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211776 08/14/2012 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1 ONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: $609.82 CARMEL, INDIANA 46032 DEPT CH 10241 PALATINE IL 60055-0241 CHECK NUMBER: 211776 CHECK DATE: 8/14/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 102 4239011 5206109-01 498 . 40 SPECIAL DEPT SUPPLIES 102 4239011 5286226-02 111 .42 SPECIAL DEPT SUPPLIES �� OP \'. t I` E H .1 SHIP TO/SOLD TO: EMSCarmel Fire Dept Head Quarters MI 135 Duryea Road, Melville, NY 11747 INVOICE z civic Sq Carmel,IN 46032-2584 010000130857105286226],100200000001,114207231,23 BILL To: Carmel Fire Dept MI 2 Civic Sq Carmel, IN 46032-7543 Carmel Fire Dept B ILL TO SHIP TO I INVOICE AMOUNT 2 Civic Sq Carmel, IN 46032-7543 1308571 1308572 111 .42 INVOICEH - INVOICE DATE 5286226-02 7/23/12 CUSTOMER PO# MARK 071612 ..HSI ORDER# ORDER DATE DUE'DATE 02068194 07/16/12 08/22/12 D&B#:Ot-243-0880 WHSE DEA# PG0229321 Fed ID: 11-3136595 k '€.,E'F �.:. Eh ba �,Iv-z.ax _'� l '_F F ,.tea ,. ) -�y fi r:'' y A�,,,,,, �.:r, ,`� C r.,SF: .,kz.n.3 Y/+, } „L^: :,.Y�... .'rR k r, This order ias been processed by our GIV D.C. 80 SUMMI VIEW ANE BASTIAN VA 2434 ARK 317-57L-2663 17-428-878 IRON DUCK D ES NOT HAVE THE RED IN STOCK TODA /ETA 2-3 WKS 991860 (32325-RD) 1 404-8520 EA STETHOSCOPE SIGNATURE 2HD 22" 6 6 18.57 111.42 1 F YOU ARE ARTICIPATING 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 SERVICES, RECEIVABLE OR REDEEMABLE N ACCO DANCE WITH DISCOUNT PROGRAM RULES. UP04 DISCOUNT RECEIPT OR REDEMPTION, IOU ARE RECEI ING OR WILL RECEIVE OTICE OF T iE DISCOUNT VALUE. FROM TIME TO TI 1E, MED ECARE, 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 GAINSq THE PURCHASE THAT ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN THESE RECORDS. MERCHANDI E TOTAL 111.42 Invoice Date + 30 days 111.42 BILL TO - SHIP TO: -INVOICE INVOICE AMOUNT ITEM STATUS KEY REM KEY 1308571 1308572 5286226-02 111.42 H Hackordered.Item will follow SK-school Kit HS1.: R I)ER# ORDER-DATE INV I OIC E DATE F'BOXES D Discontinued,Item no longer available NC-No Charge P Special Schein Free Goods 16 12 7/23/12 1 M-Manufacturer will ship Item directly w you 02068194 0 7 / / P-Prescription Drug:Return Authorization Required CUSTOMER PO 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 02068194 07/16/12 08/22/129 omo#:o|-24000uu mk PLEASE NOTE NEW REMIT TO ADDRESS Please remi-- payments only to the following address: HENRY SCHEI4 INC. EPT CH 10211 PALATINE, 1, 60055-0241 11308571 1308572 S286226-02 111 .42 13-Backordered:Item will follow SK-School Kit J 1)-Discon inue :Item no longer available NC-,,o Charge HSI ORDERW ORDER DATE INVOICE DATE: if OP,13OXES I,-Special Schein Free Goods NI-Manufacturer will ship Item directly to you 6'1 14 07/16/12 7/23/12 1 1)-Prescription Ding;Return Anthm ization Required C I UST OMER I P.o R-Refrigerated Item:May be shipped separately U-Temporarily unavailable:please reorder HMARK 071612 2 OF 2 T-Taxable Item We make every effort N,)maintai:!:prices for the duratio-n of a payment by CHECK or by the HENRY SCHEIN CREDIT CARD, vve reserve the right to make vice adkustmeM VISA,MASTERCARD,DISCOVER and AMERICAN EXPRESS response To man ufarct:u:rers'price changes Guaranteed Satisfaction: It wou have tr.ed a oroduct and it is detedive or=boas- ?t�ierfor or m M satisfactorily,we will provide a credit,refund,or exchange:it svour d Avai';ab'o sd prac.fifionoFs�n t.e US,A' Os are 'or. �O days hoice, Simp'v a.'[our cuslom:er service deparl�l. .l-Ifhir,3 a vvith:r P;vab:o 30 days, of ror.ei.pt of the merr"%v6se to arrange'or the return. Fora rr;ril'—e ah n I no r 0:1 a ',ci�ir or it sent some, i. g y ("fid t odor, ;imply c<It: Rx Products & Controlled Substances: Matrx Medical 1-800-845-3550 Rgulato,- i :s regAire us to limi�'he&z'e of�' e x anid coNrolled su--6stances on,:v to registered,licensed healthcare professionals. If you are a new customer or have recently rnoved,plea-Qe ftiPlisl I --datedstate rea'straflon. For nor-.4died us vith a copy of V ur 11P substances,L'imish a copy of your DEA ce of f ate,verifying yo- cfipping ad&ess, Class 11 drum ran bo ordered only b�- d, I - car: I i :;:ail. International Or Please Note: ........................ We proudly servo hoa!Mcare orofesxsilonals and'governments Opened handpieces and qUjprner�t nlay not be returned for or for it on throughout the wor'd, �o,place orders n expo.q credit,buflv:11 be r(,p�a'r,d or roplaced in accordance t:„,Nl He a terms and,conditions,please contact our International Department: manufacturer warranflos.Before oPening haiMpecos or 1-800-845 4,5 50 emlipment,we si.,:ggest that you t;heck'J.he shf:ipping cor-ainer arl d oacking list to verify that you have received led'exactly what , : - ; . I :IV : Prescription Drug Returns Instructions: you o-demd.Opened Computer Soffivare is not returnable, Other restrictions may also apply, A'Return A&orization is Required for all Prescription DrUgs”.&?1,1pl,1,call our C'ustomer Service Department 1-800-8415'-3550, HSI ORDER# ORDER DATE DUE DATE 02284709 07/25/12 08/24/12 Dh B#:01-243-0R 80 WHSE DEA# RHO162494 Fed ID: 11-3136595 a f£'Eb .( <Fr RIM his order has been processed by our MIDWEST D.C. 5315 WES 74TH STREET INDIANAP LIS,IN 46268 ---------- --------------------------------- ------ ----- ------------- ------- 1 987-8154 PU 100/BX SYR DISP 3CC W/22X11/2 LUERLCK 2 2 12.45 24.90 2 2 602-8100 EA COLLAR STIFNECK SELECT ADULT 50 50 C 5.95 297.50 1 ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. 3 360-1359 EA SAM SPLINT ORANGE/BLUE 36X4.25 24 24 6.50 156.00 2 4 496-6428 100/BX LANCET SURGILANCE GRAY 23G 1.8 2 2 10.00 20.00 2 F YOU ARE ARTICIPATING IN A DISCOUNT PROGRAM (E.G. POIN S, GIFTS OR or HER PECIAL AWA DS ("DISCOUNT") ) , WITH THIS PURCHASE YOU HAVE EARNED A CRED Ir TOWARD GOODS OR SERVICES, RECEIVABLE OR REDEEMABLE N ACCO DANCE WITH DISCOUNT PROGRAM RULES. UP04 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, PND UPON ANY SlJCH REQUEST, SU H VALUE MUST BE DISCLOSED AS A DI COUNT GATNSI THE PURCHASES THAT EARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN TH SE RECORDS. MERCHANDI E TOTAL 498.40 Invoice Date + 30 days 498.40 BILL TO - SHIP TO INVOICE4 INVOICE AMOUNT ITEM STATUS KEY REN/I KEY 11308571 1817102 5206109-01 4 9 8 .4 0 B-Isackordered:hcm will follow SK-School Kit D-Discontinued:hem no longer available NC-No Charge HSI RDER ORDER DATE INVOICE DATE 4 OF BOXES F-Special Schein Free Goods N1-Manufacturer will ship Item dircctfy to you 02284709 07/25/12 7/25/12 2 P-Prescription Drug:Return Authorization Required CUSTOMER PO PAGE R-Refrigerated Item:May be shipped separately $-Special Schein Pi icing U-Temporarily unavailable:please reorder MARK 1 OF 2 T-Taxable hem Continue on Next Page.......... LP300 riENRY SCHEIV SHIP TO/SOLD TO: EMS N ®� � Carmel Fire Department MI 135 Duryea Road, Melville, NY 11747 s4o w 136 St 1 Station 46 Michael Kaufmann Carmel,IN 46032-8806 01 00001308571 05206109 1110010000000498400725],25 BILL TO: Carmel Fire Dept MI 2 Civic Sq Carmel, IN 46032-7543 Carmel Fire Dept FILL TO SHIP TO INVOICE AMOUNT 2 Civic Sq Carmel, IN 46032-7543 1308571 1817102 498 .40 INVOICE# INVOICE DATE 5206109-01 7/25/12 CUSTOMER PO MARK - Please detach hero and mail the above with your payment - HSI ORDER# I ORDER DATE IDUE DATE 02284709 07/25/12 08/24/12 D&B#:01-243-0880 WHSE DEA# RHO162494 Fed ID: 1 1-3 136595 .-v'Z e` LEASE NOTE NEW REMIT TO ADDRESS Please remi payments only to the following a dress: HENRY SCHETIJ INC. DEPT CH 10211 ALATINE, I 60055-0241 ;BILL TO HIP TO INVOICE# INVOICE AMOUNT ITEM STATUS KEY REM KEY 1308571 1817102 5206109-01 498 .40 13-Hackoidered;Item will follow SK-SchoolKit D-Discontinued:Item no longer available NC-No Charge HSI ORDER#- ORDER DATE INVOICE DATE 4 OF BOXES F-Special Schein Free Goods 02284709 07/25/12 7/25/12 2 M-Macuip6urcnvill shiom Authorization you P-Prescription Dnrg:Return Authorization Required CUSTOMER PO PAGE R-Rcliigeratcd Item:May be shipped separately $-Special Schein Pricing U-Tcmpormily mtaailahle:please reorder MARK 2 OF 2 T-Taxableltem LP300 .............._ 11.1...... . ................ ......... ....... ......... ..... ...... ............... ......... ..1111.... .... ...1111_._ ........ ......... ......_... ........_ ...1111__SCHEIN'.....1111 ......... ......... ....1111_ ..1111._. M HENRY� � ._ � _ . . 11.11 .................111.. ...._.. ...... .... ........... We We Meg c`f{t to.i;<+int<i i pr,.,-'s.,',r the lurat oi�of a Rayrnent by CHECK or by the HENRY SCHEIN CREDIT CARO, + °;; ,, ee lv R 1 to i11, ke price �j i" 11-. a a catalog,..uv e!, u C:: r �fi':_ rE a t V� q y{ p^ER �y py OIS O �p q ^`J {C N g S 3`�i7e�'a,�irf.<°S�l.dw t"f ir3�#3'�t,�`.GdiWS.+3.t�'fi3�Y cdr�nd AMERICAN iss�`b..��''7'2a'i ao es pnse to nani.i€ t rs nrl e Wliari e Guaranteed Satisfaction: LL�m V you hue had a product and it is defective or does not,erto„ or sa.tislact rile y we will^rovide a credit,refund,or exchange;it's your choke.. Sliii` ad our cuslor.ner service d";ar!"en!r"Min 30 days Available to k r.Q f�€at.t3t i nors E.t.e US,Ail nvoi.;.s are; of r,�,:;+ilA of t i F rrii rc i%..€disc+to arrangr or the return, For:� �: ' .o o,or.xvarranl, at;ir or If" :.: ,verG Sent something you :i� f r — si;a;l;`;all; x Products & Controlled Substances: ilatrx Medical -300-845-3550 Re Ul+;!t S?[!j rc.'(Uir',us to hTt Me sal dRx and iiey.,i':`Wd �ljhstance,�only i '"t"atemd!licensed althl:are prole:">ii'�n�?i�. V you are a new l:US orner or have rocently moved,,:lease fumiisn us`with a copy of'your updated state regstru i n, For co mole d substances furnish a copy,of your DEA cerfil&W ,verifying your shipping address, Class Il drt us car.be onerout:only k+;J y ail. International Orders: Please tint . ............................................. - VV pr udi'v 'e :'^healt":<�re,pr`sfessi', ,a i g f%rn icy. c - Opened handpieces art<equipment ray not be returned°ar h ' naEf rn i6 r a;rit export t v i ter:^ra 1� u�the o�;;nrc;, �"o place o!Jrrs or t:�r €��.r.es on expert fii.<° °EI f)4 I'ep-jr- or replaced in ? ., rxp_; {'.':' , i'F"° x ""rlt' =r,,,s and s {t:Vr `le e t n: M�i` .er nmio _ .�r,�i:tF11. ll.lt�:�-t.;(.':<rr.rrit s. .;r�,.,) ) r a itf;'i;e;'.,,,;) 00-'8 45 r?e:. {'€1:;11,,,a7 e.6tggc s Iat`oU i;31e i:; l v t' and pacing list to verity that yri,-A.,;Lake receiveri exactly..hat Prescription Drag Returns Instructions: you crdored.Opened Computer Soffikiare is not returnable, her raarrichns may also apply, A Re1:3rn Autnvrr<.aton is(?e rilredi?Cr all Prescription Drugs–Siniplycall Tiff :t @ 9 SA- s t a. s, 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)) 5286226-02 $111.42 5206109-01 $498.40 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 VOUCHER NO. WARRANT NO. ALLOWED 20 Henry Schein IN SUM OF $ Dept Ch 10241 Palatine, IL 60055 $609.82 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1120 5286226-02 102-390.11 $111.42 I hereby certify that the attached invoice(s), or 1120 5206109-01 102-390.11 $498.40 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 AUG 132012 JF Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund