207087 03/13/2012 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1
ONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: $481.14
CARMEL, INDIANA 46032 DEPT CH 10241
PALATINE IL 60055 -0241 CHECK NUMBER: 207087
CHECK DATE: 3/13/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 4239011 3463917 -01 481.14 SPECIAL DEPT SUPPLIES
MHENRY ScHEIN (1-9
SHIP TO /SOLD TO:
EMS Carmel Fire Department MI
135 Duryea Road, Melville, NY 11747 INVOICE 540 W 136 St
Station 46 Michael Kaufmann
Carmel,IN 46032 -8806
0100001 30857103463917110010000000481 ,140221,127 BILL TO:
Carmel Fire Dept MI
2 Civic Sq
Carmel, IN 46032 -7543
Carmel Fire Dept MI
2 Civic .Sq BILL TO SHIP TO I INVOICE AMOUNT
Carmel, IN 46032 -7543
1308571 1817102 481.14
INVOICP# INVOICE DATE
3463917 -01 2/21/12
CUSTOMER PO
MARK
please detach here and mail the above with your payment
HSI. ORDER ORDER DATE' DUE DATE
98176875 02/21/12 03/22/12
WHSE DEA# RHO162494 Fed ID: 1 I- 3136595
LEASE NOTE NEW REMIT TO ADDRESS
Please remi payments only to the following address:
ENRY SCHEI INC.
EPT CH 102U
ALATINE, I 60055 -0241
BII,L —INVO C INVOICE: AMOUNT ITEM STATUS KEY REM KEY
1308571 1817102 3463917-01 4 81.14 H Backordered. Item will follow SK School Kit
D R ORDER: D DATE D Discontinued; Item no longer available NC No Charge
HSI I' Special Schein Free Goods
M Manufacturer will ship Item directly to you
98176875 02/21/12 2/21/12 7 P- Prescription Drug: Return Authorization Required
R Refrigerated Item; Nlay be shipped separately
CUS TOMER PO
Special Schein pricing
U 'remporarily unavailable; please reorder
MARK 2 OF 2 T- Taxable Item
H E NRY SCHEIN�
ENDS O SA
LE
Payment Terms.
We make event effor to maintain prices for the duration: of a payment by CHECK or by the HENRY SCHEIN CREDIT CARD,
catalog, l owever, "Ne reserve the right to make price adjustments in VISA, MASTERCARD DISCOVER and AMERICAN EXPRESS
response to manufacturers' price changes
Guaranteed Satisfaction:
If you have tried a pro duct and it is defective or does n perform (i Your Order To Your Open Account
satisfactorily, we will provide a credit, refund, or exchange; it's your Available to licensed practitioners in the U.S. AlI invoices are
choice. Simply tall our customer service departs ent w ithin 30 days
of receipt of the rnerchan disc to arrange for the return. Fora payable within 30 days,
warranty repair or if you were sent something you di =d 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 onily to registered, licensed healthcare professionals.
If you are a new customer or have recently molted, please furr is h
us with a copy of your updated state registration. For controlled
substances, furnish a copy of your DEA certificate, verifying your
shipping address. Class tl drugs can be ordered only by mail.
International Orders:
Please Note:
We proudly serve healthcare professionals and governments
Opened handpieces and equipment may not be returned for throu the world. e place orders or for ir'quires on export
credit but will be repaired or replaced in accordance avith terms and conditions, please contact our Inrernatianal Depadment:
manufacturer ,warranties. Before opening handpiece s or 1 800 84 3550
equipment, "'o si,=ggest tt at ymi check t he shipping container
and packing list to verif 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 Prescrption Drugs. Sir ply call
our Customer Service Department 1- 800 -845 -3550.
r .a: Y..:. 1 ate. ��i. :�z
a
LP300
VOUCHER NO. WARRA N
ALLOWED 20
Henry Schein
IN SUM OF
Dept Ch 10241
Palatine, IL 60055
$481.14
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
1120 I 3463917 -01 102 390.11 $481.14 1 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
received except
MAR 12 2012
I Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
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))
3463917 -01 $481.14
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