HomeMy WebLinkAbout210023 06/20/2012 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1
ONE CIVIC SQUARE HENRY SCHEIN INC
CARMEL, INDIANA 46032 DEPT CH 10241 CHECK AMOUNT: $612.00
PALATINE IL 60055 -0241 CHECK NUMBER: 210023
CHECK DATE: 6/20/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 4239011 9290106 -02 120.00 SPECIAL DEPT SUPPLIES
102 4239011 9290112 -01 492.00 SPECIAL DEPT SUPPLIES
HSIORDER# ORDER DATE DUE. DATE
00783142 05/21/12 06/29/12
D &B #:01- 243 -0880
WHSE DEA# RHO162494 Fed 1D: 11- 3136595 CONTAINS MU LTIPLE INVOICES
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his order has been processed by our MIDWEST D.C.
5315 WES 74TH 3TREET
INDIANAP LIS,IN 46268
ARK 317-57--2663
1 499 -6391 EA EASY GRIP BVM CHILD 10 10 12.00 120.00 1
F YOU ARE DARTICIPATING IN A DISCOUNT PROGRAM (E.G. POIN S, GIFTS OR O HER
PECIAL AWA DS "DISCOUNT WITH THIS PURCH SE YOU HAVE EARNED A CREDI TOWARD
GOODS OR S RVICES, RECEIVABLE OR REDEEMABLE N ACCORDANCE WITH DISCOUNT PROGRAM
RULES. UPOq DISCOUNT RECEIPT OR REDEMPTION, 'IOU ARE RECEI ING OR WILL RECEIVE
OTICE,OF T E DISCOUNT VALUE. FROM TIME TO 'TI E, MEDICARE, MEDICAID, TRI ARE OR
THER PAYER MAY REQUEST _INFORMATION REGARDING SUCH V LTtF.. Nn TIP om nNy_ c
R EQUEST, SU H VALUE MUST BE DISCLOSED AS A DI COUNT GAINS THE PURCHASE THAT
E ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN TH SE RECORDS.
MERCHANDI E TOTAL 120.00
I nvoice Date 30 days 120.00
LEASE NOTE NEW REMIT TO ADDRESS
P lease remi payments only to the following a dress:
H ENRY SCHEIR INC.
D EPT CH 102 1
ALATINE, IL 60055 -0241
BILL TO HI P'TOdNVOICE INVOICE AMOUNT
ITEM STATUS KEY REM KEY
1 1308571 1817102 1 9290106-02 12 0. 0 0 a 13ackordered; Item will follow SK school Kit
HSI 0 RDER# ORDER DATE INVOICE DATE::: X65 D Discontinued; Item no longer available NC No Charge
F- Special Schein Free Goods
00783142 05/21/12 5/30/12 2 M P Manufacturer will ship hem directly to you
Prescription Drug: Return Authorization Required
CUSTOMER `PO PAGE R Kefrigerated Item; May be shipped separately
Special Schein Pricing
MARK 0 5 2112 1 O F 1 T- Ta able j Cl n unavailable; please reorder
LP300
1 T
re e every oflort lo; maintali' prices fortho -duratiof l of a
Payment by CHECK or by the HENRY SCHEIN CREDIT CARD,
oato ho'v, ivve reserve tcl e riah o rllake prior lust ents l; U:
VISA, MASTERCARD. DISCOVER and AMERICAN EXPRESS
Guaranteed Satisfaction: vrsa �a;,..
if vol have tr 'ed aorodur-1 and it is defeclive or does -t K).erfom or
sa1is"acforilv, we -v ill orcmde a credit, refumd, or exchange Wsyo; ir
Available to licensed practifionors:n t S. e U. A'.,::nvoices are
choic-e,
M
payable iiithir. 30 days,
0� rer';eiot of th rnercl%a:4sce to arrange h)r the refurn. For a
vurrarit 'v r-oa;r or
ifvo;,J see some*hing you did ?'lot orcie!
S: ply ca
Rx Products Controlled Substances:
Nlatrx Medical 1-800-845-3550
Regulations require us to [in fhe sale of Rx arc: co*olkld
substances only to?egislered,licensed health are professionals.
1= you are a new cuRtorncr or have recently moved, fu-'sh
us with a co )v of tjofdated sate registration. For cor-.`Folled
sl-,bstances, hirnish acopy of your DEA certificate, verifying yo W r
shipping address, Glass 11 druf�s can be orderod only by --ail.
International Orders:
Please Note:
A le nroff-,simals ,and governments
fori? quirles on
Opened handpieces and ecidomen? may not be retie for
cr throughout t' neivodd, To place orders or n e X p O ...q
--placed in accordancj�
e-dil bu� be repaired or ire
terms and :condit Please contact our 1!--:4erW�ional Department: manLifacturer warranflas, P r ore opening Nrldpieresor
s In I c OUipment, we �t.Mje-Qt that "OU :;hec e sNpping co
.7 I —irne
and oancking list to verily that you have received exactly what Prescription Drug Returns Instructions:
"/0;:,1 olmie..relopened bomputer Software is not returnable.
Other restrictions may also apply,
A Reii Authorization is ReqUired for all Pre-Sn'ription Drugs. Simply call
our "ustorner Service e. ..8 :0n 1-800-845-3550,
-n
make every offo lo mainta" r pricos 'or the durrifiort of a t
Paymentby CHECK or the HENPYSCHEIN CREDITCARD,
e the JaN s make oriceadi-Arnents :1
calaloq-, NOV's-'111'er, \�Ie reser"! i righ
VISA, MASTERCARD, DISCOVER and AMERICAN EXPRESS
response o price J ianoes
-1h
Guaranteed Satisfactiow vrsA
If tiou. have tried a product aid it is defer ire or does ?:Of Derform or
satisf ac :orilvvve will provide a credit, refund, or exchange it's vo:Ur
US, r arr
Avai:ab',, to licemecl practifioner in the n
Q
r1h i rC e, i r ply al I o.: r c u tame s =vic d e pa r e f vvi I i 1 3G d a v s avabie vvifin. 30 days.,
of rec'oi.-ot of the merr" aA:sfe to armligo 'or the rowrn. For a P
Warrant v re or if 1101 "w"'re sev, somoflhing vou did Clot order,
siply call: Rx Products Controlled Substances:
Matrx Medical 1-800-845-3550
Requlatio- r0quiNe US to limit the sale of klx and conroll -ad
substances o t.) registeFed,k sed healthca,re professionals,
i
it
If you are a new customer ar have recently moved, please fur' sh
us a co.Dv of Your updated state regstralon. For contrd-led
SUbstances, Limi-sh acopy of your DEA certificate, verifying Yo :r
shipping address. Chi,% 11 d c be orderodi' onN ibw triail,
International Orders:
Please Note:
VVe proudl
p y
ay not be retur.-ned 'or
Oened hand and quipmen:1
throughout the ,vor�d, �o Place orders n export
credit buttv:11 be repnedor replaced in accordl ante w"h
terms and c0ndiflons,Please contact our lntc al[
Bekore otoening handpiec-es or
1-800-845-3-550
eapipment, v,,'e, sugge-st that you check 1he shipping container
and oa list to ver;'v t received exactly what
yc)-,.-j ofdered,Opened Computer Software is not returnable. Prescription Drug Returns Instructions:
Other restrictions may also apply.
A M-urn Authorizat:o,n is Required 'or all Prescription DRigs—S:?,1.pIv call
our Clustomer Service Depvrnent 1-.800-845 .3550,
VOUCHER NO. WARRANT NO.
ALLOWED 20
Henry Schein
IN SUM OF
Dept Ch 10241
Palatine, IL 60055
$612.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1120 9290106 -02 102- 390.11 $120.00 1 hereby certify that the attached invoice(s), or
1120 9290112 -01 102 390.11 $492.00 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
JUN 18 2012
e
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))
9290106 -02 $120.00
9290112 -01 $492.00
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