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Home My WebLink About173361 06/10/2009 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1 ONE CIVIC SQUARE HENRY SCHEIN INC CARMEL, INDIANA 46032 DEPT CH 10241 CHECK AMOUNT: $763.30 `o PALATINE IL 60055 -0241 CHECK NUMBER: 173361 CHECK DATE: 6/10/2009 D EPART ME NT A CCOU NT PO NUMBER I NVOICE NUMBER AMOUN D 102 4239011 3907268 -01 708.30 SPECIAL DEPT SUPPLIES 102 4239011 4288911 -01 55.00 SPECIAL DEPT SUPPLIES WHSE DEA# Fed ID: 11-3136595 a a c a his order ias been processed by our NORTHEAS D.C. 41 WEAVEZ ROAD DENVER, 3 A 1751-7 vIARK 317-423-8784 17 -571 -266 1 879 -8581 30 /PK MEDI -TRACE SNAP FOAM ELEC 530ECG 60 60 C 4.50 270.00 3 HIS PRODUC IS BEING SHIPPED FROM OUR MIDWES DISTRIBUTION CENTER. ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. 2 153 -2007 20 /RL BIOHAZARD BAG 14.5X19 RED 3GAL 10 10 C 2.03 20.30 4 1HIS PRODUCI IS BEING SHIPPED FROM OUR [MIDWES DISTR BUTIO CENTER. ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. 3 107 -0530 100 /BX PURPLE NITRILE PF GLOVE LARGE 50 50 C 8.36 418.00 9 HIS PRODucr IS BEING SHIPPED FROM OUR MIDWES DISTRIBUTION CENTER. ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. F YOU ARE DARTICIPATING IN A DISCOUNT PROG (E.G. POIN S, GIFTS OR OTHER PECIAL AWA DS "DISCOUNT WITH THIS PURC SE YOU HAVE EARNED A CREDI TOWARD GOODS OR S RVICES, RECEIVABLE OR REDEEMABLE N ACCO DANCE WITH DISCOUNT PROGRAM RULES. UPO4 DISCOUNT RECEIPT OR REDEMPTION, OU ARE RECEI ING OR WILL R CEIVE OTICE OF T E DISCOUNT VALUE. FROM TIME TO TIME, MEDICARE, 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 DISCOUNT GAINS THE PURCHASE THAT EARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN TH SE RE ORDS. IF YOU IIAVE BIL TO INVOICE# CUSTOMER ITEM STATUS KEY REM KEY 1308571 3907268-01 MARK 13 Backordered: Item will follow SK School Kit S HIP IPIV E DATE 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 5/27/09 1 0 1' Prescription Drug: Return Authorization Required R Refrigerated Item: May be shipped separately INVOICE TOTAL PAGE# S- Special Schein Pricing u Temporarily unavailable: please reorder 708.30 1 OF 2 T Taxable Item Continued on Next Page L HENRY SCHEIN SHIP TO: M atrx f U O I V E Carmel Fire Department MI 540 W 136 St N Station 46 Michael Kaufmann 135 Duryea Road, Melville, NY 11747 Carmel, IN 46032 8806 0100001308571103907268110010000000708300527096 BILL TO: Carmel Fire Dept MI 2 Civic Sq Carmel, IN 46032 -7543 Carmel Fire Dept MI 2 Civic Sq BILL INVOICE TOTAL Carmel, IN 46032 -7543 1308571 708.30 INVOICE# Iff INVOICE DATE 3907268 -01 5/27/09 CUSTOMER PO# SHIP TO MARK 1817102 Please detach here and mail the above with your payment WHSE DEA# Fed ID: 11- 3136595 o r X rd b� n e,;. ra t '3 ,w ,x o SED A HENR SCHEIN "HS CREDIT CARD TO MAKE THIS URCHA E, THEN ANY BENEFITS FROM PURCHA ES OF HS PRODUCTS WITH THE CARD I EXCES OF T OSE BENEFITS IVEN OR NON -HS DURCHASES MUST ALSO BE TREATED AS DISCOJNT ANE SIMILARLY DI CLOSED. MERCHANDI E TOTAL 708.30 INVOI E TOTAL 708.30 PLEASE PAY WITHIN THIRTY(3 DAYS OF RECEIPT OF THIS NVOICE. 708.30 LEASE NOTE NEW REMIT TO ADDRESS Please remi payments only to the following a dress: HENRY SCHEI4 INC. DEPT CH 10211 ALATINE, I 60055 -0241 INVOICE# CUSTOMER ITEM STATUS KEY REM KEY 1308571 3907268 MARK B Backordered: Item will follow SK School Kit HIP INVOICE DA F BOXES D Discontinued: Item no longer available NC No Charge 1= Special Schein Free Goods M Manufacturer will ship Item directly to you 1817102 S /27/09 10 P Prescription Drug: Return Authorization Required R Refrigerated Item: May be shipped separately INVOICE TOTAL PAGE Special Schein Pricing U Temporarily unavailable: please reorder 708.30 2 OF 2 T Taxable Item L H ENRY CHEIN Matrx Medical TERMS OF SALE Payment 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 Guaranteed Satisfaction: If you have tried a product and it is defective or does not perform or satisfactorily, we will provide a credit, refund, or exchange; its your Bill E Your Order To Your Open Account choice. Simply calf our customer service department within 30 days Avai able to licensed practitioners in the U.S. All invoices are of receipt of the merchandise to arrange for the return. Fora payable within 30 days. warranty repair or if you were sent something you did not order simply 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 II drugs can be ordered only by mail. International Orders: Please plate: 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, tyre suggest that you check the shipping container 1 -800- 845 -3550 and packing list to verify that you have received exactly what Prescription Drug Returns Instructions: you ordered.Opened Computer Software is not returnable. Other restrictions may also apply. A Return Authorization is Required for all Prescription Drugs. Simply calf our Customer Service Department 1- 800 -845 -3550, d uyb" 3 v u4• "p'. t C' a.. WHSirDEA# Fed ID: 11-3136595 n yF I�§.. ,r _�"..;?,ry. e e4r v r w a his order has been processed by our NORTHEAS D.C. 41 WEAVER ROAD DENVER, PA 1751-7 1 273 -5188 50 /CA ADAPTER ELBO 22MM ID 22MM OD CONN 2 2 27.50 55.00 1 F YOU ARE DARTICIPATING IN A DISCOUNT PROG (E.G. POIN S, GIFTS OR O HER PECIAL AWA DS "DISCOUNT WITH THIS PURC SE YOU HAVE EARNED A CREDI TOWARD GOODS OR S RVICES, RECEIVABLE OR REDEEMABLE N ACCO DANCE WITH DISCOUNT PROGRAM RULES. UPO4 DISCOUNT RECEIPT OR REDEMPTION, OU ARE RECEI ING OR WILL R CEIVE OTICE OF T E DISCOUNT VALUE. FROM TIME TO TI E, MEDICARE, MEDICAID, TRI ARE OR THEIR PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, AND UPON ANY S CH R EQUEST, SU H VALUE MUST BE DISCLOSED AS A DISCOUNT kGAINSrI THE PURCHASE THAT E ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN THESE RECORDS. IF YOU IAVE U SED A HENR SCHEIN "HS CREDIT CARD TO MAKE THIS 3 URCKAEE, THEN ANY BENEFITS F ROM PURCHA ES OF HS PRODUCTS WITH THE CARD IN EXCES3 OF THOSE BENEFITS GIVEN OR NON -HS DURCHASES MUST ALSO BE TREATED AS A DISCOJNT ANE SIMILARLY DI CLOSED. 2 HENRY CHEIN,INC. DISTRIBUTES THIS DRUG PRODUCF AS AN AUTHORIZED ISTRIBUTOR OF RECORD FOR THE MANUFACTURER. OUR ORDER 38014460 HAS BEEN SPLIT INTO MULTI LE SHI MENTS. CERTAIN ITEM WILL E SHIPPED 3EPARATELY. YOU WILL BE BILLED FOR THESE ITEMS WHEN THEY ARE 3HIPPED MERCHANDI E TOTAL 55.00 INVOI E TOTAL 55.00 PLEASE PAY WITHIN THIRTY(3 DAYS OF RECEIPT OF THIS INVOICE. 55.00 B ILL TO INVOICE# CUSTO PO# ITEM STATUS KEY REM KEY 1308571 4288911-01 MARK 11 Backordered: Item will follow SK School Kit Discontinued: no Ite no longer available NC No C HIP TO INVOICE DATE OF BOXES I' Special Schein Pree Goods M Manufacturer will ship Item directly to you 1817102 5/19/09 1 P Prescription Drug: Return Authorization Required R Refrigerated Item: May he shipped separately Special Schein Pricine U Temponarily unavailable: please reorder 55.00 1 OF 2 T Taxable Item Continued 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)) 4288911 -01 $55.00 3907268 -01 $708.30 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 $763.30 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 1120 4288911 -01 102 390.11 $55.00 1 hereby certify that the attached invoice(s), or 1120 3907268 -01 102 390.11 $708.30 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 n V Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund