211314 07/31/2012 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1
ONE CIVIC SQUARE HENRY SCHEIN INC
CARMEL, INDIANA 46032 DEPT CH 10241 CHECK AMOUNT: $2,536.41
PALATINE IL 60055-0241 CHECK NUMBER: 211314
CHECK DATE: 7/31/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 4239011 5282534-01 2, 316 .36 SPECIAL DEPT SUPPLIES
102 4239011 5286201-01 220 . 05 SPECIAL DEPT SUPPLIES
HSI ORDER# ORDER DATE DUE DATE
02067720 07/16/12 1 08/15/12
D&B#:O l-243-0880
WHSE DEA# RHO162494 Fed ID: 11-3136595 CONTAINS MULTIPLE INVOICES
ae a-r r r =t Em Iffim- e Eli
his order ias been processed by our MIDWEST D.C.
5315 WES 74TH 3TREET
INDIANAP LIS,IN 46268
RK 071612
17-571-266
17-428-878
---------- --------------------------------- ------ ----- ------------- -------
---------- --------------------------------- ------ ----- ------------- -------
1 499-5372 EA YANKAUER TIP W/VENT&TUBNG 40 40 1.55 62.00 11
2 701-9859 U 100/BX VANISH PT SYR 3CC W/NEEDL 22GX1" 2 2 42.43 84.86 11
3 338-2276 U 100/CA EXTENSION SET STD BORE UL 2 2 C 224.00 448.00 2
ASE GOOD I EM, MAY BE SHIPPED SEPARATELY.
4 555-1166 U EA PROTECTIV ACUVNC SFT CATH 18X1.25 200 200 C 2.73 546.00 3
ASE GOOD I EM, MAY BE SHIPPED SEPARATELY.
5 555-5396 PU EA PROTECTIV ACUVNC SFT CATH 20X1.25 200 200 C 2.73 546.00 4
ASE GOOD I EM, MAY BE SHIPPED SEPARATELY.
6 499-9022 EA ET TUBE CUFFED 8.0 30 30 1.15 34.50 12
7 507-8362 RX 100/BX NACL PREFILL SYRINGE 10ML ST 2 2 38.00 76.00 11
N - PEDIGR E ITEM.
11DC:6380701)010
8 107-0530 100/BX PURPLE NITRILE PF GLOVE LARGE 60 60 C 8.65 519.00 10
ASE GOOD I rEM, MAY BE SHIPPED SEPARATELY.
13ILL TO SHIP INVOICE E AMOUNT
ITEM STATUS KEY REM KEY
1308571 1817102 5282534-01 2316 .36 B-Backordered:Item will follow SK-School Kit
D-Discontinued:Item no longer available NC-No Charge
I RDER ORDER ATE INVOICE F BOXES 1=-Special Schein Free Goods
M-Manufacturer will ship Item directly to you
02067720 0 7/16/12 7/16/12 12 P-Prescription Drug:Return Authorization Required
CUSTOMER 20# PAGE# R-Refrigerated Item:May be shipped separately
$-Special Schein Pricing
U-Temporarily unavailable:please reorder
MARK 071612 1 OF 2 T-Taxable Item Continued on Next Page..........
LP300
HENRY CHEINc"
E�� SHIP TO/SOLD TO:
VOICE I� Carmel Fire Department MI
135 Duryea Road, Melville, NY 11747 540 W 136 St
Station 46 Michael Kaufmann
Carmel,IN 46032-8806
01000013085710528253411001000000231,6360716120 BILL TO:
Carmel Fire Dept MI
2 Civic Sq
Carmel, IN 46032-7543
Carmel Fire Dept HILL TO I SHIP To I INVOICE AMOUNT
2 Civic Sq
Carmel, IN 46032-7543 1308571 1817102 2316 .36
INVOICE INVOICE DATE--j
5282534-01 7/16/12
CUSTOMER PO
MARK 071612
Please detach here and mail the above with your payment _
HSI ORDER ORDER DATE DUE DATE
02067720 07/16/12 08/15/12
D&B#:01-243-0880
WHSE DEA# RHO162494 Fed ID: 1 1-3136595
Em
F YOU ARE PARTICIPATING IN A DISCOUNT PROGRAM (E.G. POIN S, GIFTS OR OTHER
PECIAL AWA DS ("DISCOUNT") ) , WITH THIS PURC SE YOU HAVE EARNED A CREDI TOWARD
GOODS OR S RVICES, RECEIVABLE OR REDEEMABLE N ACCO DANCE WITH DISCOUNT PROGRAM
RULES. UPON DISCOUNT RECEIPT OR REDEMPTION, OU ARE RECEI ING OR WILL RECEIVE
OTICE OF THE 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 PURCHASEI THAT
ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN TH SE RECORDS.
N - HENRY CHEIN, INC. HAS PURCHASED THE SPE IFIC U4IT OF THE PRESCRIPT ON DRUG
DIRECTLY F OM THE MANUFACTURER.
MERCHANDI E TOTAL 2316.36
Invoice Date + 30 days 2316.36
LEASE NOTE NEW REMIT TO ADDRESS
Please remi payments only to the following a dress:
ENRY SCHEII INC.
DEPT CH 10211
ALATINE, I 60055-0241
L TO SHIP TO INVOICE INVOICE# INVOICE AMOUNT ITEM STATUS KEY REM KEY
13 0 8 5 71
1817102 5 2 8 2 5 3 4-01 2316 .36 B-BacAordered:Item will follow SK-school Kit
HSI ORDER# ORDER DATE INVOICE DATE E D-Discontinued:Item no longer available NC-No Charge
# OF I'-Special Schein Free Goods
02067720 07/16/12 7/16/12 12 M-Manufacturer will ship Item directly to you
P-Prescription Drug:Return Authorization Required
CUSTOMER P R-Refrigerated Item:May be shipped separately
$-Special Schein Pricing
U-Temporarily unavailable;please reorder
MARK 071612 2 OF 2 T-Taxable Item
1P300
I�
HENRY SCHEIN`1
I EMS
TERMS
----------
Payment Terms:
We make every effort to maintain prices for the duration of a Payment by CHECK or by the HENRY SCHEIN CREDIT CARD,
catalog,however,we 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 product and it is defective or does not perform or
satisfactorily,we will provide Your Order To Your Open Account provide a credit,refund,or exchange;it's your Available to licensed practitioners in the U.S.All invoices are
choice. Simply call our customer service department within 30 days payable within n 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 new customer or have recently moved,please furnish
us with a copy of your updated state registration. For controlled
substances,furnish a copy of your DEA certificate;verifying your
shipping address. Class II drugs can be ordered only by mail.
International Orders:
Please Mote:
Opened handpieces and equipment may not be returned for We proudly serve healthcare professionals and governments
credit,but will 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,we suggest that you check the shipping container 1-800-845-3550
and packing list to verify 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 Prescription Drugs.Simply call
our Customer Service Department @ 1-800-845-3550.
w
NE
HSI ORDER ORDER DATE DUE DATE
02068194 1 07/16/12 08/15/12
D&B#:01-243-0880
WHSE DEA# RHO162494 Fed ID: 11-3136595
This order has been processed by our MIDWEST D.C.
5315 WES 74TH 3TREET
INDIANAP LIS,IN 46268
RK 317-57 -2663
17-428-878
IRON DUCK D ES NOT HAVE THE RED IN STOCK TODA /ETA 2-3 WKS
991860 (32Q5-RD)
1 499-0652 EA PENLIGHT METALITE 10 10 2.35 23.50 1
2 499-9994 EA ULTRA SOFBOX PLUS ROYLBLU 1 1 196.55 196.55 2
HIS PRODUCr IS BEING SHIPPED FROM OUR NORTHE ST DIS17RIBUTION CENTER.
---------- --------------------------------- ------ ----- ------------- -------
---------- --------------------------------- ------ ----- ------------- -------
OUR ORDER 2068194 HAS BEEN SPLIT INTO MULTIPLE SHI MENTS. CERTAIN ITEM WILL
E SHIPPED EPARATELY. YOU WILL BE BILLED FOR THESE ITEMS HEN THEY ARE HIPPED.
F YOU ARE DARTICIPATING IN A DISCOUNT PROG (E.G. POIN S, GIFTS OR OTHER
PECIAL AWARDS ("DISCOUNT")) , WITH THIS PURL SE YOU HAVE EARNED A CREDI TOWARD
GOODS OR SERVICES, RECEIVABLE OR REDEEMABLE N ACCO DANCE WITH DISCOUNT PROGRAM
RULES. UPON DISCOUNT RECEIPT OR REDEMPTION, rOU ARE RECEI ING OR WILL R CEIVE
OTICE OF THE DISCOUNT VALUE. FROM TIME TO TI E, MEDICARE, MEDICAID, TRI ARE OR
PTHER PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, PND UPON ANY S JCH
EQUEST, SU H VALUE MUST BE DISCLOSED AS A DI COUNT kGAINS1 THE PURCHASES THAT
ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN THESE RECORDS.
BILL TO SHIP TO INVOICElf INVOICE AM ITEM STATUS KEY REM KEY
13 0 8 5 71 1308572 5286201-01 2 2 0. 0 5 B-Backordered:Item will follow SK-School Kit
D-Discontinued:Item no longer available NC-No Charge
I DER DER DATE INVOICE DA F-Special Schein Free Goods
16 12 7/16/12 2 M-Manufacturer will ship Item directly to you
02068194 0 7
/ / p_Prescri ption Drug:Return Authorization Required
R-Refrigerated Item:May be shipped separately
CUSTOMER 20# PAGE# $-Special Schein Pricing
U-Temporarily unavailable:please reorder
MARK 071612 1 OF 2 T-Taxable Item Continued on Next Page..........
LP300
HENRY SCHEIN"
A�
SHIP TO/SOLD TO:
EMS Carmel Fire Dept Head
135 Duryea Road, Melville, NY 11747 INVOICE�\ ,o I C 2 Civic Sq p Quarters MI
' V �/ L Carmel,IN 46032-2584
010000130857105286201110010000000220050716124 BILL TO:
Carmel Fire Dept MI
2 Civic Sq
Carmel, IN 46032-7543
Carmel Fire Dept ]SILL TO SHIP TO INVOICE AMOUNT
2 Civic Sq
Carmel, IN 46032-7543 1308571 1308572 220.05
INVOICE# INVOICE DATE
-]
5286201-01 7/16/12
CUSTOMER PO
MARK 071612
Please detach here and mail the above with your paymem _
HSI ORDER# ORDER DATE DUE DATE
02068194 07/16/12 1 08/15/12
D&B#:01-243-0880
WHSE DEA# RHO162494 Fed ID: 11-3136595
Northeast D stribution Center
1 WEAVER ROAD
DENVER, PA 17517
MERCHANDI E TOTAL 220.05
Invoice Date + 30 days 220.05
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
BIJ,L TO SHIP TO INVOICE# I E ITEM STATUS KEY REM KEY
1308571 1308572 5286201-01 220.05 It-Backordered:Item will follow SK-School Kit
D-Discontinued:Item no longer available NC-No Charge
I RDER ORDER INVOICE ATE BOXES P-Special Schein Free Goods
02068194 07/16/12 7/16/12 2 M-Manufacturer will ship Item directly to you
P-Prescription Drug:Return Authorization Required
CTJSTOMER P E
R-Refrigerated Item:May be shipped separately
$-Special Schein Pricing
U-Temporarily unavailable:please reorder
MARK 071612 2 OF 2 T-Taxable Item
LP300
HENRY CHEIN"
EMS TERMS OF SALE
Payment Terms:
We make every effort to maintain prices for the duration of a Payment by CHECK or by the HENRY SCHEIN CREDIT CARD,
catalog,however,we 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 product and it is defective or does not perform or
satisfactorily,we will provide a credit,refund,or exchange;its your Bill Your Order To Your Open Account
choice. Simply call our customer service department within 30 days Available to licensed practitioners in the U.S.All invoices are
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:
Matrx Medical 1-800-845 73550
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 your DEA certificate;verifying your
shipping address. Class II drugs can be ordered only by mail.
International Orders:
Please Note:
y not be returned for throughout the world. To place orders or for inquiries on export
Opened handpieces and equipment may We proudly serve healthcare professionals and governments
Qpe
credit,but will be repaired or replaced accordance with
Department
terms and conditions,please contact our International Departmen
manufacturer warranties.Before opening handpieces or
1-800-845-3550
equipment,we suggest that you check the shipping container
and packing list to verify 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 Prescription Drugs.Simply call
our Customer Service Department @ 1-800-845-3550.
)rescribed by State Board of Accounts City Form No.201(Rev.1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
Nn invoice or bill to be properly itemized must show: kind of service,where performed, dates service rendered, by
nrhom, 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))
5282534-01 $2,316.36
5286201-01 $220.05
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
$2,536.41
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1120 5282534-01 102-390.11 $2,316.36 1 hereby certify that the attached invoice(s), or
1120 5286201-01 102-390.11 $220.05 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
jut 3 0 2012
V _ . .
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund