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Home My WebLink About212616 09/12/2012 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1 ONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: $4,787.63 CARMEL, INDIANA 46032 DEPT CH 10241 "ti oN,�o PALATINE IL 60055-0241 CHECK NUMBER: 212616 CHECK DATE: 9112/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 102 4239011 9465383-01 4, 787 . 63 SPECIAL DEPT SUPPLIES HSI ORDER# ORDER DATE DUE DATE 03116248 08/28/12 09/27/12 D&B#:01-243-0880 WHSE DEA# RH0162494 Fed ID: 1 1-3136595 F •%F,�� ..$dE:k3.t,.<:="; < �o HENRY SCHEINQ' SHIP TO/SOLD TO: EMS Carmel Fire Department MI 135 Duryea Road, Melville, NY 11747 INVOICE Sta w 136 St Station 46 Michael Kaufmann Carmel,IN 46032-8806 01 00001 308571094653831100],0000004787630828126 BILL TO: Carmel Fire Dept MI 2 Civic Sq Carmel, IN 46032-7543 Carmel Fire Dept BILL To I SHIP TO INVOICE AMOUNT 2 Civic Sq Carmel, IN 46032-7543 1308571 1817102 4787.63 INVOICE# INVOICE DATE 9465383-01 8/28/12 CUSTOMER PO# MARK 082812 HSI ORDER# ORDER DATE DUE DATE 03116248 08/28/12 09/27/12 D&B#:01-243-0880 WHSE DEA# RHO162494 Fed ID: 11-3136595 sf':":-y,-a° '�".' ,;�. .e'��.:.a ;° ,,�° C`�. a rv�n �„d:'.e"^"�: ;;Z•-��„• z "' '`'r`':♦ � ' 9 602-8100 EA COLLAR STIFNECK SELECT ADULT 50 50 C 5.75 287.50 16 ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. 10 107-0502 100/BX PURPLE NITRILE PF GLOVE MEDIUM 60 60 C 8.60 516.00 22 ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. 11 107-0530 100/BX PURPLE NITRILE PF GLOVE LARGE 80 80 C 8.60 688.00 30 ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. 12 153-6483 PX 250ML/BT STERILE WATER FOR IRRIG 250ML 24 24 C 1.10 26.40 31 N - PEDIGREE ITEM. ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. DC:0033800 402 13 101-5979 6/BX CLOTH SURGICAL TAPE 2"X10YD 24 24 7.77 186.48 37 14 101-2323 12/BX CLOTH SURGICAL TAPE 1"X10YD 12 12 C 7.77 93.24 32 ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. 15 499-5224 EA NASAL CANNULA W/CURVD TIP ADULT 100 100 C 0.34 34.00 34 ASE GOOD I CEM, MAY BE SHIPPED SEPARATELY. 16 120-8808 EA COMBITUBE ROLL-UP KIT 41FR 6 6 40.96 245.76 38 17 857-0670 EA BERMAN AIRWAY 70MM SZ 2 12 12 0.27 3.24 36 18 857-6255 EA BERMAN AIRWAY 90MM SZ 4 12 12 0.27 3.24 36 19 857-9780 EA BERMAN AIRWAY 100MM SZ 5 12 12 0.27 3.24 36 BILL TO HIP TO INVOICE# INVOICE: ITEM STATUS KEY REM KEY 1308571 1817102 9465383-01 4787.63 B-Backordered:Item will follow SK-School Kit HSI ORDER# ER DATE INVOICE DATE 4 OF BOXES D-Discontinued:Item no longer available NC-No Charge F-Special Schein Free Goods M-Manufacturer will ship Item directly to you 03116248 0 8/2 8 12 8/28/12 3 9 P-Prescription Drug:Return Authorization Required T M R PA R-Refrigerated Item:May be shipped separately $-Special Schein Pricing U-Temporarily unavailable:please reorder MARK 082812 2 OF 3 T-Taxable Item Continued on Next Page.......... LP300 1,7 x HENRY SCHEIN, EMS SHIP TO/SOLD TO: INVOICE Carmel Fire Department MI 135 Duryea Road, Melville, NY 11747 540 w 136 St Station 46 Michael Kaufmann Carmel,IN 46032-8806 0100001308571094653831100 10000004787630828126 BILL TO: Carmel Fire Dept MI 2 Civic Sq Carmel, IN 46032-7543 Carmel Fire Dept BILL TO SHIP To I INVOICE AMOUNT 2 Civic Sq Carmel, IN 46032-7543 1308571 1817102 4787.63 INVOICE# INVOICE DATE 9465383-01 8/28/12 CUSTOMER PO MARK 082812 Please detach here and ma:l the above with your payment HSI ORDER# ORDER DATE DUE DATE 03116248 08/28/12 09/27/12 DRB#:01-243-0880 WHSE DEA# RH0162494 Fed ID: 1 1-3136595 *.•f ,., ._. .t.�'s< y. .,,,& A<'°`,.az"�.j�;;r'E•;�„'rr-t.,,, «., ��, ;t. ,s,l. 4' ®.x,C /N<t"^�LP10 9 .YA:LY"'t'N F e&' 9 f :L. aa 't,•, ✓ 5 �' N 9 —————————— ————————————————————————————————— —————— ————— ————————————— ——————— 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 SERVICES, RECEIVABLE OR REDEEMABLE N ACCO DANCE WITH DISCOUNT PROGRAM RULES. UPOW DISCOUNT RECEIPT OR REDEMPTION, OU ARE RECEI ING OR WILL RECEIVE OTICE OF TIE DISCOUNT VALUE. FROM TIME TO TI E, MEDICARE, MEDICAID, TRI ARE OR THER PAYER MAY REQUEST INFORMATION REGARDING SUCH VALUE, P.ND UPON ANY S CH REQUEST, SU H VALUE MUST BE DISCLOSED AS A DI COUNT AGAINSI THE PURCHASE THAT EARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN THESE RECORDS. N - HENRY 3CHEIN, INC. HAS PURCHASED THE SPE IFIC UNIT OF THE PRESCRIPT ON DRUG DIRECTLY F OM THE MANUFACTURER. ---------- --------------------------------- ------ ----- ------------- ------- ---------- --------------------------------- ------ ----- ------------- ------- MERCHANDI E TOTAL 4787.63 Invoice Date + 30 days 4787.63 LEASE NOTE NEW REMIT TO ADDRESS lease remi payments only to the following a dress: ENRY SCHEIN INC. EPT CH 10211 ALATINE, 11, 60055-0241 BILL TO SHIP TO INVOI CE ITEM STATUS KEY REM KEY 1308571 1817102 9465383-01 4787 .63 B-Backordered:Item will follow SK-School Kit D-Discontinued:Item no longer available NC-No Charge H I RDER ORDER DATE INV I E DATE F B XE F-Special Schein Free Goods 2 8 12 8/28/12 3 g M-Manufacturer will ship Item directly to you 03116248 O S / / 1'-Prescription Drug:Return Authorization Required T MER P PA E R-Refrigerated Item:May be shipped separately $-Special Schein Pricing U-Temporarily unavailable:please reorder MARK 082812 3 OF 3 T-Taxable Item LP300 allEN ICY SCHEIN EMS 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 detective or does not perform or satisfactorily,we will provide a credit,refund,or exchange;it's your Bill Your Order To Y�,tir Open Ac..ount Available to li censed practitioners in the U.S.All invoices are choice. Simply call our customer service department within 30 days payable within 30 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 11 drugs can be ordered only by mail. International Orders: Please Note: Opened-handpieces and equipment may not be returned for We proudly serve healthcare professionals and governments but will ill be repaired or replaced in accordance with throughout the world.-TI o 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. .......... .... 7PIT 7,7• D 'W D 0 0 , VOUCHER NO. WARRANT NO. ALLOWED 20 Henry Schein IN SUM OF $ Dept Ch 10241 Palatine, IL 60055 $4,787.63 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO#/Dept. INVOICE NO. I ACCT#/TITLE AMOUNT Board Members 1120 I 9465383-01 1 102-390.11 I $4,787.63 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 SEP 10 2012 Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund Drescribed 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 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)) 9465383-01 $4,787.63 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