168997 02/17/2009 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1
1 j. ONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: $186.10
l CARMEL, INDIANA 46032 DEPT CH 10241
PALATINE IL 60055 -0241 CHECK NUMBER: 168997
CHECK DATE: 2/17/2009
DEPARTMENT ACCOUNT PO NUM INVOICE NUMBER AMOUNT DESCRIPTION
1120 4239011 13928840 -17.90 SPECIAL DEPT SUPPLIES
1120 4239011 6959997.01 99.00 SPECIAL DEPT SUPPLIES
1120 4239011 935699501 105.00 SPECIAL DEPT SUPPLIES
I
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WHSE DEA Fed ID: 1 1-3136595
W I N
1
s
s
r his order has been processed by our NORTHEAST D.C.
41 WEAVER ROAD
DENVER, A 175L7
1 250 -9611 EA ACLU -CHEK CONTROL COMFORT HI /LO 12 12 8.75 105.00 1
F YOU ARE PARTICIPATING IN A DISCOUNT PROG I (E.G. POINr1S, GIFTS OR 0 HER
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
RULES. UPO DISCOUNT RECEIPT OR REDEMPTION, OU ARE RECEI 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 V LUE, PND UPON ANY S CH
R EQUEST, SU H VALUE MUST BE DISCLOSED AS A DISCOUNT GAINSq THE PURCHASE THAT
E ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN THESE RECORDS. IF YOU 1 AVE
SED A HENR SCHEIN "HS CREDIT CARD TO MAKE THIS DURCHASE, THEN ANY B NEFITS
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 DISCOJNT ANE SIMILARLY DI CLOSED.
MERCHANDI E TOTAL 105.00
INVOI E TOTAL 105.00
PLEASE PAY WITHIN THIRTY(3 DAYS OF RECEIPT OF THIS NVOICE. 105.00
BILL TO INVOICE INVOICE# CUSTOMER P
ITEM STATUS KEY r RTE M KEY
1308571 9356995-01 MARK HUI ETT 1- Backordered: Item will follow SK School Kit
HIP T INVOICE HATE p B gE D Discontinued: Item no longer available NC -No Charge
F- Special Schein Free Goods
M Manufacturer will ship Item directly to you
13 08572 1/30/09 1 P- Prescription Drug: Return Authorization Required
R Refrigerated Item: May be shipped separately
H I BER INVOICE TOTAL PAGE# Special Schein Pricing
U Temporarily unavailable: please reorder
1145220- 1 105.00 1 OF 2 T Taxable Item Continued on Next Page..........
P
WHSE DEA# Fed ID: 11-3136595
x_ %.t y t`�`. 5.-
a a "µy.�c Y.1 s4 g® si,.
his order ias been processed by our NORTHEAS D.C.
41 WEAVER ROAD
DENVER, A 17517
17- 428 -878
V[A RK HUIETT
1 954 -4202 1 /CA ACCU -CHEK GO CONTROL SOL. 2LEVEL 12 12 8.25 99.00 1
F YOU ARE ARTICIPATING IN A DISCOUNT PROG
4
(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. UPON DISCOUNT RECEIPT OR REDEMPTION, IOU 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 V LUE, PND UPON ANY STICH
R EQUEST, SU H VALUE MUST BE DISCLOSED AS A DI COUNT GAINSq THE PURCHASES THAT
E ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN THESE RECORDS. IF YOU RAVE
SED A HENR SCHEIN "HS CREDIT CARD TO MAK THIS DURCHASE, THEN ANY BENEFITS
F ROM PURCHA ES OF HS PRODUCTS WITH THE CARD II EXCES3 OF T OSE BENEFITS TIVEN
OR NON -HS DURCHASES MUST ALSO BE TREATED AS DISCO3NT ANE SIMILARLY DI CLOSED.
MERCHANDI.E TOTAL 99.00
INVOI E TOTAL 99.00
PLEASE PAY WITHIN THIRTY(3 DAYS OF RECEIPT OF THIS INVOICE. 99.00
BILL TO CU S TOMER PQ# ITEM STATUS KEY REM KEY
130 6959997 MARK B- Backordered: Item will follow SK School Kit
D Discontinued: Item no longer available NC No Charge
S HIP TO INVOICE DATE OF BOXES P- Special Schein Free Goods
M Manufacturer will ship Item directly to you
1308572 1/23/09 1 P- Prescription Drug: Return AuthoriiAtion Required
R Refrigerated Item: May be shipped separately
H I NTNBER TNVOICE TOTAL PAGE# S Special Schein Pricing
U Temporarily unavailable: please reorder
1145220 1 99.00 1 OF 2 T- Taxable Item Continued on Next Pa =e
,t w', zx�.. 3.r� i�
1 1533144 20 /Rl Infectious Waste Bag Red ll "x14.25" 10 6009591 1.79 17.90
01/23/09 Order 6231425 1.000 MARK-
Credit amount 17.90
Sub Net Total 17.90
Total' Credit. 17.90
aaE.
a`
ACCOUNT TOTAL CREDIT
1308571 17.90
CREDIT MEMO# CREDIT MEMO DATE
13928840 01/23/09
PAGE CREDIT APPLIED TO
1 of 1 Account
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))
13928840 CREDIT ($17.90)
6959997 -01 EMS Supplies $99.00
9356995 -01 EMS Supplies $105.00
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 Scoein
IN SUM OF
Dept 'Ch 10241
Palatine, IL 60055
$186.10
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1120 13928840 102 390.11 4 ($17.90) 1 hereby certify that the attached invoice(s), or
1120 6959997 01 102 390.11 $99.00 bill(s) is (are) true and correct and that the
1120 1 9356995 01 1 102 390.11 $105.00
materials or services itemized thereon for
which charge is made were ordered and
received except
CCR 1 3
a
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund