174905 07/22/2009 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1
ONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: $323.00
CARMEL, INDIANA 46032 DEPT CH 10241
PALATINE IL 60055 -0241 CHECK NUMBER: 174905
CHECK DATE: 7/22/2009
DEPARTMENT ACCOUNT PO NU MBER INVOICE NUMBER AMOUN DESC RIPTION
102 4239011 3695760 -03 323.00 SPECIAL DEPT SUPPLIES
6i'
MARK 1817102
-I
WHSE DEA# Fed ID: 11-3136595
a
T his order has been processed by our MIDWEST D.C.
5315 WEST 74TH 3TREET
INDIANAP LIS,IN 46268
ARK 317 -42 -8784
1 107 -0540 90 /BX PURPLE NITRILE PF GLOVE X -LARGE 38 38 8.50 323.00 4
HIS PRODUC IS BEING SHIPPED FROM OUR MIDWES DISTR BUTIO CENTER.
F YOU ARE DARTICIPATING IN A DISCOUNT PROG^ (E.G. POIN S, GIFTS OR OTHER
PECIAL AWA DS "DISCOUNT WITH THIS PURCH SE YOU HAVE EARNED A CREDI TOWARD
GOODS OR SERVICES, RECEIVABLE OR REDEEMABLE N ACCORDANCE WITH DISCOUNT PROGRAM
RULES. UPOI DISCOUNT RECEIPT OR REDEMPTION, OU ARE RECEI"ING OR WILL RECEIVE
OTICE OF THE DISCOUNT VALUE. FROM TIME TO TIME, MED CARE, MEDICAID, TRI ARE OR
THER PAYER MAY REQUEST INFORMATION REGARDING SUCH VALUE, P.ND UPON ANY S CH
REQUEST, SU H VALUE MUST BE DISCLOSED AS A DI COUNT AGAINST THE PURCHASE THAT
EARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN THESE RECORDS.
142 HENRY 3CHEIN,INC. DISTRIBUTES THIS DRUG PRODUCC AS AUTHORIZED
ISTRIBUTOR OF RECORD FOR THE MANUFACTURER.
MERCHANDI E TOTAL 323.00
INVOI E TOTAL 323.00
PLEASE PAY WITHIN THIRTY(3 DAYS OF RECEIPT OF THIS NVOICE. 323.00
BILL INVOICE# CUSTOMIRR PO# ITEM STATUS KEY REM KEY
1308571 369S760-03 MARK R- Backordered: Item will follow SK School Kit
D Discontinued; hem no longer available NC No Charge
S
SHIP 4- P]V I E ATE F B XE F Spacial Schein Free Goods
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))
3695760 -03 $323.00
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. 'r'VARRANT NO.
ALLOWED 20
Henry Schc-in
IN SUM OF
Dept Ch 10241
Palatine, IL 60055
$323.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1120 3695760 -03 102 390.11 $323.00 1 hereby certify that the attached invoice(s), or
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
2009
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund