HomeMy WebLinkAbout172358 05/13/2009 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1
0 ONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: $1,171.48
CARMEL, INDIANA 46032 DEPT CH 10241
PALATINE IL 60055 -0241 CHECK NUMBER: 172358
CHECK DATE: 5113/2009
DEPART ACCOUNT PO NUMBE INVOICE NUM BER AMOUNT DESCRIPTI
102 4239011 2269050 -01 17.62 SPECIAL DEPT SUPPLIES
1110 4239012 20105 254264701 193.60 QUICK CLOT
102 4239011 4286679 -01 832.26 SPECIAL DEPT SUPPLIES
102 4239011 47075 -01 128.00 SPECIAL DEPT SUPPLIES
WHSE DEA# Fed ID: 11- 3136595
t,
s
fr' .K� .r .i.'.�_ a° a s a c o as• M .w� a a e
RK 317 -57 -2663
1 499 -1688 EA PELICAN CASE #1500 W /FOAM BLACK 1 1 128.00 128.00
PRODUCT IS BEING SHIPPED TO YOU DIRECTLY FROM THE MAqUFACTI.RER.
F YOU ARE DARTICIPATING IN A DISCOUNT PROGRAM (E.G. POINTS, GIFTS OR OTHER
PECIAL AWA DS "DISCOUNT WITH THIS PURL SE YOU HAVE EARNED A CREDI TOWARD
GOODS OR S RVICES, RECEIVABLE OR REDEEMABLE N ACCO DANCE WITH DISCOUNT PROGRAM
RULES. UPO DISCOUNT RECEIPT OR REDEMPTION, rOU ARE RECEI ING OR WILL R CEIVE
OTICE OF THE DISCOUNT VALUE. FROM TIME TO TIME, MED CARE, MEDICAID, TRI ARE OR
THER PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, AND UPON ANY S CH
R EQUEST, SU H VALUE MUST BE DISCLOSED AS A DI COUNT kGAINST THE PURCHASES THAT
E ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN TH SE RECORDS. IF YOU RAVE
SED A HENR SCHEIN "HS CREDIT CARD TO MAKE THIS URCHA E, THEN ANY B NEFITS
ROM PURCHA ES OF HS PRODUCTS WITH THE CARD III EXCES3 OF T1 BENEFITS TIVEN
OR NON -HS DURCHASES MUST ALSO BE TREATED AS A DISCOJNT ANE SIMILARLY DI CLOSED.
MERCHANDISE TOTAL 128.00
INVOICE TOTAL 128.00
PLEASE PAY WITHIN THIRTY(3 DAYS OF RECEIPT OF THIS NVOICE. 128.00
LEASE NOTE NEW REMIT TO ADDRESS
lease remi payments only to the following a dress:
ENRY SCHEI4 INC.
EPT CH 10211
ALATINE, .I 60055 -0241
BILL INVOICE11 CUS PO# ITEM STATUS KEY KEY
13 47 MARK 13 Backordered: Item will follow SK School Kit
D Discontinued: Item no longer available NC No Charge
HIP T INVOICE DATE F BOXES F- Special Schein free Goods
M Manufacturer will ship Item directly to you
1308572 4/30/09 P- Prescription Drug: Return Authorization Required
R Refrigerated Item: May be shipped separately
INVOICE TOTAL PAGE Special Schein Pricing
U Temporarily unavailable: please reorder
128.00 1 OF 1 T Taxable Item
LP
Pam t rin
We make every effort to maintain prices for the duration of a Payment by CHECK or by the HENRY SCHEIN PLATINUM BUSINESS
catalog, however. Gyre reserve the right to make price adjustments in CARD, VISA, MASTERCARD, DISCOVER and AMERICAN EXPRESS
response to manufacturers' price changes
Guaranteed Satisfaction: 4 lei
If you have tried a product and it is defective or does not perform f'ttr° girder ,rfi£.ert
satisfactorily, we will provide a credit, refund, or exchange; it's your Avai'able to licensed practitioners in the U.S. All invoices are
choice. Simply call our customer service department within 30 days na +fable 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
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:
Pease Note:
We proudly serve healthcare professionals and governments
Opened handpieces and equipment may not be returned for throughout the world. To place orders or for inquiries on export
credit, but will be repaired or replaced in accordance with terms and conditions, please contact our International Department:
manufacturer warranties. Before opening handpieces or 1- 300 045 -3350
equipment, we suggest that you check the shipping container
and packing list to verify that you have received exactly ;.ghat Prescription Drug Returns Instructions:
you ordered.4pened Computer Software is not returnable.
Other restrictions may also apply.
A Return Authorization is Required for all Prescription Drugs. Simply call
our C! €stonier Service Department 1- 800 845 -3550.
WHSE D8A# Fed ID: 11- 3136595
9 0 1 1 NNIA '1 0
PA W I
Mm
his order as been processed by our NORTHEAST D.C.
41 WEAVER ROAD
DENVER, PA 175L7
AARK
3578219
150/BT TUMS TABLETS ASSORTED
1 908-8668 100/BT MOTRIN IB TABLETS 200MG 1 1 8.98 8.98 1
2 357-8219 150/BT TUMS TABLETS ASSORTED ASSORTE 2 2 4 .32 8.64 1
F YOU ARE :1ARTICIPATING IN A DISCOUNT PROGRAM (E.G., POINIS, GIFTS OR OTHER
PECIAL AWA ZDS ("DISCOUNT") WITH THIS PURL SE YOU HAVE EARNED A CREDI" TOWARD
GOODS OR S RVICES, RECEIVABLE OR REDEEMABLE -N ACCOZDANCE WITH DISCOUNT PROGRAM
RULES. UPOq DISCOUNT RECEIPT OR REDEMPTION, YOU ARE RECEI%ING OR WILL RECEIVE
70TICE OF TIE DISCOUNT VALUE. FROM TIME TO TIME, MEDICARE, MEDICAID, TRI ARE OR
)THER PAYER MAY REQUEST INFORMATION REGARDING SUCH VALUE, ;ND UPON ANY SUCH
REQUEST, SU VALUE MUST BE DISCLOSED AS A DI COUNT AGAINS I THE PURCHASES THAT
EARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RETAIN THESE RECORDS. IF YOU KAVE
JSED A HENRf SCHEIN "HS CREDIT CARD TO MAKE THIS ?URCHAEE, THEN ANY BINEFITS
ROM PURCH7+ES OF HS PRODUCTS WITH THE CARD IN EXCESS OF THOSE BENEFITS TIVEN
OR NON-HS )URCHASES MUST ALSO BE TREATED AS I DISCO AN E SIMILARLY DI CLOSED.
MERCHANDI E TOTAL 17.62
INVOIIE TOTAL 17.62
PLEASE PAY WITHIN THIRTY(3 I) DAYS OF RECEIPT OF THIS :NVOICE. 17.62
BILL TO I NV OI CUSTOMER PQ# ITEM STATUS KEY REM KEY
1308571 2269050-01 MARK B Backordered: Item will follow SK School Kit
1) Di Item no longer available NC No CharL
SHIP TO TNVOICE DATF OF BOXES Special Schein Free Goods
M Manufacturer will ship Item directly to you
13085 72 4/20/09 1 P prescription Drug: Return Authorization Required
R Refrigerated Item: Ma be shipped separately
INVOICE TOTAL PAGE# Special Schein pricing
U Temporarily unavailable: please reorder
17.62 1 OF 2 T Taxable Item Continued on Next Page
WHSEDEA# Fed 1D:1 1-3136595
r 3i� i�f iii t .,w y.�.
�1..<' ;a aS..,_ ^t 3a- 'Ttx„�.., fd'� ✓r_ ,sLlr.�. N <ft ✓a .,0
his order has been processed by our NORTHEAS D.C.
41 WEAVER ROAD
DENVER, PA 175L7
1 890 -6868 3 /PK LIFEPAK 12 PAPER EKG 12 12 11.25 135.00 3
2 220 -1398 3 /ST BODY STRAP SET DISP YELLO W 100 100 4.89 489.00 2
3 469 -8399 EA MYCLYNS PROTECTIVE SPRAY 1 1 16.50 16.50 4
HIS PRODUC IS BEING SHIPPED FROM OUR MIDWES DISTR BUTIO CENTER.
4 153 -6483 RX 250ML /BT STERILE WATER FOR IRRIG 24 24 C 0.99 23.76 1
ASE GOOD I EM, MAY BE SHIPPED SEPARATELY.
2 PEDIGR E ITEM.
DC:0033800 402
5 555 -1166 PU EA PROTECTIV ACUVNC SFT CATH 18X1.25 50 50 2.73 136.50 3
6 496 -2369 100 /BX SURGILANCE SAFETY LANCET 2.2 ORG 3 3 10.50 31.50 2
LEQUE ARTICIPATING IN A DISCOUNT PROG (E.G. POINTS, GIFTS OR OTHER
A DS "DISCOUNT WITH THIS PURL SE YOU HAVE EARNED A CREDI TOWARD
SERVICES, RECEIVABLE OR REDEEMABLE N ACCO DANCE WITH DISCOUNT PROGRAM
O DISCOUNT RECEIPT OR REDEMPTION, 'IOU ARE RECEI ING OR WILL RECEIVE
T E DISCOUNT VALUE. FROM TIME TO TIME, ME D CARE, MEDICAID, I ARE OR
R MAY REQUEST INFORMATION REGARDING SUCH V LUE, D UPON ANY S CH
U H VALUE MUST BE DISCLOSED AS A DI COUNT GAINS THE PUR CHASE THAT
BILL TO INVOIC CTJ STOMER INVOICE PO4 ITEM STATUS KEY REM KEY
1308571 4286679-01 MARK u Backordered: Item will follow SK school Kit
D Discontinued: Item no longer available NC -No Charee
HIP TO INVOICE DATE OF BOX 1=- Special Schein Free Goods
M Manufacturer will ship Item directly to you
18 17102 5 /04/09 4 P- Prescription Diug: Return Authorization Required
R Refriecrated Item: May be shipped separately
Special Schein Pricing
U Temporarily unavailable: please reorder
832 2 6 1 OF 2 T Taxable hem Continued on Next Page
AH ENRY S CHEIN
SHIP TO:
s
q Carmel Fire Department MI
9� 540 W 136 St
INVOIC I
Station 46 Michael Kaufmann
135 Duryea Road, Melville, NY 11747 Carmel, IN 46032 -8806
0100001, 308571042866791 ,10010000000832260504092 BILL TO:
Carmel Fire Dept MI
2 Civic Sq
Carmel, IN 46032 -7543
Carmel Fire Dept MI
2 Civic .SCI BILL TO INVOICE TOTAL
Carmel, IN 46032 -7543 1308571 832.26
INVOICE# INVOICE DATE
4286679 -01 5/04/09
CUSTOMER PO4 SHIP TO
MARK 1817102
Please detach here and mail the above with your payment
A'HSE DEA# Fed 1D: 11- 3136595
a f`o�
s eta
^t t.k xy s k4:
E ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN THESE RECORDS. IF YOU AVE
SED A HENRC SCHEIN "HS CREDIT CARD TO MAKP, THIS DURCKASE, THEN ANY BENEFITS
ROM PURCHA ES OF HS PRODUCTS WITH THE CARD I EXCES OF THOSE BENEFITS IVEN
OR NON -HS URCHASES MUST ALSO BE TREATED AS DISCOJNT ANE SIMILARLY DI CLOSED.
2 HENRY 3CHEIN,INC. DISTRIBUTES THIS DRUG PRODUCr AS AUTHORIZED
ISTRIBUTOR OF RECORD FOR THE MANUFACTURER.
OUR ORDER 58014460 HAS BEEN SPLIT INTO MULTI LE SHI MENTS. CERTAIN ITEMT WILL
E SHIPPED 3EPARATELY. YOU WILL BE BILLED FOR THESE ITEMS WHEN THEY ARE HIPPED
MERCHANDI E TOTAL 832.26
INVOI E TOTAL 832.26
PLEASE PAY WITHIN THIRTY(3 DAYS OF RE EIPT OF THIS NVOICE. 832.26
PLEASE NOTE NEW REMIT TO ADDRESS
P lease remi payments only to the following a dress:
H ENRY SCHEI4 INC.
D EPT CH 10211
ALATINE, I 60055 -0241
BILL TO INVOICE# CUSTOMER PO# ITEM STATUS KEY REM KEY
13 4286679 MARK 11 Backordered: Item will follow SK School Kit
HZP T INVOICE DATE F BOXES D Discontinued: Item no longer available NC- No Charge
P- Special Schein Free Goods
M Manufacturer will ship Item directly to you
1817102 5/04/09 4 P- Prescription Drog: Return Authorization Required
R Refrigerated Item: May be shipped separately
Special Schein 11icing
U Temporarily unavailable: please reorder
832. 2 6 2 OF 2 T- Taxable Item
I
H ENRY CHEIN
Matrx Medical
F
0 17-
�:u'e cake e ven; effort to maintain prices for the duration of a Payment by CHECK or by the HENRY SC, EIN PLATINUM BUSINESS
cataioc, however, we reserve the right to make price adjustments in CARD, 4IISA, MASTERCARD, DISCOVER and AMERICAN EXPRESS
response to manufacturers price changes
i Yaa'8wi,p N mV
Guaranteed Satisfaction:
or 1
It vCU have tried a Prod: and it is defective or does not perf orm a` i ;F'' T t 0 r. s A c, U n t
satisfac we wig provide a cr?"l refund, or exchange; Its your b e C a c
choice. fir p`yr call our customer service department within 3u lays Avails ii ease Pr s in the U., All invoice, are
of receipt of the merchandise to arrange for the return. Fora pays l ,�i :rt uay
y;- arranty= re;air or if yoat were sent something y ou did not order
simply cal(; Rx Products controlled Substances;
Matra Medical 1-800-845-3550
Re:°a l aliens require us to limi the sale of Rx and ontrofleal
r JuDstance on11� to reg stl.�, d(., lk ice' l eC''s i iC :a e -1c�D ::E fail.
s, you are v ilv','i CllStofTter G P=ave recenrl,- rnc; ed, Diease t irn;sh
us l� a colt' of your updated state reyis`:ration. For controlled
su ;stances, furnish a copy of your [)FA certificate, verifying you<
shipping address. C ass it drugs can be ord erer only b` mall.
International Orders:
P
p h--8-5p- to
We prn idly serve hea "hcare professionals and cover ni
Opened handp leces and euuipment may no be returned for thr 7i! �Ut the word. To place orders or fo 3 :�Lir eS on expo, vreui but 'll be repaired or replaced in a,coru3nf.:B with g J n n.- n r r
manutactur:-r ak�arrant es, Before opening Ilan ;pieces or
terms an(J ,ondi': p1nasE ontac our i, :ernationa C7;,.anment
equipment, we suggest that you check the shipping container
any Packing list to verify that you have received exactly what Prescription Drug Returns Instructions:
you ordered,Opened Computer Software is not returnable.
{ether restrictions may also apply.
A Heturn Authori?a €ion is Required for a l Frescribticn Drags. Simply call
our C ustome' Se. is �e Departs ent l 3550,
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))
47075 -01 $128.00
4286679 -01 $832.26
2269050 -01 $17.62
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 NO.
ALLOWED 20
Henry Schein
IN SUM OF
Dept Ch 10241
Palatine, IL 60055
$977.88
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1120 47075 -01 102 390.11 $128.00 I hereby certify that the attached invoice(s), or
1120 4286679 -01 102 390.11 $832.26 bill(s) is (are) true and correct and that the
1120 2269050 -01 102 390.11 $17.62
materials or services itemized thereon for
which charge is made were ordered and
received except
MAY 112000
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
HENRY SCI IEIN
i cal SHIP TO:
City Of Carmel Police Dept MI
I1 \I tl IC E 3 Civic Sq
Carmel,IN 46032 -2584
135 Duryea Road, Melville, NY 11747
�100002249758�25426471 ,1,001000000�19360D417090 BILL TO:
City Of Carmel Police Dept MI
3 Civic Sq
Carmel, IN 46032 -2584
City Of Carmel Police Dept MI
3 Civic Sq
Carmel IN 46032 -2584 BILL TO INVOICE TOTAL
2249758 193.60
INVOICE# INVOICE DATE
2542647 -01 4/17/09
CUSTOMER PO# SHIP TO
20105 2249759
WHSE DEA# Fed ID: 11-3136595
�*c�[r 131 sZO �I iIieP .,y _.a aa. ,ra
6 a •a,# fir. 1
T his order ias been processed by our NORTHEAS D.C.
41 WEAVER ROAD
DENVER, A 1751-7
IM BARLOW
O 20105
17 -571 -252
FAX 317-571-2512
1 644 -3135 5 /BX QUIKCLOT 25GM 5 5 38.72 193.60 1
HIS PRODUCC IS BEING SHIPPED FROM OUR MIDWES DISTR BUTIO CENTER.
F YOU ARE PARTICIPATING IN A DISCOUNT PROGRAM (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 N ACCO DANCE WITH DISCOUNT PROGRAM
RULES. UPOW DISCOUNT RECEIPT OR REDEMPTION, OU ARE RECEI ING OR WILL RECEIVE
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 STICH
EQUEST, SU H VALUE MUST BE DISCLOSED AS A DISCOUNT kGAINS1 THE PURCHASES THAT
ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN TH SE RECORDS. IF YOU WAVE
SED A HENR SCHEIN "HS") CREDIT CARD TO MAKE THIS PURCHASE, THEN ANY BENEFITS
ROM PURCHA ES OF HS PRODUCTS WITH THE CARD IT EXCES3 OF THOSE BENEFITS TIVEN
OR NON -HS PURCHASES MUST ALSO BE TREATED AS DISCOJNT ANE SIMILARLY DI CLOSED.
MERCHANDISE TOTAL 193.60
INVOI E TOTAL 193.60
BILL To INVOICE# CUSTOMER ITEM STATUS KEY REM KEY
2249758 2 5 4 2 6 4 7 01 20 105 l3 -Backordered: Item will follow SK School Kit
SH IP T E F D Discontinued: Item no loneer available NC -No Charge
1: Special Schein Free Goods
N1 Manufacturer will ship Item directly to y ou
2 2 4 9 7 5 9 4/17/09 1 1' prescription Drug: Return Authorization Required
R Refrigerated Item: May be shipped separately
INVOICE TOTAL PAGE# Special Schein Pricing
U Temporarily unavailable: please reorder
193.60 1 OF 2 T T axable Item Continued on Next Page
AH
ENRY CNEIN
SHIP TO:
Matrx Med City Of Carmel Police Dept MI
3 Civic
INVOIC Carmel,IN
46032 -2584
135 Duryea Road, Melville, NY 11747
0100002249758025426471 ,10010000000],93600417090 BILL TO:
City Of Carmel Police Dept MI
3 Civic Sq
Carmel, IN 46032 -2584
City Of Carmel Police Dept MI
3 Civic Sq BILL TO INVOICE TOTAL
Carmel, IN 46032 -2584
2249758 193.60
INVOICE# INVOICE DATE
2542647 -01 4/17/09
CUSTOMER PO# SHIP TO
20105 2249759
Please detach here and mail the above with your payment
WHSEDEA# Fed ID: ll- 3136595
N '...z3lg?`�,✓.�..e ak u S. .ig c w.?g.� ..rs.E.§s:.?c Lk`. t ;?6�, awe„
PLEASE PAY WITHIN THIRTY(3 DAYS OF RECEIPT OF THIS INVOICE. 193.60
LEASE NOTE NEW REMIT TO ADDRESS
lease remi payments only to the following a dress:
ENRY SCHEI4 INC.
DEPT CH 10211
ALATINE, I 60055 -0241
BILL TO INVOICE# CUSTOMER PQ# ITEM STATUS KEY REM KEY
2249758 2542647 -01 20105 13- Backordered: Item will follow sK- Sehool-- it
HIP T I E ATE F BOXES D Discontinued: Item no longer avail NC -No Charge
P Special Schein Free Goods
M Manufacturer will ship item directly to you
2249759 4/ 17 0 9 1 P Prescription Drug: Return Authorization Required
R Refri Berated Item: May be shipped separately
Special Schein Pricing
U Temporarily unavailable: please reorder
193.60 2 OF 2 T- Taxable hem
H ENRY SCHEIN
Matrx Medidai 1 ��"RM 0 A
11.11.111 :1,1''1'1,._1
H I ta
We make ever=; effort to maintain prices for the dflurafiorl of a Payment by CHECK or by the HENRY SCHEIN PLA TINUUI BUSINESS
Catalog. however, we reserve the right to make price adjustments in CARD, VISA, MASTERCARD, DISCOVER and AMERICAN EXPRESS
response to manufacturers' price changes
4 YtNm Buftnesa N
fi Rcft i @y
Guaranteed Satisfaction:
If you have tried a product and it is defective or does not perform OC
ff Y O rd e r r_ Acco u n t
satisfactorily, Vote will provide a credit, refund, or exchange its your n; c f .0 n
choice. simply call our customer service department within 3u days
Availed e o license Practition tion in ftt J fall i nvoic e s are
p 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
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 are a new customer or have recently moved, please furnish
us with a copy of your updated slate registration. For controlled
sucstances, furnish a code of your Dr--A certificate, verifying your
shipping address. Class II drugs can be ordered only by mail.
International Orders:
Plva.c Note:
We proudly serve hea ^care prof°esS onals and y7vgrnm2n °S
Dpened handpieces and equipment may not be returned for throughout the world To place o "bets or for
inquires t n export
Credit, bill ,kd,l be repaired or replaced in accordance with
manufacturer wan"ant es. Before opening handpieces or terms any ccndit cns, p. as cone ar International Departr,E r;:_
equipment, we sugu„ s. hat you check the shipping container
and Decking list to verity 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 call
our Customer Se vic. Depart uv3i -845-3550,
g
4 r �..t y .rz� 4�;.u,_ �`l`� ai l a r-=F ri
;4
by .xw...s. ......�.�LV.G.,m<_.:,:a. a....,,_,z.
LP300
°a INDIANA RETAIL TAX EXEMPT PAGE C it y f C rme I CERTIFICATE NO.003120155 002 0 CL� 1i PURCHASE ORDER NUMBER
Police Department FEDERAL EXCISE TAX EXEMPT
35- 60000972 2010
3 g_ E,CIVIC SQUARE EHISN BER MUST APPEAR ON INVOICES, A/P
CARMEL INDIANA 46032 -2584 DELIVERY MEMO
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL 1997 LABELS AND ANY CORRESPONDENCE.
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
April 16.2009 Quick Clot
VENDOR Henry Schein Matrx Medical SHIP City of Carmel Police Department
1-x+0 Crouch Commercial Court TO 3 Civic Square
Irmo, '�Q_ 2906.3 Carmel, IN 46002
ATTN: Julie Baker ATTN: Major Jim Barfiow
CONFIRMATION BLANKET CONTRACT PAYMENTTERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
5 6443135 QuikClot 25gm ZMEDIC Z- Medica Corp 38.72 193.60
a
a q s� e}° 9a
t
F
e
6
City of Carmel Pot e ir,
PIP
Send Invoice To:�'
ATTN: Teresa Anders /7
3 Civic Square`
Carmel, IN 46032
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT I PROJECT I PROJECT ACCOUNT AMOUNT
1110 390 -12 medical supplies PAYMENT
A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
SHIP REPAID.
THIS APPROPRIATION SUFFICIENT TO PAY F OR THE ABOVE ORDER.
C.O.D. SHIPMENTS CANNOT BE ACCEPTED.
PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY
SHIPPING LABELS.
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE Chief of Police
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
..J 10 CLERK- TREASURER
F CUMENT CONTROL NO. A COPY SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO.__ WARRANT NO,-
ALLOWED 20
IN THE SUM OF
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or INVOICE NO, ACCT #/TITLE AMOUNT
DEPT. I 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
receivedexcept
20
Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
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
Henry Schein Matrx MEdical Purchase Order No. 20105F
135 Duryea Road Terms
Melville, NY 11747 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
4/17/09 254264701 Payment for quick clot 193.60
Total
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
VQUCHER NO. WARRANT NO.
ALLOWED 20
H enry Schein Matrx Medical IN SUM OF
135 Duryea Road
Melville, NY 11747
193.60
ON ACCOUNT OF APPROPRIATION FOR
p olice genera lfund
Board Members
Po# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
20105F 254264701 390 -12 193.60 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
Mav 6 20 09
Signature
Chief of Police
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund