208721 05/10/2012 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1
ONE CIVIC SQUARE HENRY SCHEIN INC
CARMEL, INDIANA 46032 DEPT CH 10241 CHECK AMOUNT: $2,322.00
PALATINE IL 60055 -0241 CHECK NUMBER: 208721
CHECK DATE: 5110/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 4239011 1395249 -01 2,039.76 SPECIAL DEPT SUPPLIES
102 4239011 1395249 -02 21.56 SPECIAL DEPT SUPPLIES
102 4239011 1395658 -01 260.68 SPECIAL DEPT SUPPLIES
HSI ORDER ORDER DATE -DUE DATE
99636308 04/17/12 05/17/12
WHSE DEA# RHO 162494 Fed ID: 11-3136595
01
g-�
his order ias been processed by our MIDWEST D.C.
5315 WES 74TH 3TREET
INDIANAP LIS,IN 46268
1 4 ARK 317 -42 -8784
1 777 -5964 EA STETH LITTMANN CLSC2 2HD 28" 4 4 65.17 260.68 1
F YOU ARE DARTICIPATING IN A DISCOUNT PROG (E.G. POIN S, GIFTS OR OTHER
PECIAL AWA DS "DISCOUNT WITH THIS PURCH SE YOU HAVE EARNED A CREDI TOWARD
GOODS OR _S RVICES, RECEIVABLE OR REDEEMABLE N ACCO DANCE WITH DISCOUNT PROGRAM
RULES. UPO4 DISCOUNT RECEIPT OR REDEMPTION, OU ARE RECEI ING OR WILL R CEIVE
OTICE'OF TIE DISCOUNT VALUE. FROM TIME TO TI E, MEDICARE, MEDICAID, TRI ARE OR
THER PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, PNID UPON ANY S CH
EQUEST, SU H VALUE MUST BE DISCLOSED AS A DI COUNT GAINSU THE PURCHASE THAT
ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN TH SE RECORDS.
MERCHANDI E TOTAL 260.68
I nvoice Date 30 days 260.68
LEASE NOTE NEW REMIT TO ADDRESS
P lease remi payments only to the following a dress:
ENRY SCHEI4 INC.
D EPT CH 102 1
ALATINE, I 60055 -0241
Err TO SHTP TO IYVOICE4 INV AMOUNT ITEM STATUS KEY REM KEY
130857 1 13 0 8 572 13 9 5 6 5 8 O 1 2 60.68 H 13ackordcred: Item will follow SK school Kit
HSI' ORDER ORDER: DATE INVOICE; O DATE 4 OF BOXES O D Discontinued: Item no longer available NC No Charge
I' Special Schein Pme Goods
99636308 0 4 17 12 4 1 M Manufacturer will ship Item directly to you
P Prescription Drug: Return Authorization Required
CUSTOMER PO PAGE R Refrigerated Item. May be shipped separately
Special Schein Pricing
U Temporarily unavailable: please reorder
IRK 1 OF 1 T- Taxable Item
L
We in,,-.Ike overy offo to maintair, pricos br the dmat:o ota
Payment by CHECK or by the HENRY SCHEIN CREDIT CARD,
nat g.huvvovar,wmenowe(ha r i a h o rn a k e pr I c madivaknnn ts|n
VISA, MASTERCARD, DISCOVER and AMERICAN EXPRESS
mnponno|nmanufa�uumm' once ohonAen
Guaranteed Satisfaction:
or
i(ynu have kiad8omduc; and itindo(odivenrdnennutpedb,m
oatiufu credit, refund, nr exchange; it's your
Avai:ablo to licensed practifioner, :n the US, A:'.rivoic are
Choice, SknplVc��n:roudume/uow�odnpo8mon|��in3Odayo
dmceipt of the rnem|�aod|mn�u arrange 'or the m\um. For u
payable within 30 days,
:mnan�mpairor�yo:we�oeo�monm�ingyoudidno|o�a�,
Simply call:
Rx Products Controlled Substances:
Matrx Medical 1-800~845~3550
R !mho: o|n|imi11hos�eodF d
hennon|m}ind
aobo��muuntv to registamd. |inonaod hea8hcam Professionals,
U you are a new nustuma,o/ have recently moved, iumiah
us with a copyi-)f your updated s'ate registration. For cor4olled
shipping address. Class 11 drup can be ordered only byiy%ail,
International Orders:
Please Note:
We proudly serve health-care professionals undgnvamma�n
Opened handp�rea and oquipmentm |b 1 ned|nr throughout np
o,odii u�w|i!bo�pai�odormp}o�odinacou�ancowi|h orders
b— terms omdcnndh|onm p(eaaennn�u our|n�am�inoo| Depa�me��
monu/uuiurnrwmr�nbno,8alcm opening ho:dpieconnr 1'RG0'D45'86�O
equipment, We ggnv|!�a� oo h k|honh|p |n nu:�ainor
and poukiog list \over4\hatynuhavomnaivadoxwct|ywhat
you ord*edO d Computer Softwereisnotraturnmb|e. Prescription Drug Returns Instructions:
Other restrictions may also apply,
ARn|um Authorization inRoquimdforu||P,eumipUnn Drugs, 6|n`piyna||
ur Customer Service Deparkment 1-800-845-35%
HSI ORDER# ORDER DATE DUE DATE
99635896 04/17/12 05/17/12
WHSE DEA# RHO162494 Fad ID: 11-3136595
x�...�
his order has been processed by our MIDWEST D.C.
5315 WES 74TH 3TREET
INDIANAP LIS,IN 46268
1 507 -0791 PU EA IV EMS SET W /ULTRA SITE 8 15DROPS 200 186 1.54 286.44 Il
ARTIAL SHI MENT WILL SHIP AND INVOICE WHEN AVAILA LE.
2 338 -2276 PU 100 /CA EXTENSION SET STD BORE UL 3 3 C 224.00 672.00 4
ASE GOOD I EM, MAY BE SHIPPED SEPARATELY.
3 890 -4563 25 /BX CURITY COVER SPONGE STER 4 1 IX4" 75 75 3.07 230.25 11
4 857 =9780 EA BERMAN AIRWAY 100MM SZ 5 12 i2 0.30 3.60 11
5 507 -8362 RX 100 /BX NACL PREFILL SYRINGE 10ML ST 2 2 38.00 76.00 11
1 4 N PEDIGREE ITEM.
DC:6380701 010
6 555 -4687 PU EA PROTECTIV ACUVNC SFT CATH 22GX1" 100 100 2.73 273.00 13
HIS PRODUCU IS BEING SHIPPED FROM OUR NORTHE ST DIS RIBUT ON CENTER.
7 654 -1395 PU 50 /BX PROTECTIV ACUVANCE SAFETY 24GX5/8 2 2 144.95 289.90 11
8 499 -5377 EA MULTI TRAUMA DRESSING 12X30 25 25 1.00 25.00 11
9 891 -3037 PU 50 /CA IV PREP KIT W/ TEGADERM 3 3 C 61.19 183.57 10
ASE GOOD I EM, MAY BE SHIPPED SEPARATELY.
BILL. TO SHIP TO INVOICE INVOICE4 INVOICE AMOUNT
I TEM STATUS KEY 12E�4 KF_Y
1308571 1817102 1395249-01 2039.76 n Backordered: hem will fallow sK School Kit
HSI ORDER ORDER DATE INVOICE DATE F BOXES D Discontinued: Itcm no longer available NC vo Charge
f Special Schein Pree Goods
M Manufacturer will ship hem directly to you
99635896 04/17/12 4/17/12 1 3 P PrescnptionDrng :RctmnAmhmizationRcynircd
R Pelt igerated Item: May be shipped separately
CUSTOMER PO PA E Special Schein Pricing
U -Temporarily unavailable: please icorder
1 OF 2 T- Ta.cablc hem Continued on Next Page
1 detach here and mail me doove with your payment
14SI ORDER# ORDER DATE DUE DATE
99635896 04/17/12 05/25/12
WHSEDEA# RH0162494 Fed ID: 11-3136595
S N w
IN
I
A IR
This order as been processed by our MIDWEST D.C.
5315 WES" 74TH 3TREET
INDIANAPOLIS,IN 46268
1 507-0791 PU EA IV EMS SET W/ULTRA SITE 8 15DROPS 14 14 1.54 21.56 1
IF YOU ARE ARTICIPATING IN A DISCOUNT FROG I (E.G. POINqS, GIFTS OR O
SPECIAL AWAZDS ("DISCOUNT")), WITH THIS PURCHASE YOU HAVE EARNED A CREDI TOWARD
GOODS OR Si RECEIVABLE OR REDEEMABLE N ACCOZDANCE WITH DISCOUNT PROGRAM
RULES. UPO4 DISCOUNT RECEIPT OR REDEMPTION, yOU ARE RECEI ING OR WILL RECEIVE
NOTICE OF T DISCOUNT VALUE. FROM TIME TO TIME, MEDFCARE, MEDICAID, TRIWARE OR
DTHER MAY REQUEST INFORMATION REGARDING SUCH VkLUE, PND UPON ANY SITCH
ZEQUEST, SU VALUE MUST BE DISCLOSED AS A DI COUNT GAINS 7 THE PURCHASE THAT
EARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE THESE RECORDS.
1 4N HENRY CHEIN, INC. HAS PURCHASED THE SPE'IFIC UNIT OF THE PRESCRIPT ON DRUG
DIRECTLY FZOM THE MANUFACTURER.
MERCHANDI E TOTAL 21.56
Invoice Date 30 days 21.56
LEASE NOTE NEW REMIT TO ADDRESS
LE ASE
lease remi payments only to the following aldress:
ENRY SCHEI INC.
EPT CH 10211
ALATINE, J 60055-0241
13ILL TO SHIP TO INVOICE INVOICE AMOUNT ITEM STATUS KEY RffEM �KEY
13 08 571 1817102 1395249-02 21.56 13 -13ackoodered; Item will follow SK Sehool Kit
Discontinued; Item no longer available NC N.Chaige
HSI QRDER# ORDER DATE INVOICE DATE OF BOXES i- Special Schein Free (foods
NI Manufacturer will ship Item directly to you
99635896 04/17/12 4/2S/12 1 P Prescription Ding: Rciunn Authorization Required
R Refrigerated Ilcm:,'%Iay be shipped separately
CUSTOMER PO4
PAGE Special Schein PI icing
U Temporarily unavailable: please reorder
1 OF 1 T Taxable Item
Pa Term f°,
V' fe masse every effort to maintain prices for the duration of a Payment by CHECK or by the HENRY SCHEI CREDIT CARD,
catalog, however. we reserve the right to make price adjustments 'n VISA MASTERCARD DISCOVER and AMERICAN EXPRESS
response to ma nufacturers' pace changes
Guaranteed Satisfaction:
It you have tried a product and it is defective or does not perform 4tr Orr ''r .tr° Open Account
satis`actorily, we will provide a credit, refund, or exchange, it's your Avai'abie to licensed a titiorters in the J.S. All invoices are
choice. Simply call our customer service department within 30 days p`
of receipt of the merchandise to arrange for the return, For a payable within 30 days.
warranty repair or if you were sent something you did not order,
simply call: Rx Products Controlled Substances:
Matra 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 furnish
us with a copy of your updated state registration. For controlled
substances, furnish a copy of year DEA certificate verfying your
shipping address. Class 11 drags can be ordered only by ;mail.
Please Note: International Orders:
Opened handpieces and equipment may not be returned for 0,e proudly serve healthcare professionals and governments
credit, but wrill be repaired or replaced in accordance with throughout the world. To place orders or for inquiries on export
manufacturer warranties. Before opening handpieces or terms and conditions, please contact our International Department:
equipment, ,fire suggest that you check the shipping container
1- 800 845 -3550
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 ail Prescription Drugs. Sirnply call
our Customer Service Ceparment 1-800-845-3550,
LP300
MHENRY SCHEIN
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
0],00001,3085710139524911 ,00100000020397604171,29 BILL TO:
Carmel Fire Dept MI
2 Civic Sq
Carmel, IN 46032 -7543
Carmel Fire Dept MI
2 Civic Sq BILL TO I SHIP TO I INVOICE AMOUNT
Carmel, IN 46032 -7543
1308571 1817102 2039.76
INVOICE# INVOICE DATE
1395249 -01 4/17/12
CUSTOMER PO
l
Please detach here and mail the above with your payment
HSI ORDER# ORDER DATE DUE DATE
99635896 04/17/12 05/17712
WHSE DEA# RHO162494 Fed ID: 11-3136595
F YOU ARE DARTICIPATING IN A DISCOUNT PROGRAM (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, OU ARE RECEI ING OR WILL RIECEIVE
OTICE OF TIE 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
"QUEST, SU H VALUE MUST BE DISCLOSED AS A DI COUNT kGAINSq THE PURCHASE THAT
EARNED SUCH VALUE.' ACCORDINGLY, YOU SHOULD RE AIN THESE RECORDS.
N HENRY 3CHEIN, INC. HAS PURCHASED THE SPE IFIC U IT OF THE PRESCRIPT ON DRUG
DIRECTLY F OM THE MANUFACTURER.
MERCHANDI E TOTAL 2039.76
Invoice Date 30 days 2039.76
LEASE NOTE NEW REMIT TO ADDRESS
Please remi payments only to the following a dress:
ENRY SCHEIN INC.
DEPT CH 10211
ALATINE, I 60055 -0241
BILL TO SHIP TO INVOICE INVOICE AMOUNT
EM KEY
1308571 8571 1817102 13 9 524 9 O1 2 0 3 9 7 6 R l;ackordcred; It ITEM S [ATUS KEY REM
will rollow SK School Kit
RDER ORDER DATE INVOICE DATE OF BOXES
D Discontinued: Itcm uo longer available NC No Charge
HSI P- Special Schcin Frcc Goods
9 9 63 5 8 9 6 04/17/12 4/17/12 13 M Nlanul'acturcr will ship Item directly m you
I'- I'iescriptiou Drug: Return Aulhorization Reyuimd
R Rclrigcrated Itcm: %lay be shipped separately
CUSTOMER PO# PAGE
Special Schcin Ihicing
U Temporarily unavailable: please reorder
2 OF 2 T -Taxable ❑em
H ENRY Iqf:
A T 1
i EMS A.. J
We; ake every effort to maintain prices for the duration of a Payment by CHECK or by the HENRY SCHEIN CREDIT CARD,
catalog, ho ever, awe reserve the right to make price adjustments in VISA MASTERCARD, DISCOVER and AMERICAN EXPRESS
response to manufacturers' price changes
Guaranteed Satisfaction:
visA
if you ha ve tried a product and it is defective or does not perform rif O rder Accoun
satls`ad rill`, if,'e will profit ue a credit, refund, or exchange; it's your
hoice, Sii 1ply c<ll cur customer ser��ice department within 30 days A�tai ac.e `o licensed p �.;c..t.o ors in the U.S. ,AI, invoices are
of receipt of the merciland.se to arrange for the return. For a
payable €thin 30 da ys.
',varranty repair or if you were stint somet'lEng you dill not order,
simply call; x Products Controlled Substances:
Matrx Medical -800- 845 -3550
Regulations require us to lin the sale of R.x and controlled
substan€ es orl[y 'o replered, l tensed heilthca,e professionals,
if you are a €leiiv customer or ha• e recently moved, please furnish
us with a copy of your updated stafe registration. For controlled
substances, furnish a copy of your DEA certificate, verifying your
shipping address. Glass 11 ci uas can be ordered only by mail.
International Orders:
Pl ease tote:
p Yi proudly serve healtt,ca professionals and governme.n`s
Opened hE.;,dpi .des an e art uipm -.nf ma,' not b r e t urned for throiaa c31;t the t rl{d. To place orders or for inquiries on export
credit bjui v 'll be repaired or replaced in acl ,vifh
!'l;r.tlfa t` :arCa a :.1 5. Be ,t1 `lat :e C,5 or
tei ins c to i :t °it ns, p CC C. our ilitCiit :tli ?i' :.a1 t)epart e
ecu, ;meta, =:e sia est that you check the shipping con`a container 1 -8C"- 8415 -35 5u
4 9a y
and packing list to verify that you have received exactly what Prescription Drug tarn Instructions:
you orderrd.Opened Computer Software is not returnable.
Other restrictions may also apply.
A f ieturn Authorizatio n s Required for ail t'r ascription Drugs, Sirr ply call
cur Customer Ser epar ri;erit r 1-80 =5- 3550.
s C ti p �a� s Na y ig
1
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))
1395249 -02 $21.56
1395658 -01 $260.68
1395249 -01 I I $2,039.76
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
$2,322.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1120 1395249 -02 102 390.11 $21.5_ hereby certify that the attached invoice(s), or
1120 1395658 -01 102 390.11 $260.68 bill(s) is (are) true and correct and that the
1120 I 1395249 -01 1 102 390.11 I $2,039.76 materials or services itemized thereon for
which charge is made were ordered and
received except
MAY 7 2012
i
y
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund