU EA IV EMS SET W/ULTRA SITE 8 15DROPS 50 so 1.65 82.50 13
HIS PRODUC r IS BEING SHIPPED FROM OUR MIDWES" DISTREBUTIOE CENTER.
6 788-7386 EA YANKAUER SUCTION OPEN TIP BLUE 100 100 C 0.60 60.00 11
HIS PRODUCT IS BEING SHIPPED FROM OUR MIDWES" DISTREBUTIO CENTER.
ASE GOOD IrEM, MAY BE SHIPPED SEPARATELY.
BILL TO INVOICE# CUSTOLIER PO4 ITEM STATUS KEY REM KEY
1308571 3129564-01 MARK 13 Backordered: Item will follow SK School Ki
D Discontinued: Item no longer available NC No Charge
SHIP T O INVOICE DATE OF BOXES F- Special Schein Free Goods
M Manufacturer will ship Item directly to you
1817102 7/14/09 15 11 prescription Drug: Return Authorization Required
R L Item: May be shipped separately
INVOICE TOTAL PA (3E# Special Schein pricing
U Temporarily unavailable: please ,corder
1134.30 1 OF 3 T Taxable Item Continued on Next Page
A H E NRY SCHEIN
SHIP TO:
Matrx Medical Carmel Fire Department MI
IN VOIC E Stati Kaufmann
135 Duryea Road, Melville, NY 11747 Carmel IN 46032 -8806
01000013085710312956411,0010000001134300714090 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 1134.30
INVOICE# INVOICE DATE
3129564 -01 7/14/09
CUSTOMER PO# SHIP TO
MARK 1817102
WHSE DEA# Fed ID: 11-3136595
�74 Nom« -2-'-
s,) �...x t+ �I� -c
499 -7629 EA ET TUBE CUFFED 7.0 30 30 1.06 31.80 12
7 2
HIS PRODUCT IS BEING SHIPPED FROM OUR MIDWEST DISTR BUTIO CENTER. 7
8 857 -5266 EA DISP MIL LARYGOSCOP BLADE SZ 2 4 4 4.50 18.00 13
HIS PRODUC IS BEING SHIPPED FROM OUR MIDWES DISTREBUTIOD CENTER.
9 857 -5362 EA DISP MIL LARYGOSCOP BLADE SZ 0 4 4 4.50 18.00 14
HIS PRODUCC IS BEING SHIPPED FROM OUR MIDWES DISTR BUTIO CENTER.
10 857 -1425 EA DISP MIL LARYGOSCOP BLADE SZ 1 4 4 4.50 18.00 13
HIS PRODUCC IS BEING SHIPPED FROM OUR MIDWES DISTR BUTIO CENTER.
11 857 -3605 EA DISP MIL LARYGOSCOP BLADE SZ 3 4 4 4.50 18.00 12
HIS PRODUCT IS BEING SHIPPED FROM OUR MIDWES DISTREBUTIOD CENTER.
12 857 -9052 EA DISP MAC LARYNGSCOP BLADE SZ 2 4 4 4.50 18.00 13
HIS PRODUCT IS BEING SHIPPED FROM OUR MIDWES DISTRIBUTIO1 CENTER.
13 857 -2059 EA DISP MAC LARYNGSCOP BLADE SZ 3 4 4 4.50 18.00 '13
HIS PRODUC IS BEING SHIPPED FROM OUR MIDWES DISTREBUTION CENTER.
14 857 -1785 EA DISP MAC LARYNGSCOP BLADE SZ 4 4 4 4.50 18.00 12
HIS PRODUC IS BEING SHIPPED FROM OUR MIDWES `DISTR BUTIO CENTER.
F YOU ARE 3 ARTICIPATING IN A DISCOUNT PROGRAM (E.G. POINTS, GIFTS OR OTHER
PECIAL AWARDS "DISCOUNT WITH THIS PURL SE YOU HAVE EARNED A CREDI TOWARD
GOODS OR SERVICES, RECEIVABLE OR REDEEMABLE N ACCO DANCE WITH DISCOUNT PROGRAM
RULES. UPOq DISCOUNT RECEIPT OR REDEMPTION, IOU ARE RECEI ING OR WILL RECEIVE
j OTICE OF T E DISCOUNT VALUE. FROM TIME TO TI E, MED CARE, MEDICAID, TRI ARE OR
BILL TO INVOICE CUSTOMER PO# ITEM STATUS KEY REM KEY
1308571 3129S64-01 MARK 13 Backordered: Item will follow SK ,S houl Kit
D Discontinued: Item no longer available NC No Chargc
HIP TO INVOICE DATE OF BOXES 1= Special Schein Free Goods
M Manufacturer will ship Item directly to you
1817102 7 14 0 9 15 P- Prescription Drug: Return Authorization Required
R Refrigerated Item: May be shipped separately
INVOICE TOTAL PAGE Special Schein Pricing
U Temporarily unavailable; please reorder
1134.30 2 OF 3 T Taxable Item Continued on Next Page
L
KHENR SCHEIN
SHIP TO:
i Carmel Fire Department MI
INVOIC Stati Kaufmann
135 Duryea Road, Melville, NY 11747 Carmel, IN 46032 -8806
0100001308571031, 2956411001000000],13430071,4090 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 1134.30
INVOICE# INVOICE DATE
3129564 -01 7/14/09
CUSTOMER POO SHIP TO
MARK 1817102
Please detach here and mail the above with your payment
WHSE DEA# Fed ID: 11-3136595
mtea
THER PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, TND UPON ANY S CH
EQUEST, SUCH VALUE MUST BE DISCLOSED AS A DI COUNT GAINSq THE PURCHASES THAT
ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN TH SE RECORDS.
MERCHANDI E TOTAL 1134.30
INVOI E TOTAL 1134.30
PLEASE PAY WITHIN THIRTY(3 DAYS OF RECEIPT OF THIS NVOICE. 1134.30
LEASE NOTE NEW REMIT TO ADDRESS
lease remi payments only to the following a dress:
ENRY SCHE14 INC.
EPT CH 102 1
ALATINE, I 60055 -0241
BILL TO INVOICE* CUSTOMER PO# ITEM STATUS KEY REM KEY
1308571 3129564-01 MARK H Backordered: Item will follow SK -,School Kit
1) Discontinued: Item no longer available NC No Charge
HIP TO INVOICE DATE OF BOXES F Special Schein Free Goods
M Manufacturer will ship Item directly to you
1817102 7/14/09 15 P- Prescription Drug: Return Authorization Required
R Refrigerated Item: May be shipped separately
INVOICE TOTAL PAGE# Special Schein Pricing
U Temporarily unavailable: please reorder
1134.30 3 OF 3 T- Taxable Item
L
ENRY SCHEW 1
trx R Medical
Al
I
ay i is Ternis:
'Ale make every 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, MASTERCARD, DISCOVER and AMERICAN EXPRESS
response to manufacturers` price changes
r
Guaranteed Satisfaction:��
If you have tried a product and it is defective or does not perform tiff Your Order
satisf actorily, we will provide a credit, refund, or exchange; it's your Available to licensed practitioners in the U.S. All invoices are
choice. Simply call our customer service department within 30 days
of receipt of the merchandise to arrange for the return, For a pay able within 30 days
warranty repair or if you were sent something you did not order
simply call: fix P roducts Controlled Substances:
Matrx Medical 1- 800 845 -3550
Regulations require us to limit the sale of Rx an 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. Far 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 Note:
Opened handpieces and equipment may not be returned for u °e proudly serve healthcare professionals and governments
credit, bat will be repaired or replaced in accordance with the world. To place orders or for inquiries on export
manufacturer warranties. Before opening handp eves or terms and conditions, please contact our International Department:
equipment, e suggest that you check the shipping container 1-800-845-3550
and packing list to verity that you have received exactly what Prescription Drug Returns Instructions:
you ordered.Opened Computer Software is net returnable.
Other restrictions may also apply.
A Return; Authorization is Required for all Prescription Drugs. Simply call
cur Customer Service Department 1 -800- 845 -3550.
v
'�.�`x2a" ti,�.� .r,..,....... L ay CnS n�' �'R. w ;....a._... t.:„
S
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))
14223166 ($371.62)
3129564 -01 $1,134.30
3090199 -01 $907.60
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
$1,670.28
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1120 14223166 102 390.11 ($371.62) 1 hereby certify that the attached invoice(s), or
1120 3129564 -01 102 390.11 $1,134.30 bill(s) is (are) true and correct and that the
1120 3090199 -01 102 390.11 $907.60
materials or services itemized thereon for
which charge is made were ordered and
received except
AUG 3 2009
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund