208318 04/25/2012 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1
ONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: $3,944.64
CARMEL, INDIANA 46032 DEPT CH 10241
PALATINE IL 60055 -0241 CHECK NUMBER: 208318
CHECK DATE: 4125/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 4239011 1407289 -01 1,069.34 SPECIAL DEPT SUPPLIES
102 4239011 7150538 -01 46.30 SPECIAL DEPT SUPPLIES
102 4239011 9782287 -01 2,829.00 SPECIAL DEPT SUPPLIES
HSI ORDER ORDER DATE DUE DATE
99151783 03/27/12 04 2 6 1 2
WHSF DEA# 8140162494 Fed 11): 11-3136595
his order as been processed by our MIDWEST D.C.
5315 WES" 74TH 3TREET
INDTANAPOLTS,TN 46268
VIARK 317-423-8784
317-571-266
1 107-0501 100/BX PURPLE NITRILE PF GLOVE SMALL 10 10 C 8.45 84.50 1
C ASE GOOD ITEM, MAY BE SHIPPED SEPARATELY.
2 107 100/BX PURPLE NITRILE PF GLOVE MEDIUM 20 20 C 8.45 169.00 3
CASE GOOD IPEM, MAY BE SHIPPED SEPARATELY.
3 107 0530 30 100/8X PURPLE NITRILE PF GLOVE LARGE 60 60 C 8.45 507.00 9
GOOD I'EM, MAY BE SHIPPED SEPARATELY.
4 107 90/BX PURPLE NITRILE PF GLOVE X-LARGE 20 20 C 8.45 169.00 11
CASE GOOD TCEM, MAY BE SHIPPED SEPARATELY.
5 111 100/CA RAZOR STERILE SHAVE PREP 2 SIDED 2 2 C 30.50 61.00 13
CASE GOOD irEm, MAY BE SHIPPED SEPARATELY.
6 602-8100 EA COLLAR STIFNECK SELECT ADULT 100 100 C 5.95 595.00 15
CASE GOOD ITEM, MAY BE SHIPPED SEPARATELY.
7 935 50/PK BLUE SENSOR SP ELECTRODES 80 80 11.55 924.00 16
8 890 3/PK LIFEPAK 12 PAPER EKG 18 18 10.87 195.66 17
BILL TO SHIP TO INVOICE INVOICE AMOUNT I rnm S KEY C
1308571 1817102 9782287-01 2829.00 11 Backordered: 11cm will tollow SK School Kit
H ORDER ORDER DATE INVOICE DATE OF BOXES 1) Discontinued: 11cm no longer available NC- No Charge
4 F Special Schein Fn, Goods
N1 ManuJacturer will ship hem directly to you
99151783 03/27/12 3/27/12 17 P Prescription Ding: Return Authorization Requited
CUSTOMER PO4 PAGE# R Re1mcrated hem: May be shipped separately
Special Schein Pricing
U Tempomnly unavailable: please reorder
MARK 1 OF 2 T -Taxable bent Continued mi Next Page
ENTRY CE}
EMS SHIP TO /SOLD TO:
I V Carmel Fire Department MI
135 Duryea Road, Melville, NY 11747 540 W 136 St
Station 46 Michael Kaufmann
Carmel, IN 46032 -8806
01 00001308571097822871 ,10010000002829000327],28 BILL TO:
Carmel Fire Dept MI
2 Civic Sq
Carmel, IN 46032 -7543
Carmel Fire Dept MI
2 Civic S q BILL TO I SHIP TO INVOICE AMOUNT
Carmel, IN 46032 -7543
1308571 1817102 2829.00
INVOICE# INVOICE DATE
9782287 -01 3/27/12
CUSTOMER PO
l MARK
please detach here and mail the above with your payment
HSI ORDER# ORDER DATE DUE DATE
99151783 03/27/12 04/26/12
WHSE DEA# RH0162494 Fed ID: 11- 3136595
Nam F o AN
r
9 101 -5979 6 /BX CLOTH SURGICAL TAPE 2 "X10YD 16 16 7.74 123.84 17
F YOU ARE ARTICIPATING IN A DISCOUNT PROGRAM (E.G. POIN S, GIFTS OR OTHER
PECIAL AWA DS "DISCOUNT WITH THIS PURCHASE YOU HAVE EARNED A CREDIr I TOWARD
GOODS OR S RVICES, RECEIVABLE OR REDEEMABLE N ACCO DANCE WITH DISCOUNT PROGRAM
RULES. UPO DISCOUNT RECEIPT OR REDEMPTION, 'IOU ARE RECEI ING OR WILL RECEIVE
OTICE OF T E DISCOUNT VALUE. FROM TIME TO TI E, MED CARE, 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 DI COUNT GAINSI THE PURCHASES THAT
ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN THESE RECORDS.
MERCHANDI E TOTAL 2829.00
Invoice Date 30 days 2829.00
LEASE NOTE NEW REMIT TO ADDRESS
lease remi payments only to the following a dress:
ENRY SCHEI INC.
EPT CH 102 1
ALATINE, I 60055 -0241
BILL TO SHIP TO INVOICEft INVOICE AMOUNT ITEM STATUS KEY RENT KEY
1308571 1817102 9782287-01 2 8 2 9. 0 0 B Backordered: Item will follow SK School Kit
D Discontinued: Item no longer available NC -No Charge
H I ORDER ORDER DATE INVOICE DATE F BORE P- Special Schein free Goods
99151783 03/27/12 3/27/12 17 11 Ma will n e ut do y ou
I' Pitscription Drug: Return Authari nation Itcyuircd
R Refrigerated Item: May be shipped separately
CUS TOMER PO# PA E
Special Schein Pricing
U -Temporarily unavailable: please reorder
MARK 2 OF 2 'r Taxable hen,
9i HENRY SCHEIN""
EMS SALE
We make every effort to maintain prices for the duration of a Payment by CHECK or by the HENRY SCHEIN CREDIT CARD,
catalog, ho.. we reserve the right to make price adjustments in VISA, MASTERCARD, DISCOVER and AMERICAN EXPRESS
response to rnanufacturers' price changes
vzsa
Guaranteed Satisfaction: W
If you have tried a product and it is defective or does not perform# «rgr Yrrrr Oar curt
satis #actcrily, }e will provide a credit, refund, or exchange; it's your Available to licensed practitioners in the US. 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 you are a ne a storner or have recently moved, please furnish
Lis 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:
Please Note:
Opened handpieces an equipment may not be returned for We proudly serve healthcare professionals and governments
throughout the world. To place orders or for inquiries on export
credit, but will be repaired or replaced in accordance with
manufactt rer tvarranfies. Before opening handp eves or terms and conditions, please contact our International Department:
1-800 815 3350
equipment, :.le suggest that you check the shipping container
and packing list to verify that you have received exactly ,:hat Prescription Drug Returns Instructions:
you order ed.Opened tomputer Software is not returnable.
Other restrictions may also apply.
A Return Authorization is Required for all Prescription Drugs. Simply call
our Custorrter Service @1-800-845
GOMME
LP300
HSl ORDER# ORDER DATE LE
DUE DATE
99343670 04/04/12 0
WHSEDEA# RHO162494 Fed ID: 11-3136595
I R ININ ON -A
his order has been processed by our MIDWEST D.C.
5315 WES" 74TH STREET
INDIANAPOLIS,IN 46268
1 666 EA SHARP DISP.CONTAINER RED 18GA/EA 2 2 23.15 46.30 1
F YOU ARE ARTICIPATING IN A DISCOUNT PROGRAM (E.G. POINIS, GIFTS OR or HER
PECIAL AWA DS ("DISCOUNT")), WITH THIS PURCHASE YOU HAVE EARNED A CREDI TOWARD
GOODS OR SPRVICES, RECEIVABLE OR REDEEMABLE :N ACCOZDANCE WITH DISCOUNT PROGRAM
RULES. UPO4 DISCOUNT RECEIPT OR REDEMPTION, ARE RECEI ING OR WILL R CEIVE
OTICH OF TIE DISCOUNT VALUE. FROM TIME TO TIME, MED CARE, MEDICAID, TRI ARE OR
OTHER" PAYER MAY REQUEST 'INFORMATION REGARDING SUCH V LUE, PND UPON ANY SIJCH
REQUEST, SU VALUE MUST BE DISCLOSED AS A DI COUNT AGAINS I THE PURCHASES THAT
EARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN TH ESE RECORDS.
MERCHANDI E TOTAL 46.30
Invoice Date 30 days 46.30
PLEASE NOTE NEW REMIT TO ADDRESS
Please remi payments only to the following aidress:
HENRY SCHEI4 INC.
DEPT CH 10211
PALATINE, 1, 60055-0241
B ILL TO SHIP TO "•INVOICE I I W 0 ICE M 0 UN T ITEM STATUS KEY REM KEY
1308571 1817102 7150538-01 46.30 B liackordered: Item will follow SK School Kit
HSI ORDER# ORDER DATE INVOIC E D A T E OF F30XES 1) Discontinued: Item no longer available NC No Charge
F- Special Schein free Goods
M Manufacturer will ship Item directly to you
99343670 04/04/12 4/04/12 1 11 Prescription Drug: Return Authorization Required
CUSTOMER PO4 PAGE R Refrigerated Item: May be shipped separately
Special Schein Pricing
U Temporarily unavailable: please reorder
�P30PRK 1 OF 1 T Taxable hem
L
die make every rffo `'c naintai prices for the duration of a Payment by CHECK or by the HENRY SCI EIN CREDIT CARD,
rata: g, 1'o,Fie'ver, t:1 reserve th right to (Hake price adjust: E nts VISA, MASTERCARD, DISCOVER and AMERICAN EXPRESS
response to manufacturers' price changes
Guaranteed Satisfaction:
or
If .ou have tried a crcduc and it is defective or does not cerfo
Bill Yo Order o Your Open r o rat
satistac °drily, we will urov:de a credit, refund, or exchange: it's your vtai :ab.o to Ilc nsud raE.tit or:ers .r: t :E? U.� i
choice. Simply call our customer service de;aarImeN 4 hin '30 days p° es are
0': r 'i:ciut f the rT1B(4':ar':diSu' t o arrange for the re 'urn. For r a pay' with in �ii <zJ'S.
.;arrant- ;evair or it yon ;ere sera something you did not order,
s; ail: x Products Controlled Substances:
Matrx Medical 1 -800- 845-3550
Regulatio:'S rectuir:: us to limit the sale of 'fix and controlled
substances o r` to .registered, l ceased healthcare professionals.
If you are anew customer or have recently moved, please furs ish
us odth a copy of your updated state r0stragon. For controlled
substances, L,rnish a copy of your DEA certificate, verifying yo: r
shipping address, Class It drugs can be ordered only by °.rail.
International Orders:
Pleasc- Note:
Opened hand ;eces and e' moment ,a„ not to returned for vie proudly servo health :Care professionals and governments
k p E v throughout the world, o p ace orders cr for iF-g r es on export
credit tut wpYill be repaired or r f;laced in acccrdancE .i ifh terms an d conditions please contact our Inter��aJonal Department:
manufactu ?e r y ^.arranges.130ore opening ha dp eces or 1-800-845-355`0
equipment, we suggest that you check the shippi con fainer
and packing list to verify that you have received exactly: what
Prescription Drug Returns lrtstructions.
you ordered.Opened Computer Software is not returnable.
Other restrictions may also apply.
A iFlefurn Authorization is Required for all Prescription Drugs, Sin ply call
our 4ustomer Service Department 1- 800-845)-3550.
i�'a_"�;. ?�,„.°et gz aa''` fi ��,'�s"� ::i� k �>E x?,� 'a Y.. t,€ �:fi t' x I
LZ== 05 1 �O3 11
WHSE DEA# RHO162494 Fed ID: 11-3136595
000
w"
T
This order as been processed by our MIDWEST D.C.
5315 WES" 74TH STREET
INDIANAP LIS,IN 46268
IARK828-428-8784
1 555-5396 U EA PROTECTIV ACUVNC SFT OATH 20X1.25 150 150 2.73 409.50 11
2 555-1166 [U EA PROTECTIV ACUVNC SFT CATH 18X1.25 100 100 2.73 273.00 11
3 891-3037 U 50/CA IV PREP KIT W1 TEGADERM 4 4 C 62.19 248.76 4
ASE GOOD I MAY BE SHIPPED SEPARATELY.
4 153-.6483 250ML/BT STERILE WATER FOR IRRIG 250ML 48 48 C 1.15 55.20
N PEDIGREE ITEM.
2ASE GOOD IPEM, MAY BE SHIPPED SEPARATELY.
'4DC:0033800)402
5 496-6428 100/BX LANCET SURGILANCE GRAY 23G 1.8 3 3 10.96 32.88 11
6 499-0814 24/CA INSTANT WINTER COLD PK OD 4 4 C 7.25 29.00 10
GOOD ITEM, MAY BE SHIPPED SEPARATELY.
7 221-3973 3/PK GLUCOBURST GLUCOSE GEL 15GM 4 4 5.25 21.00 11
S OR 0 HER
IF YOU ARE ARTICIPATING IN A DISCOUNT PROG (E.G. POIN S, GIFT
SPECIAL AWA DS ("DISCOUNT")), WITH THIS PUR SE YOU HAVE RNED A CREDI TOWARD
IN S' GIFTS F
F ARE ARTI PA E RN ED D
I YOU C I TI' PO
3 PECIAL AWA DS "DISCOUNT ISCOI V
GOODS OR S RVICES, RECEIVABLE OR REDEEMABLE ACCO LD7ANCE WITH DISCOUNT PROGRAM
SHIP To 70�16
1 0 ITEM STATUS KEY FTREF-M
308571 71 181 02 1407 1 289-01 1069.34 11 Backordered: Item will follow SK School Kit
H
qRDER ORDE AT T
E DATE 4 OF BOXES 1) Discontinued: hem no longer available NC No Char
I' Special Schein Free Goods
3 9 3 0 5 14 0 04 4/03/12 11 M Manufaconer w-ill ship Item directl to you
11 prescription Dru Return Authorization Required
CUSTOMER PO PA R Reffterau,d Item: May be shipped separately
Special Schein pricin
U Temporarily unavailable: please reorder
MARK 1 OF 2 T Taxable Itcm Continued on Next Page
3300
HENRY SCH EIN@
EMS SHIP TO /SOLD TO:
I Carmel Fire Department MI
135 Duryea Road, Melville, NY 11747 540 W 136 St
Station 46 Michael Kaufmann
Carmel, IN 46032 -8806
0100001308571014072891 10010000001069340403120 BILL To:
Carmel Fire Dept MI
2 Civic Sq
Carmel, IN 46032 -7543
Carmel Fire Dept MI
2 Civic .SCI BILL TO I SHIP TO I INVOICE AMOUNT
Carmel, IN 46032 -7543 1308571 1817102 1069.34
INVOICE# INVOICE DATE
1407289 -01 4/03/12
CUSTOMER PO
MARK
Please detach here and mail the above with your payment
HSI`ORDER ..ORDER DATE: "DUE DATE`:
99305140 04/03/12 05/03/12
WHSE DEA# RHO] 62494 Fed ID: 11- 3136595
e b�.;
itl
RULES. UPO4 DISCOUNT RECEIPT OR REDEMPTION, OU ARE RECEI ING OR WILL RECEIVE
OTICE OF TIE DISCOUNT VALUE. FROM TIME TO TI E, MED CARE, MEDICAID, TRI ARE OR
O THER PAYER MAY REQUEST INFORMATION REGARDING SUCH VALUE, PND UPON ANY STICH
R EQUEST, SU H VALUE MUST BE DISCLOSED AS A DI COUNT GAINSI THE PURCHASES THAT
E ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN TH SE RECORDS.
N HENRY 3CHEIN, INC. HAS PURCHASED THE SPE IFIC U4IT OF THE PRESCRIPTION DRUG
DIRECTLY F OM THE MANUFACTURER.
MERCHANDI E TOTAL 1069.34
nvoice Date 30 days 1069.34
LEASE NOTE NEW REMIT TO ADDRESS
lease remi payments only to the following a dress:
ENRY SCHE14 INC.
EPT CH 10211
ALATINE, I 60055 -0241
SILL TO SHIP TO '`INVOICE 'INVOICE 'AMOUNT
ITEM STATUS KEY REM KEY
08571 181710 2 1407289-01 1069.34 li Backordered; Item will follow SK School Kit
I OR DER ORDER' DATE INVOICE DATE OF ES D Discontinued; Item no longer available NC- No Charge
Special Schein free Goods
Drug'. bt Item drectly ocd`
1 1� 1'n.xrip \ion Dcng'. Retum no\hornauon Rcyuimd
R RC(tigoc'a\cd 1 \cm'. Nlay he shipped scpaca�c \y
JeAGE .'rly $-Specia \Schein \ridng c
Taxable rein
C�S�OM�R 40
2oF2
MARK
N H ENRY SCREW
P
AL A-1111'ARI
EMS ERMS OF
1 4n, make c ever o`t n <flnf<;i Payment by r ri:;es for the durafior; of a
CHECK car y the HENRY SC`HEI CREDIT CARD
cataioa, I o ,e e Vr,e reserU -e 0:0 rich' to make oriceadjustmen VISA, MASTERCARD, DISCOVER and AMERICAN EXPRESS
response to manufacturers` price 10anges
G uaranteed Satisfactions
or
If ,vou have tried a product and it is defecfire or does not not oerfor f 1 ":)uf Ondfer To Your €r ,r, k,-our;".
satisfactorily, r;8'vl`ili provide a credit, refund, or exchange; it syo it n n U. ti
choice. Simply call o it customer serv ice departrr,ent .Ar thi '30 stays Arai �fb to lic c� prat;fit i r r f ll;' Svc ic{ a ar
of r ipf of the rner4'%a:A:se'o arrange for the return. Fora Payab within days,
.;arrarrty repair or if yo :i,-ere Sent something yo u did notorder
si ;:ply call:' Px Products Controlled Substances:
M Medical 1-8
Regulatioris mquire us to limit ft sat o of '.x and on'r llnd
substance orliy to registered, iicer;sed healthcare pm tessionals.
If you are a new customer or have rec- antl.l moved, please turnish
us -;itl; a rcp, of ;cur updated s fate e istration. For controlled
sufrstances, k :mish a copy of your DEAD ccrtif cafe, verifying yg.,.
shipping address. Glass 11 druf s can he ordered only by n ail.
International Orders:
Please Note:
:`opened handpieces and equipment may not he returned for
We proudly Serve healthcare: Jrofe ss €onals nd governments
t1 r :,ughcut the .rorld, o puce orders or or f it rt: r es on expo t
credit. f r t tp il! k)u rE3pair >ed or rsplacF d in accordance ar ce .rith terms ar d coneitlo s. clease c ntact our lnterrlational Depa try ent:
Mnufactr rer 4r arrant' s, Be.k-,rt open €'ig ha dpiec :-s or
8i C °845 u
eq uipment, ,a.e s agest that you heck fhe shippOci ;o? miner
and packing list to veri=;, tha ycrr a e receiwed exactly what Prescription Drag Returns Instructions:
you crdered.0pened Computer Software is not returnable.
ether restrictions may also apply, a Ref urn Authorization is Required for ali. 'Pres ripl on ifugs. Simp lil calf
our Cust omer Service Department t `l'•,i:i�i?u�? °v'7Jc1,
11
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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))
7150538 -01 $46.30
1407289 -01 $1,069.34
9782287 -01 I I $2,829.00
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
$3,944.64
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. I ACCT #/TITLE I AMOUNT Board Members
1120 7150538 -01 1 102 390.11 j $46.30 1 hereby certify that the attached invoice(s), or
1120 1407289 -01 102 390.11 $1,069.34 bill(s) is (are) true and correct and that the
1120 I 9782287 -01 1 102 390.11 I $2,829.00 materials or services itemized thereon for
which charge is made were ordered and
received except
APR 23 2042
�P zA onw g A
0 'G
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund