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Home My WebLink About174347 07/08/2009 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1 ONE CIVIC SQUARE HENRY SCHEIN INC 0 CARMEL, INDIANA 46032 DEPT CH 10241 CHECK AMOUNT: $2,107.07 PALATINE IL 60055 -0241 CHECK NUMBER: 174347 CHECK DATE: 7/8/2009 DE PARTME NT ACCOUNT PO NUMBER INVO NUMBER AMOUNT DESCRIPTION 102 4239011 3695760 -01 2,022.07 SPECIAL DEPT SUPPLIES 102 4239011 3695760 -02 85.00 SPECIAL DEPT SUPPLIES WHSE DEA# Fed ID: 11- 3136595 6- AYE m N This order as been processed by our NORTHEAS" D.C. 41 WEAVER ROAD DENVER, )A 175L7 vIARK 317-423-8784 1 496-2369 100/BX SURGILANCE SAFETY LANCET 2.2 ORG 5 5 10.25 51.25 8 2 555-5396 PU EA PROTECTIV ACUVNC SFT CATH 20X1.25 50 50 2.70 135.00 10 THIS PRODUCU IS BEING SHIPPED FROM OUR MIDWES DISTRIBUTIO1 CENTER. 3 555-1166 U EA PROTECTIV ACUVNC SFT CATH 18X1.2 50 50 2.70 135.00 10 HIS PRODUCC IS BEING SHIPPED FROM OUR MIDWES DISTRIBUTIO C ENTER. 4 654-5076 U 50/BX PROTECTIV ACUVANCE SAFETY 22GX111 1 1 135.00 135.00 8 5 507-8362 R-X 100/BX NACL PREFILL SYRINGE 2 2 53.00 106.00 9 142 PEDIGR E ITEM. ITDC:6380701)010 6 890-6800 EA SHARPS SHUTTLE SINGLE USE P2 48 48 1.54 73.92 8 7 120-0186 EA SHARPS CONTAINER RED 1 GAL 12 12 2.45 29.40 8 8 107-0540 90/BX PURPLE NITRILE PF GLOVE X-LARGE 50 2 8.50 17.00 10 PARTIAL SHI?MENT WILL SHIP AND INVOICE WHEN AVAILA3LE. THIS PRODUCT IS BEING SHIPPED FROM OUR MIDWES" DISTRIBUTIO11 CENTER. 9 107-0530 100/BX PURPLE NITRILE PF GLOVE LARGE 50 50 C 8.50 425.00 5 BILL TO INVOICE# CUSTO ER PQ# ITEM STATUS KEY REM �KEY 1308571 3695760-01 MARK D- Backordered: I tem will follow SK School Kit D Discontinued: Item no longer available NC -,N Charge SHIP TO IMMICE DATE OF BOXES F Special Schein Free Goods Ni Manufacturer will ship Item directly to you 1817102 6/18/09 11 11 prescription Drug: Return Authorization Required R e Item:,mav be shipped separatel TNVOTrf, T07AT. PAGE# Special Schein Pr icing U Temporarily unavailable: please reorder 2022 .07 1 OF 3 T Taxable Item Continued on Next Page r HENRY SCHEING SHIP TO: Matrx Medical Carmel Fire Department MI INVOICE Stati Kaufmann 135 Duryea Road, Melville, NY 11747 Carmel, IN 46032 -8806 01000013085710369576011 ,001000000202207061,8099 BILL TO: Carmel Fire Dept MI 2 Civic Sq Carmel, IN 46UT2 -7543 Carmel Fire Dept MI 2 Civic Sq BILL TO INVOICE TOTAL Carmel, IN 46032 -7543 1308571 2022.07 INVOICE INVOZCE DAZE 3695760 -01 6/18/09 CUSTOMER PO# SHIP TO MARK 1817102 WHSE DEA# Fed ID: H- 3136595 Z s ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. 10 220 -1398 3 /ST BODY STRAP SET DISP YELLO W 50 50 4.85 242.50 11 11 602 -8100 EA COLLAR EXTRIC. STIFFNECK ADJ. 100 100 C 5.75 575.00 7 ASE GOOD ITEM, MAY BE SHIPPED SEPARATELY. 12 879 -8581 30 /PK MEDI -TRACE SNAP FOAM ELEC 530ECG 20 20 4.85 97.00 8 F YOU ARE DARTICIPATING IN A DISCOUNT PROGRAM (E.G. POINTS, GIFTS OR OTHER PECIAL AWA S "DISCOUNT WITH THIS PURCHASE 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 T E DISCOUNT VALUE. FROM TIME TO TI.E, MED CARE, MEDICAID, TRI ARE OR THER PAYER MAY REQUEST INFORMATION REGARDING SUCH VALUE, PND UPON ANY SljCH REQUEST, SU H VALUE MUST BE DISCLOSED AS A DISCOUNT AGAINSI THE PURCHASES THAT EARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN THESE RECORDS. IF YOU 11AVE SED A HENR SCHEIN "HS CREDIT CARD TO MAKE THIS DURCHAEE, THEN ANY BENEFITS ROM PURCHA ES OF HS PRODUCTS WITH THE CARD IN EXCES3 OF THOSE BENEFITS TIVEN OR NON -HS URCHASES MUST ALSO BE TREATED AS DISCOJNT ANE SIMILARLY DI CLOSED. 2__- HENRY 3CHEIN,INC. DISTRIBUTES THIS DRUG PRODUCC AS AUTHORIZED ISTRIBUTOR OF RECORD FOR THE MANUFACTURER. MERCHANDI E TOTAL 2022.07 INVOI E TOTAL 2022.07 PLEASE PAY WITHIN THIRTY(3 DAYS OF RECEIPT OF THIS NVOICE. 2022.07 BILL TO INVOICE INVOICE4 CUSTOMER PO ITEM STATUS KEY REM KEY 1308571 3695760-01 MARK It Backordered: Item will follow SK School Kit HIP T INVOICE DATE F H XE Discontinued: Item no longer available NC No Charge 1= Special Schein Free Goods M Manufacturer will ship Item directly to y ou 1817102 6/18/09 11 P Prescription Drug: Return Authorization Required R Rcfrieerated Item: May be shipped separately INVOICE TOTAL PAGE# Special Schein Pricing U Temporarily unavailable: please reorder 2022.07 2 OF 3 T- Taxable Item Continued on Next Page WHSE DEA" Fed ID: 11-3136595 NMI. 4" 11; W W I WIN This order has been processed by our MIDWEST D.C. 5315 WES" 74TH 3TREET INDIANAPQLIS,IN 46268 AARK 317-423-8784 1 107-0540 90/BX PURPLE NITRILE PF GLOVE X-LARGE 48 10 C 8.50 85.00 1 PARTIAL SHI?MENT WILL SHIP AND INVOICE WHEN AVAILA3LE. THIS PRODUC IS BEING SHIPPED FROM OUR MIDWES DISTREBUTIO CENTER. ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. F YOU ARE ARTICIPATING IN A DISCOUNT PROGRAt (E.G. POINqS, GIFTS OR 0 HER PECIAL AWARDS ("DISCOUNT")), WITH THIS PURCH' �SE YOU HAVE EARNED A CREDI TOWARD GOODS OR SRVICES, RECEIVABLE OR REDEEMABLE N ACCOZDANCE WITH DISCOUNT PROGRAM RULES. UPOi DISCOUNT RECEIPT OR REDEMPTION, YOU ARE RECEI ING OR WILL R1,CEIVE NOTICE OF T DISCOUNT VALUE. FROM TIME TO TIME, MEDECARE, MEDICAID, TRITARE OR DTHER PAYER MAY REQUEST INFORMATION REGARDING SUCH VkLUE, PND UPON ANY STCH EQUEST, SU VALUE MUST BE DISCLOSED AS A DI COUNT kGAINS rl THE PURCHASES THAT EARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE =SE RECORDS. IF YOU HAVE JSED A HENR SCHEIN ("HS") CREDIT CARD TO MAKE THIS DURCHASE, THEN ANY BENEFITS FROM PURCHA3ES OF HS PRODUCTS WITH THE CARD Ill EXCES3 OF TF.OSE BENEFITS TIVEN FOR NON-HS DURCHASES MUST ALSO BE TREATED AS A DISCO AN SIMILARLY DI CLOSED. 42 HENRY 3CHEIN,INC. DISTRIBUTES THIS DRUG PRODUCC AS AUTHORIZED )ISTRIBUTOR OF RECORD FOR THE MANUFACTURER. MERCHANDISE TOTAL 85.00 INVOITE TOTAL 85.00 BILL TO INVOICE4 CUSTOMER PO# ITEM STATUS KEY REM �KEY 1308571 3695760-02 MARK 13 -13ackordered: Item will follow SK School Kit Discontinued: Item no longer available NC No Charge SHIP TO INVOICE DATE 4 OF BOXFS Special Schein Free Goods M Manufacturer will ship Item directly to von 1817102 6/22/09 1 P- Prescription Drug: Return Authorization Required R Refri Item: May be shipped separately INVO TC)TAL PAQE# Special Schein pricing' U Temporarily unavailable: please reorder 85.00 1 OF 2 T Taxable Item on Next Page 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 -02 $85.00 3695760 -01 $2,022.07 1 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 N ALLOWED 20 Henry 15chein IN SUM OF Dept Ch 10241 Palatine, IL 60055 $2,107.07 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 1120 3695760 -02 102 390.11 $85.00 1 hereby certify that the attached invoice(s), or 1120 3695760 -01 102 390.11 $2,022.07 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 r ZIP Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund