170425 04/01/2009 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1
0 ONE CIVIC SQUARE HENRY SCHEIN INC
CARMEL, INDIANA 46032 DEPT CH 10241 CHECK AMOUNT: $1,980.83
PALATINE IL 60055 -0241 CHECK NUMBER: 170425
CHECK DATE: 4/1/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4239011 6515751 -01 77.50 SPECIAL DEPT SUPPLIES
.M.1120 4239011 6523591 -01 1,344.43 SPECIAL DEPT SUPPLIES
;,,1120 4239011 6523591 -02 558.90 SPECIAL DEPT SUPPLIES
WHSE DEA# Fed ID: 11- 3136595
K 4 A i s a ,'.fit
his order has been processed by our MIDWEST D.C.
5315 WES 74TH TREET
INDIANAP LIS,IN 46268
vIA RK 317-423-8784
1 555 -5396 PU EA PROTECTIV ACUVNC SFT CATH 20X1.25 207 207 2.70 558.90 2
HIS PRODUC IS BEING SHIPPED FROM OUR MIDWES DISTR BUTIO CENTER.
F YOU ARE ARTICIPATING 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 SERVICES, RECEIVABLE OR REDEEMABLE N ACCO DANCE WITH DISCOUNT PROGRAM
RULES. UPO4 DISCOUNT RECEIPT OR REDEMPTION, VOU ARE RECEI ING OR WILL RECEIVE
OTICE OF T E DISCOUNT VALUE. FROM TIME TO TI E, MEDICARE, MEDICAID, TRI ARE OR
THER PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, PND UPON ANY S CH
EQUEST, SU H VALUE MUST BE DISCLOSED AS A DISCOUNT %GAINS1 THE PURCHASES THAT
ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RETAIN THESE RECORDS. IF YOU RAVE
SED A HENR SCHEIN "HS") CREDIT CARD TO MAKE THIS URCHA E, THEN ANY BENEFITS
ROM PURCHA ES OF HS PRODUCTS WITH THE CARD III EXCES3 OF T OSE BENEFITS G3IVEN
OR NON -HS URCHASES MUST ALSO BE TREATED AS DISCOJNT ANE SIMILARLY DI CLOSED.
MERCHANDI E TOTAL 558.90
INVOI E TOTAL 558.90
PLEASE PAY WITHIN THIRTY(3 DAYS OF RECEIPT OF THIS INVOICE. 558.90
BILL TO INVOICE# CUSTOM PO# ITEM STATUS KEY REM KEY
1308571 6523591-02 MARK B Backordered: Item will follow SK School Kit
S HIP TO INVOICE DATE OF BOXES D Discontinued: Item no longer available NC No Charge
I Special Schein Free Goods
M Manufacturer will ship Item directly to you
1817102 3/17/09 2 1' Prescription Drug: Return Authorization Required
R Rclrigerated Item: May be shipped separately
I NUMBER INVOICE TOTAL P E Special Schein Pricing
U Temporarily unavailable: please reorder
1145220— 3 558.90 1 OF 2 T Taxable Item Continued on Next Page
WHSE DEA# Fed ID: 11- 3136595
This order has been processed by our NORTHEAS D.C.
41 WEAVER ROAD
DENVER, 3 A 1751.7
vIARK 317-423-8784
1 499 -0750 EA BP CUFF ECON ADULT RED 5 5 15.50 77.50 1
F YOU ARE 3ARTICIPATING IN A DISCOUNT PROG (E.G. POIN S, GIFTS OR O HER
PECIAL AWA DS "DISCOUNT WITH THIS PURCHASE YOU HAVE EARNED A CREDI TOWARD
GOODS OR SERVICES, RECEIVABLE OR REDEEMABLE N ACCO DANCE WITH DISCOUNT PROGRAM
RULES. UPOI DISCOUNT RECEIPT OR REDEMPTION, YOU ARE RECEI VING OR WILL R CEIVE
OTICE OF TIE 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 AGAINSI THE PURCHASES THAT
EARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN THESE RECORDS. IF YOU IIAVE
SED A HENR SCHEIN "HS CREDIT CARD TO MAKE THIS PURCHASE, THEN ANY BENEFITS
ROM PURCHA ES OF HS PRODUCTS WITH THE CARD IN EXCES OF THOSE BENEFITS TIVEN
OR NON -HS DURCHASES MUST ALSO BE TREATED AS A DISCOJNT ANE SIMILARLY DISCLOSED.
MERCHANDISE TOTAL 77.50
INVOI E TOTAL 77.50
PLEASE PAY WITHIN THIRTY(3j) DAYS OF RECEIPT OF THIS NVOICE. 77.50
ILL TO INVOICE# CUSTOMER ITEM STATUS KEY REM KEY
1308571 6 515 7 51— 01 MARK R Backordered: Item will follow SK School Kit
p DATE F B D Discontinued: Item no longer available NC -No Charge
1= Special Schein Free Goods
M Manufacturer will ship Item directly to you
1308572 3/10/09 1 P- Prescription Drug: Return Authorization Required
R Refrigerated Item: May be shipped separately
INVO ICE T Special Schein Pricing
114 5 2 2 0— 1 5 0 l O F 2 T- Taxable Item unavailable: please reorder
7 7.
L Continued on Next Page
WHSE DEA# Fed ID: 11- 3136595
This order ias been processed by our NORTHEAST D.C.
41 WEAVER ROAD
DENVER, A 175L7
RK 317-423-8784
1 890 -6868 3 /PK LIFEPAK 12 PAPER EKG 12 12 10.59 127.08 2
2 879 -8581 30 /PK MEDI -TRACE SNAP FOAM ELEC 530ECG 20 20 4.50 90.00 2
3 220 -1652 EA STIFNECK SELECT COLLAR PEDI 20 20 C 5.75 115.00 1
ASE GOOD I EM, MAY BE SHIPPED SEPARATELY.
4 360 -1359 EA SAM SPLINT ORANGE /BLUE 36X4.25 25 25 6.75 168.75 2
5 555 -5396 PU EA PROTECTIV ACUVNC SFT OATH 20X1.25 400 193 2.70 521.10 3
ARTIAL SHI MENT WILL SHIP AND INVOICE WHEN AVAILA LE.
HIS PRODUCP IS BEING SHIPPED FROM OUR MIDWES DISTR BUTIO CENTER.
6 654 -5076 PU 50 /BX PROTECTIV ACUVANCE SAFETY 22GX1" 2 2 135.00 270.00 3
HIS PRODUCr IS BEING SHIPPED FROM OUR MIDWES DISTR BUTIO CENTER.
7 499 -0757 EA PROSPHYG CUFFED COTTON 5 5 10.50 52.50 2
F YOU ARE ARTICIPATING IN A DISCOUNT PROG (E.G. POIN S, GIFTS OR OTHER
PECIAL AWA DS "DISCOUNT WITH THIS PURL SE YOU HAVE RNED A CREDI TOWARD
GOODS OR S RVICES, RECEIVABLE OR REDEEMABLE N ACCO DANCE WITH DISCOUNT PROGRAM
BILL T ITEM STATUS KEY REM KEY
1308571 6523591-01 MARK B Backordered: Item will follow SK School Kit
TE XE D Discontinued: Item no longer available NC -No Charge
I' Special Schein Free Goods
M Manufacturer will ship Item directly to you
1817102 3/10/09 3 P Prescription Drug: Return Authorization Required
R Rcl'rigerated Item: May be shipped separately
I HER E TOTAL Special Schein Pricing
U Temporarily unavailable: please reorder
1145220— 3 1344.43 1 OF 2 T Taxable Item Continued on Next Page..........
HENRY SCHEIN
SHIP TO:
Matrx Medical INVOIC Carmel Fire Department MI
540 W 136 St
Station 46 Michael Kaufmann
135 Duryea Road, Melville, NY 11747 Carmel, IN 46032 8806
0100001308571065235911100 ],0000001344430310093 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 1344 "43
INVOICE# INVOICE DATE
6523591 -01 3/10/09
CUSTOMER PO# SHIP To
MARK 1817102
Please detach here and mail the above with your payment
WHSE DEA# Fed ID: 11- 3136595
P M 0
RULES. UPON DISCOUNT RECEIPT OR REDEMPTION, 'IOU ARE RECEI ING OR WILL RECEIVE
OTICE OF THE 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
R EQUEST, SU H VALUE MUST BE DISCLOSED AS A DISCOUNT kGAINSI THE PURCHASE THAT
E ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN THESE RECORDS. IF YOU ILAVE
SED A HENRC SCHEIN "HS") CREDIT CARD TO MAKE THIS DURCHASE, THEN ANY BENEFITS
F ROM PURCHA ES OF HS PRODUCTS WITH THE CARD IN EXCES3 OF T OSE BENEFITS IVEN
OR NON -HS URCHASES MUST ALSO BE TREATED AS A DISCOJNT ANE SIMILARLY DI CLOSED.
MERCHANDI E TOTAL 1344.43
INVOI E TOTAL 1344.43
PLEASE PAY WITHIN THIRTY(3 DAYS OF RE EIPT OF THIS NVOICE. 1344.43
LEASE NOTE NEW REMIT TO ADDRESS
lease remi payments only to the following a dress:
ENRY SCHEI INC.
EPT CH 10211
ALATINE, I 60055 -0241
13I TO INVOICE# CUSTOMER 204 L TATUS TEM STATUS KEY REM KEY
1308571 6523591-01 MARK kordcred: Item will follow SK School Kit
ontinued: Item no longer available NC No Charge I NV I E A F ial Schein Free Goods nufacturer will ship Item directly to you 1 81710 2 3 10 0 9 3 cription Drug: Return Authorization Required rigerated Item: May be shipped separately NV I E TAL P E cial Schein Pricing
mporarily unavailable: please reorder 1145220- 3 1344.43 2 OF 2 xable Rem
wr+n�awle'S� i a tr�Ydi a I I I
HENRY SCHEIN
Matrx Medical T ERMS OF SALE
I
Paynnent T'enns,,
We snake 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: w
If you have tried a product and it is defective or does not performIt Your Order C'c�'Ic�r O A ccount
satisfactorily, 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 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:
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 yo u 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. Glass 11 drugs can be ordered only by mail.
International Orders:
Please Note.
Opened handpieces and equipment may not be returned for We proudly serve healthcare professionals and governments
Opened nl7 Y flu re en r L throughout the world. To place orders or for inquiries on export
Grad:., bi will bo r i,.,
v: _p!aced accordance with terms and conditicns, p °ease contact our international Department:
manufacturer warranties. Before opening handpieces or 1-800-845-3550
equipment, we suggest that you check the shipping container
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 call
our Customer Service Department 1 -800- 845 -3550.
M.
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))
6523591 -02 Misc. EMS Supplies $558.90
6523591 -01 Misc. EMS Supplies $1,344.43
6515751 -01 Misc. EMS Supplies $77.50
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 N O.. WARRANT NO.
ALLOWED 20
Henry Schein
IN SUM OF
Dept Ch 10241
Palatine, IL 60055
$1,980.83
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1120 6523591 -02 102 390.11 $558.90 1 hereby certify that the attached invoice(s), or
1120 6523591 -01 102- 390.11 $1,344.43
bills) is (are) true and correct and that the
1120 6515751 -01 1 102- 390.11 $77.50
materials or services itemized thereon for
which charge is made were ordered and
received except
MAR 20 200
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund