210888 07/17/2012 \,f CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1
` ONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: $393.10
CARMEL, INDIANA 46032 DEPT CH 10241
PALATINE IL 60055-0241 CHECK NUMBER: 210888
CHECK DATE: 7/17/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 4467006 6583038-01 393 . 10 EMS EQUIP
___ _-----_—' —' ----
S1 ORDER4 I ORDER DATE IDLE DATE
01506284 06/20/12 07/26/12
cmm,0e43-0880
*xssoaxV xxn162*94 Fed ID: 11'3136595
1 499-1860 EA ULTRA SOFT BOX PLUS RED 2 2 196.55 393.10
YOUR ORDER )1506284 HAS BEEN SPLIT INTO MULTIPLE SHI?MENTS. CERTAIN ITEM WILL
E SHIPPED EPARATELY. YOU WILL BE BILLED FOR THESE ITEMS WHEN THEY ARE HIPPED.
IF YOU ARE DARTICIPATING IN A DISCOUNT PROGRAI (E.G. POINIS, GIFTS OR OTHER
SPECIAL AWAZDS ("DISCOUNT") ) , WITH THIS PURCHASE YOU HAVE EARNED A CREDI" TOWARD
GOODS OR S�RVICES, RECEIVABLE OR REDEEMABLE -N ACCOZDANCE WITH DISCOUNT PROGRAM
RULES. UPO,I DISCOUNT RECEIPT OR REDEMPTION, 'IOU ARE RECEI-,,ING OR WILL RECEIVE
qOTICE OF TIE DISCOUNT VALUE. FROM TIME TO TIME, MEDICARE, MEDICAID, TRITARE OR
DTHER PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, PND UPON ANY SJCH
REQUEST, SU-H VALUE MUST BE DISCLOSED AS A DI3COUNT .GAINSl THE PURCHASE ; T14AT
EARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE—AIN THESE RECORDS.
MERCHANDI ,E TOTAL 393.10
Invoice Date + 30 days 393.10
PLEASE NOTE NEW REMIT TO ADDRESS
Please remi- payments only to the following aldress:
HENRY SCHEI4 INC.
DEPT CH 10211
PALATINE, I� 60055-0241
BILL TO SHIP TO INVOICE# INVOICE AMOUNT r--RE—MK—EY--)
— iTEM STATUS KEY
IF308571 1308572 6583038-01 393 .10 B-Backm dered:Item�vill I llow SK-Sch I Kit
tiger available
HSI ORDER ORDER DATE INVOICE DATE 4 OF BOXES F-Special Schem Free Goods
0 ol 0 NI-Manufacturer will ship Item directly to you
1506284 06/20/12 6/26/12 11-I'lescription Drug:Return Authorization Required
R-Refrigerated Itcm:,'vlay be shipped separately
CUSTOMER PO# PAGE# $-Special Schein Pi icing
v',te rmake ;<<e r,{aflort N-;maintair l pri,:,,,s for the dunafio:%'of a
Payrnent by CHECK or by the HENRY SCHEIN CREDIT CARD,
r tita i
hOVIle've?,"Ne reserve t'le rigN to make ori.-Ce,adjust ens;.n
VISA,N
I 1ASTERCARD,DISCOVER and AMERICAN EXPRESS
response°o manufacturers'-price.1--ianges
Guaranteed Satisfaction: vrsA
or
It vou have tried a Oro tact and it is defective-c;r does Ot oerform
satisfactorily,we will orov:cle a credit refuM,or Pxchange-its your
Ava;,:ab'e to licensed practrfionorcz:n Ue US.M . voices are
Vloic`e. Sir;1pivca:1 o--ur custorn,er se`Jrl-e deoartmen;vi"hin 30 days
pavab:o i,�,iith:n 3,0;Ways,
o°reice0t(%f Me rnerc'r�and:sce to arrange'or the retirn. For a ............
wi�rrantv repair or if yc :.{ere sect sonii-vthing yoo did not orde'-!"
sI :ply Rx Products & Controlled Substances:
Matrx Medical 1-800-845-3550
Re,oulafio:,:s mq;;J:re us to lin-iit the&-lo of Rx and con'rolled
substances oinly to regis-tered,licenSed healthcare professionals.
If you are ane,,tv customer or have recently rnoved,.Ull-dase fumb
::Sri
LIS'Alith a CODY Of y,Ur updated state registration. For con rolled
c!ubstances,h mish acopy of your DEA ceirtificate,verifyinig
shipping address. Class 11 drugs can be ordercd only is .;ail.
International Orders,
Please Note:
-----------------------------
V'ile[Iroudki snrvo and giovernm-,onts
Opened handpieces and equipment rnay not be reti�innedtor
throughout Mev.,or'd. To 0ce orders or f.-j, on export
credit:but*,:I[be rePa':;',d or rerllaced in accordance terms and conditions,ulease contact ov
manufacture warranfles,Before opening handpieca cz,or
PQUipment,we sugge-st tMt yo;u::Beck he ship ping coillainer
and Oank:na list to ver:lv that you have recei,.;ed exactly!,,;hat
you ordefed.Opened Computer Software is not returnable, Prescription Drug Returns Instructions:
Other restrictions may also apply,
A Return authorization is Required for all Pros,Iriolion Drugs.SImply call
our lustome.r Service Depanment 1-800-8,11`5-3550,
4. .........
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LP300
VOUCHER NO. WARRANT NO.
ALLOWED 20
Henry Schein
IN SUM OF $
Dept Ch 10241
Palatine, IL 60055
$393.10
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1120 I 6583038-01 1 102-670.06 I $393.10 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
jUL 16 2012
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
rescribed by State Board of Accounts City Form No.201 (Rev.1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
kn invoice or bill to be properly itemized must show: kind of service,where performed, dates service rendered, by
Thom, 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))
6583038-01 $393.10
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