169460 03/04/2009 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1
(9, ONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: $837.50
CARMEL, INDIANA 46032 DEPT CH 10241
PALATINE IL 60055 -0241 CHECK NUMBER: 169460
Al CHECK DATE: 3/4/2009
DEPARTMENT ACC OUNT PO NUMBER INVO NUMBER AMOUNT DESCRIPTION
1120 4239011 2221284 -01 212.00 SPECIAL DEPT SUPPLIES
1120 4239011 2550326 -01 143.50 SPECIAL DEPT SUPPLIES
1120 4239011 2550326 -02 7.00 SPECIAL DEPT SUPPLIES
1120 4467006 3533353 -01 475.00 EMS EQUIP
WHSE DEA# Fed ID: 1 I- 3136595
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his order las been processed by our MIDWEST D.C.
5315 WES 74TH 3TREET
INDIANAP LIS,IN 46268
1 677 -9945 EA CYLINDER WRENCH METAL SZ SM 4 4 1.75 7.00 1
HIS PRODUCT IS BEING SHIPPED FROM OUR MIDWES DISTR BUTIO CENTER.
F YOU ARE 3 ARTICIPATING IN A DISCOUNT PROG (E.G. POIN S, GIFTS OR OTHER
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. UPO4 DISCOUNT RECEIPT OR REDEMPTION, 7 0U ARE RECEI ING OR WILL RECEIVE
OTICE OF T E DISCOUNT VALUE. FROM TIME TO TIME, MED CARE, MEDICAID, TRI ARE OR
THER PAYER MAY REQUEST INFORMATION REGARDING SUCH VALUE, PND UPON ANY S CH
R EQUEST, SU H VALUE MUST BE DISCLOSED AS A DISCOUNT AGAINSq THE PURCHASET THAT
E ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN THESE RECORDS. IF YOU RAVE
SED A HENR SCHEIN "HS CREDIT CARD TO MAKE THIS PURCHASE, THEN ANY B NEFITS
ROM PURCHA ES OF HS PRODUCTS WITH THE CARD IN EXCES3 OF T OSE BENEFITS IVEN
OR NON -HS DURCHASES MUST ALSO BE TREATED AS A DISCOJNT ANE SIMILARLY DI CLOSED.
MERCHANDI E TOTAL 7.00
INVOI E TOTAL 7.00
PLEASE PAY WITHIN THIRTY(3 DAYS OF RECEIPT OF THIS NVOICE. 7.00
BIL TO INVOICE4 CUSTOME
ITEM STATUS KEY REA1 KEY
1308571 2550326-02 MARK it Backordered: Item will follow SK School Kit
HIP TO INVOICE DATE OF B U Discontinued: Item no longer available NC -No Charge
h- Special Schein Free Goods
V1 Manufacturer will ship Item directly to you
130 2/12/09 1 P- Prescription Drug: Return Authorization Required
H I HER INVOICE TOTAL PA E R- Refrigerated Item: May be shipped separately
Special Schein Pricing
U -Temporarily unavailable: please reorder
1145220- 1 7.00 1 OF 2 T Taxable hem Continued on Next Page
L
WHSE DEA# Fed ID: 1 1- 3 136595
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T his order has been processed by our NORTHEAST D.C.
41 WEAVER ROAD
DENVER, A 175L7
1 226 -1824 48 /BX PEPTO BISMOL TABLETS CHERRY 2 2 5.50 11.00 2
HIS PRODUCE IS BEING SHIPPED FROM OUR MIDWES DISTR BUTIO CENTER.
2 891 -5261 EA ACLU -CHEK ADVANTAGE CARE KIT 2 2 64.50 129.00 1
3 677 -9945 EA CYLINDER WRENCH METAL SZ SM 6 2 1.75 3.50 2
ARTIAL SHIPMENT WILL SHIP AND INVOICE WHEN AVAILA LE.
HIS PRODUCE IS BEING SHIPPED FROM OUR MIDWES DISTR BUTIO CENTER.
4 565 -1031 100 /BX NITRILE PF GLOVE BLACK LARGE 1 1 0.00 0.00 1 NC
F YOU ARE PARTICIPATING IN A DISCOUNT FROG (E.G. POIN S, GIFTS OR 0 HER
PECIAL AWA DS "DISCOUNT WITH THIS PURCHASE YOU HAVE EARNED A CREDI TOWARD
GOODS OR S RVICES, RECEIVABLE OR REDEEMABLE IN ACCO DANCE WITH DISCOUNT PROGRAM
RULES. UPOF DISCOUNT RECEIPT OR REDEMPTION, yOU ARE RECEIVING 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 V LUE, P.ND UPON ANY S CH
EQUEST, SU H VALUE MUST BE DISCLOSED AS A DISCOUNT AGAINSI THE PURCHASET, THAT
ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RETAIN THESE RECORDS. IF YOU IIAVE
SED A HENR SCHEIN "HS CREDIT CARD TO MAKE THIS DURCHASE, THEN ANY BENEFITS
ROM PURCHA ES OF HS PRODUCTS WITH THE CARD II EXCES3 OF T OSE BENEFITS GIVEN
OR NON -HS URCHASES MUST ALSO BE TREATED AS A DISCOJNT AN SIMILARLY DI CLOSED.
BILL TO INVOICE# CUS TQM ETZ PO# ITEM STATUS KEY REM KEY
13 2 MARK B Backordcred: Item will follow SK School Kit
D Discontinued: Item no longer available NC -No Charge
HIP INV DATE F BOXES 1- Special Schein Free Goods
M- Manulacturer will ship Item directly to you
1308572 2 11 0 9 2
P Prescription Drug: Return Authorization Required
H I HER INVOICE TOTAL p E R Refrigera Item: May be shipped separately
Special Schein Pricing
114 5 2 2- 1 Taxable Item unavailable: please reorder
14 3. 5 0 1 O F 2 T-
Continued on Next Page
WHSE DEA# Fed ID: 11- 3136595
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his order ias been processed by our NORTHEAS D.C.
41 WEAVER ROAD
DENVER, PA 17517
1 111 -7983 EA SUCTION UNIT COMPACT 800ML 1 1 C 475.00 475.00 1
ASE GOOD I EM, MAY BE SHIPPED SEPARATELY.
F YOU ARE ARTICIPATING IN A DISCOUNT PROG (E.G. POIN S, GIFTS OR OTHER
PECIAL AWA DS "DISCOUNT WITH THIS PURCHASE YOU HAVE EARNED A CREDI TOWARD
GOODS OR S RVICES, RECEIVABLE OR REDEEMABLE N ACCORDANCE WITH DISCOUNT PROGRAM
i
RULES. UPO DISCOUNT RECEIPT OR REDEMPTION, OU ARE RECEI 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 V LUE, PND UPON ANY SIJCH
R EQUEST, SU H VALUE MUST BE DISCLOSED AS A DISCOUNT %GAINSI THE PURCHASEI THAT
E ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN THESE RECORDS. IF YOU IJAVE
SED A HENR SCHEIN "HS") CREDIT CARD TO MAKE THIS DURCHASE, THEN ANY BENEFITS
ROM PURCHA ES OF HS PRODUCTS WITH THE CARD Il EXCES3 OF THOSE BENEFITS TIVEN
OR NON -HS URCHASES MUST ALSO BE TREATED AS DISCO3NT ANE SIMILARLY DISCLOSED.
MERCHANDISE TOTAL 475.00
INVOI E TOTAL 475.00
PLEASE PAY WITHIN THIRTY(31) DAYS OF RECEIPT OF THIS NVOICE. 475.00
LL TO INVOICE14 CUS ER 20# ITEM STATUS KEY REM KEY
13 3533353- MARK B Backordered: Item will follow SK School Kit
HIP INVOICE ATE F D Discnnunued: Item no longer available NC No Charge
P Special Schein Free Goods
M Manufacturer will ship Item directly to y ou
1308572 2/16/09 1 P- prescription Drug: Return Authorrr�tion Required
HSI R Refrigerated Item: May he shipped separately
NUMBE Special Schein Pricing
U Temporarily unavailable: please reorder
1145220- 1 475.00 1 OF 2 T Taxable Item Continued on Next Page
WHSE DEA# Fed ID: 11-3136595
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MERCHANDI E TOTAL 143.50
INVOI E TOTAL 143.50
PLEASE PAY WITHIN THIRTY(3 DAYS OF RECEIPT OF THIS NVOICE. 143.50
LEASE NOTE NEW REMIT TO ADDRESS
P lease remi payments only to the following a dress:
ENRY SCHEII INC.
D EPT CH 10211
ALATINE, I 60055 -0241
BILL Tn INVO ICE11 CUSTOMER o ITEM STATUS KEY REM KEY
130 2S5 MARK 13 Rackordered: Item will follow SK School Kit
HIP T INVOICE DATE F BOXES Discontinued: Item no longer available NC -No Charge
P Special Schein Free Goods
NI Manufacturer will ship Item directly to you
13 08572 2/11/09 2 P- Prescription Drug: Return Authorization Required
R Refrigerated Item: May be shipped separately
M B ER INVOICE TOTAL PAGE Special Schein Pricing
114 5 2 2 0— 1
143.50 2 O F 2 T- TaxablTemporarily unavailable: please reorder
I tem
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tI 'fit Tll rrris:
We make every effort to maintain prices for the duration of a Payment by CHECK or by the HENRY SCHEIN PLATINUM BUSINESS
catalog, holivever. we reserve the right to make price adjustments :n CARD, V ISA, MASTERCARD, 1SCOVE' and AMERICAN EXPRESS
response to manufacturers p°ce changes
Y 6uetm Numb
Guaranteed Satisfaction: z
If you have tried a product and it is defective or does not perform or
satisfactorily, we will provide a credit. refund, or exchange; it's your Bill Ordeffo Your Operi Account
choice, Simply our customer ser ice depa tment v,ithin 30 cla is Availao e to licensed practitioners is the J.S. Al' invoices are
P y Nayable within 30 days.
of receipt of the merchandise to arrange for the return. For a
warranty repair or it 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 fumish
us with a copy of your updated state registration. For controlled
substances, furnish a copy of your DEA certificate, verifying your
shipping address. Class 11 drugs can be ordered only by mail,
International Orders:
Ol-ase 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 w'll be repaired or replaced in accordance with
manufacturer warranties. Before opening handpieces or terms and conditions, please contact our International Department:
equipment, we suggest that you check the shipping container 1-800-8495-3D50
and packing list to verify that you have received exactly :.ghat 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- 3'350.
Z;�ti..2�9'�.,<,.z,'._z.au'„ �5;, a., m.»ab lu K'.«i...�Y
WHSE DEA# Fed ID: 11- 3136595
F
his order las been processed by our NORTHEAS D.C.
41 WEAVEZ ROAD
DENVER, A 1751-7
RK 317-423-8784
1 507 -8362 RX 100 /BX NACL PREFILL SYRINGE 4 4 53.00 212.00 1
2 PEDIGR E ITEM.
DC:0638070 010
F YOU ARE ARTICIPATING IN A DISCOUNT PROGRAM (E.G. POIN S, GIFTS OR OTHER
PECIAL AWARDS "DISCOUNT WITH THIS PURL SE YOU HAVE EARNED A CREDII TOWARD
GOODS OR SERVICES, RECEIVABLE OR REDEEMABLE IN ACCO DANCE WITH DISCOUNT PROGRAM
RULES. UPO4 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 VALUE, PND UPON ANY S CH
EQUEST, SU H VALUE MUST BE DISCLOSED AS A DISCOUNT kGAINSI THE PURCHASE THAT
EARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN THESE RECORDS. IF YOU VE
SED A HENR SCHEIN "HS CREDIT CARD TO MAKE THIS URCHA E, THEN ANY B1
ROM PURCHA ES OF HS PRODUCTS WITH THE CARD III EXCES OF T OSE BENEFITS IVEN
OR NON -HS DURCHASES MUST ALSO BE TREATED AS A DISCOJNT ANE SIMILARLY DISCLOSED.
2 HENRY CHEIN,INC. DISTRIBUTES THIS DRUG PRODUC AS AUTHORIZED
ISTRIBUTOR OF RECORD FOR THE MANUFACTURER.
MERCHANDI E TOTAL 212.00
IN' E TOTAL 212.00
BILL TO INVOICEff CUSTOMER PO# ITEM STATUS KEY REM KEY
1308571 2221284-01 MARK B Backordered: Item will follow sK School Kit
SH IP T INVOICE DATE 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 2/17/09 1 P P rescription Drug: Return Authorization Required
R Refrigerated Item: May be shipped separately
H I LMBER INVOICE TOTAL PA Special Schein Pricing
U Temporarily unavailable: please reorder
114 5 2 2 0 3 212. 00 1 OF 2 T Taxable Item Continued on Next Page
L
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))
3533353 -01 Suction Unit $475.00
2221284 -01 EMS Supplies $212.00
2550326 -01 EMS Supplies $143.50
2550326 -02 EMS Supplies $7.00
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. WARRANT NO.
ALLOWED 20
Henry Schein
IN SUM OF
Dept Ch 10241
Palatine, IL 60055
$837.50
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1120 3533353 -01 102 670.06 $475.00 I hereby certify that the attached invoice(s), or
1120 102- 390.11
bills) is (are) true and correct and that the
1120 2221284 -01 102 390.11 $212.00
materials or services itemized thereon for
1120 2550326 -01 102 390.11 $143.50
1120 2550326 -02 102 390.11 $7.00 which charge is made were ordered and
received except
MAR 2 2009
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund