168508 02/04/2009 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: $1,401.14
PALATINE IL 60055 -0241 CHECK NUMBER: 168508
CHECK DATE: 2/4/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION T
102 4239011 6959232 -01 1,360.54 SPECIAL DEPT SUPPLIES
102 4239011 7081096 -01 40.60 SPECIAL DEPT SUPPLIES
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t t
WHSE DEA# Fed ID: 11-3136595
s /..rte x.:a ec a._e€ ._�_vnr,', ..$s,..c r cgs o o
his order ias been processed by our NORTHEAS D.C.
41 WEAVEZ ROAD
DENVER, A 175L7
1 153 -2007 20 /RL BIOHAZARD BAG 14.5X19 RED 3GAL 20 20 C 2.03 40.60 2
ASE GOOD I EM, MAY BE SHIPPED SEPARATELY.
CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1
ONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: $1,401.14
CARMEL, INDIANA 46032 DEPT CH 10241
MiIOM PALATINE IL 60055 -0241 CHECK NUMBER: 168508
CHECK DATE: 2/4/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBE AMOUNT DESCRIPTION
102 4239011 6959232 -01 1,360.54 SPECIAL DEPT SUPPLIES
102 .4239011 7081096 -01 40.60 SPECIAL DEPT SUPPLIES
NM I-
e
t
R Refri Item: May he shipped separately
H I BE Special Schein pricing'
U Temporarily unavailable: please reorder
114 5 2 2 0- 3 40.60 l OF 2 T- Taxable ttem Continued on Next Page
j
u
WHSE DEA# Fed ID: 11- 3136595
This order ias been processed by our NORTHEAS D.C.
41 WEAVER ROAD
DENVER, A 175L7
vlARK 317-423-8784
1 891 -5261 EA ACCU -CHEK ADVANTAGE CARE KIT 2 2 64.70 129.40 5
2 555 -1166 PU EA PROTECTIV ACUVNC SFT CATH 18X1.25 100 100 2.64 264.00 7
HIS PRODUCC IS BEING SHIPPED FROM OUR MIDWES DISTR BUTIO CENTER.
3 220 -1398 3 /ST BODY STRAP SET DISP YELLO W 100 100 4.95 495.00 5
4 338 -2276 PU 100 /CA EXTENSION SET STD BORE UL 1 1 C 224.26 224.26 6
HIS PRODUC IS BEING SHIPPED FROM OUR MIDWES DISTR BUTIO CENTER.
ASE GOOD I EM, MAY BE SHIPPED SEPARATELY.
5 891 -3037 PU 50 /CA IV PREP KIT W/ TEGADERM 4 4 C 61.97 247.88 4
ASE GOOD I EM, MAY BE SHIPPED SEPARATELY.
F YOU ARE PARTICIPATING 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 SERVICES, RECEIVABLE OR REDEEMABLE IN ACCO DANCE WITH DISCOUNT PROGRAM
RULES. UPON DISCOUNT RECEIPT OR REDEMPTION, OU ARE RECEI ING OR WILL RECEIVE
OTICE OF THE DISCOUNT VALUE. FROM TIME TO TI E, MEDICARE, MEDICAID, TRI ARE OR
P THER PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, D UPON ANY S CH
EQUEST, SU H VALUE MUST BE DISCLOSED AS A DI COUNT GAINS THE PURCHASES THAT
LL To INVOICE# CUSTOMER PO# ITEM STATUS KEY REM KEY
1308571 6959232-01 MARK 13 13ackordered: Item will follow SK School Kit
D Discontinued: Item no loneer available NC- No Charee
HIP TO INV I E DATE OF BOXES F Special Schein Free Goods
M Manufacturer will ship Item directly to you
1817102 1/15/09 7 P Prescription Drug: Return Authorization Required
K ReGigerated Item: May be .chipped separately
H I NUMBER INVOICE TOTAL PAGE# S Special Schein Pricing
U Temporarily unavailable: please reorder
1145220- 3 1360.54 l OF 2 T- Taxable Item Continued on Next Page
92 HENRY C HEIN
SHIP TO:
m
Matrx
INVOICE Carmel Fire Department MI
540 W 136 St
Station 46 Michael Kaufmann
135 Duryea Road, Melville, NY 11747 Carmel, IN 46032 -8806
0100001, 30857106959232110010000001360540115090 BILL TO:
Carmel Fire Dept MI
2 Civic Sq
Carmel, IN 46032 -7543
Carmel Fire Dept MI
2 C1V1C Sq BILL TO INVOICE TOTAL
Carmel, IN 46032 -7543
1308571 1360.54
INVOICE# INVOICE DATE
6959232 -01 1/15/09
CUSTOMER PO# SHIP TO
MARK 1817102
Please detach here and mail the above with your payment
WHSEDEA# Fed ID: 11-3136595
OWN
z
Mme
EARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN THESE RECORDS. IF YOU RAVE
USED A HENRC SCHEIN "HS CREDIT CARD TO MAKE THIS PURCHASE, THEN ANY B NEFITS
FROM PURCHA ES OF HS PRODUCTS WITH THE CARD IN EXCES3 OF THOSE BENEFITS TIVEN
OR NON -HS DURCHASES MUST ALSO BE TREATED AS DISCOJNT AN SIMILARLY DI CLOSED.
MERCHANDI E TOTAL 1360.54
INVOI E TOTAL 1360.54
PLEASE PAY WITHIN THIRTY(3 DAYS OF RE EIPT OF THIS INVOICE. 1360.54
LEASE NOTE NEW REMIT TO ADDRESS
lease remi payments only to the following a dress:
ENRY SCHEI 4 INC.
EPT CH 102:1
i PALATINE, i., 60055 -0241
ILL TO INVOICE INVOICE# CUSTOMER POO ITEM STATUS KEY r REM KEY
1308571 6959232-01 MARK 13 13ackordered: Item will follow SK School Kit
D Discontinued: Item no longer available NC -No Charne
AIP TO INVOICE DATE k QF BOXE F- Special Schein Free Goods
M Manufacturer will ship Item directly to you
1817102 1/15/09 7 P- Prescription Drug: Return Authorization Required
R Refrigerated Item: May he shipped separately
I NUMBER Special Schein Pricing
1145220— 3 1360.54 2 OF 2 T- Ta able Item unavailable: please reorder
TERMS O F
HENRY SCHEIN'
y� t; Teri
v e make every effortt to maintain prices forhe d oration o a Payment by CHECK or by the HENRY SCHEIN PLATINU44 BUSINESS
catalog, however, we reserve the right to make price adjustments in GAR�1, VISA, MASTERCARD, DISCOVER and AMERICAN EXPRESS
response to manufacturers' pave changes
raw&nfireaa N �a@s�e,
i i S. �I�. VISA Ne �ro.." r Y•$ +.c
Guaranteed Satisfaction:
It you have tried a prodaci and i is detective or does not perform or
B ill Y ou n- Yo ur en
satisfacvi v e wil. provide a credit, refund, or exchange', it's your ce n er e I v e
AAvaila <o i practiti i,; th J.>s. All invoices ar.,
choi 5inip ?y call our customer ser>rice department with n 30 days payable within 30 datds.
of receipt of the merchandise to arrange for the return. For a
vxananty repair or if you were sent something you did rot order
simply call' Rx Products Controlled Substances:
Matra Medical 1 -800- 845 -3550
Regulations require us to limit the sal: of Rx and controlled
substances only to registered licensed healthcare wrofessionals.
f you ar a neY c ustforne€ or have re cenily niveed, please [u-ish
us vJtn a cony of your updated State regis`ration. For controlled
substances, furnish a copy of your DEA certificate verifying your
shipping address. Glass it drugs can be orderer.= only by mail.
International Orders:
F ote:
We proudly serve heathcare protessionals and governrnents
Ooened undo ie eS and equ oment rnl v not be returned for t 1r: iinhu ^ut the 'fiiD "d. TO Place Orders Or fOr inquires on exp? n credit. bui .:i?! be repaired or replaced in accordance with oa ,in t:
hand terms an cond�tc ;r~s, our please c :�r' €art i nternat i ona l De,,,�rtriEU.i
manufacturer vvarranties. Before opening 1 piece's or
1-800-84:)-35 50
equipment, vale suggest that you of 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.
r'y Return Authorization is Required for all Prescription Drugs. Simply ca
r a. a Departme
oG Iustcrn r itiiC
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))
6959232 -01 EMS Supplies $1,360.54
7081096 -01 EMS Supplies $40.60
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
$1,401.14
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1120 6959232 -01 102 390.11 $1,360.54 1 hereby certify that the attached invoice(s), or
1120 7081096 -01 102 390.11 $40.60 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
FEB 2 2009
rC)i
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund