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Home My WebLink About214323 11/07/2012 CITY OF CARMEL, INDIANA VENDOR. 357526 Page 1 of 1 ONE CIVIC SQUARE HENRY SCHEIN INC ,.� CARMEL, INDIANA 46032 DEPT CH 10241 CHECK AMOUNT $1,270.58 4,,,raM do PALATINE IL 60055-0241 CHECK NUMBER. 214323 CHECK DATE. 1117/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 102 4239011 4358006-01 1, 001 58 SPECIAL DEPT SUPPLIES 102 4239011 4746529-01 269 00 SPECIAL DEPT SUPPLIES -- HSI 0lZ;ER# ORDER DIE IDUE DATE 04264423 10/15/12 11/14/129 D&B#-Ol 243-0880 WHSE DEA# RHO 162494 Fed ID- 11 3136595 CONTAINS MULTIPLE INVOICES .......... gym. mn ,C ME, This order as been processed by our MIDWEST 1) C 5315 WES" 74TH STREET INDIANAPOLIS,IN 46268 1ARK 175712663 174288784 1 857-0670 EA BERMAN AIRWAY 70MM SZ 2 12 12 0 27 3 24 7 2 857-0680 EA BERMAN AIRWAY SOMM SZ 3 12 12 0 27 3 24 8 3 857-6255 EA BERMAN AIRWAY 90MM SZ 4 12 12 0 27 3 24 7 4 857-9780 EA BERMAN AIRWAY 100MM SZ 5 12 12 0 27 3 24 8 5 857-8871 EA NASAL AIRWAY LF 24FR 12 12 2 25 27 00 8 6 857-3847 EA NASAL AIRWAY LF 26FR 12 12 2 27 27 24 8 7 857-3190 EA NASAL AIRWAY LF 28FR 12 12 2 27 27 24 7 8 857-6066 EA NASAL AIRWAY LF 32FR 12 12 2 27 27 24 8 9 890-6800 EA SHARPS SHUTTLE SINGLE USE P2 25 25 1 57 39 25 7 10 507-8362 ZX 100/BX NACL PREFILL SYRINGE 10ML ST 3 3 38 95 116 85 8 N - PEDIGR E ITEM DC 6380701 010 BILL TO SHIP TO INVOICE INVOICE AM ITEM STATUS KEY REM KEY 1308571 1817102 4358006-01 1001 58 B Backordered:Item will follow SK School Kit ) Discontinued:Item no longer available NC No Charge HSI QRQER# ORDER DATE INVOICE DATE # OF BOXES :P Special Schein Free Goods M Manufacturer will ship hern directly to you 04264423 10/15/12 10/15/12 8 11 Prescription Drug:Return Authorization Required 04 R Refrigerated Item:May be shipped separately CUSTOMER P PAGE $ Special Schein Pricing U Temporarily unavailable;please reorder T Taxable Item Continued on Next Page MARK 1 OF 3 9 LP300 HENRY SCHEINc SHIP TO/SOLD TO EIS Carmel Fire Department MI 135 Duryea Road, Melville, NY 11747 INVOICE 540 W 136 St Station 46 Michael Kaufmann Carmel IN 46032-8806 010000130857104358006110010000001001581015127 BILL TO Carmel Fire Dept MI 2 Civic Sq Carmel IN 46032-7543 Carmel Fire Dept BILL To I SHIP To I INVOICE AMOUNT 2 Civic Sq Carmel, IN 46032-7543 1308571 1817102 1001 58 INVOICE# 11 INVOICE DATE 4358006-01 10/15/12 CUSTOMER PO MARK HSI ORDER# ORDER DATE DUE DATE 04264423 10/15/12 11/14/12 D&B#'01 243-0880 WHSE DEA# RHO162494 Fed ID' 11 3136595 ... M g b 11 220-1652 EA COLLAR STIFNECK SELECT PEDI 50 50 5 50 275 00 7 12 153-6483 RX 250ML/BT STERILE WATER FOR IRRIG 250ML 48 48 C 1 10 52 80 4 N - PEDIGREE ITEM ASE GOOD I EM, MAY BE SHIPPED SEPARATELY DC 0033800 402 13 890-4524 EA KERLIX GAUZE RL STER 6PLY 4 5X4 1 200 200 C 1 30 260 00 6 ASE GOOD I CEM, MAY BE SHIPPED SEPARATELY 14 220-2270 EA THOMAS HOLDER F/ET TUBE ADULT 50 50 2 72 136 00 7 F YOU ARE ARTICIPATING IN A DISCOUNT PROGRAM (E G POIN S, GIFTS OR OTHER PECIAL AWA DS ("DISCOUNT")) , WITH THIS PURL SE YOU HAVE EARNED A CREDIT TOWARD GOODS OR SERVICES, RECEIVABLE OR REDEEMABLE IN ACCO DANCE WITH DISCOUNT PROGRAM RULES UPOF DISCOUNT RECEIPT OR REDEMPTION, OU ARE RECEI ING OR WILL RECEIVE OTICE OF THE DISCOUNT VALUE FROM TIME TO TI E, MEDICARE, MEDICAID TRI ARE OR THER PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE PND 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 CHEIN, INC HAS PURCHASED THE SPE IFIC UNIT OF THE PRESCRIPT ON DRUG DIRECTLY F OM THE MANUFACTURER MERCHANDI E TOTAL 1001 58 Invoice Date + 30 days 1001 58 BILL TO SHIP TO INVOICE# INVOICE AMOUNT ITEM STATUS KEY REM KEY 1308571 1817102 4358006-01 10 0 1 58 B Backordered:Item will follow SK School Kit HSI ORDER# ORDER DATE NV I E DATE # OF BOXES D Discontinued:Item no longer available NC No Charge F Special Schein Free Goods 10/15/12 $ M Manufacturer will ship Item directly to you 04264423 10/15/12 P Prescription Drug:Return Authorization Required U T MER PO p E R Refrigerated Item:May he shipped separately $ Special Schein Pricing U Temporarily unavailable:please reorder MARK 2 OF 3 T Taxable Item Continued on Next Page LP300 M HENRY SCHEIN;'o EMS SHIP TO/SOLD TO Carmel Fire Department MI 135 Duryea Road, Melville, NY 11747 INVOICE 540 W 136 St Station 46 Michael Kaufmann Carmel,IN 46032-8806 01000013085710435800611,0010000001001581015127 BILL TO Carmel Fire Dept MI 2 Civic Sq Carmel, IN 46032-7543 Carmel Fire Dept BILL To I SHIP To I INV�100158 2 Civic Sq Carmel, IN 46032-7543 1308571 1817102 INVOICE# INVOICE DATE 4358006-01 10/15/12 CUSTOMER PO MARK Please detach here and mail the above with your payment --- HSI ORDER# I ORDER DATE DUE DATE 04264423 10/15/12 11/14/12 D&B#O1 243-0880 WHSE DEA# RHO 162494 Fed ID 11 3136595 ... ........... . ........................ „ LEASE NOTE NEW REMIT TO ADDRESS Please remi payments only to the following a dress ENRY SCHEI INC EPT CH 10211 ALATINE I 60055-0241 BILL To SHIP TO INVOICE# INVOICE AMOUNT ITEM STATUS KEY REM KEY 1308571 1817102 4358006-01 10 O 1 58 H Backordered:Item will follow SK School Ku D Discontinued:Item no longer available NC No Charge HSI ORDER# ORDER ATE INVOICE DATE # OF BOXES F Special Schein Free Goods M Manufacturer will ship Item directly to you 04264423 10/15/12 10/15/12 8 P Prescription Drug,Return Authorization Required R Refrigerated Item:May be shipped separately CUSTOMER PO# PAGE $ Special Schein Pricing U Temporarily unavailable,please reorder MARK 3 OF 3 T Taxable Item LP300 !2 HENRY SCHEWK EMS make E>very(-,,sfo: -o rnaint<—pr€c,,�s°or the durat:or of a Payment by CHECK orbythe HENRYSCHEIN CREDIT CARD, cata:oci, %oov,--,P, we reserve[:n?J&soo make orice adlustMen:s VISA,MASTERCARD DISCOVER and AUERICAN EXPRESS response ,,manufant,:revs pace changes Guaranteed Satisfaction vrsa If 1,sou have tried a oroduC,a,:d it is d,-fec,.ive r does �otoertorn, or vve-vvik orov:de a credit,refund,w exchange it syuor y Avai:ab:c.to licensed practifior,:o-s:r.[!,e U A: :rroices are c�cojce simpov'al 0.--jr custor%-. servi�le deparr—er,vithi.r,30 days Pavab:;(-jvith:r-30 days. o' ecijot If the merc-andise'o arrange or the return. Fc a ,01,arrant,y,rpr)air or it vl— ,�-ero sev sonitathing yaU aia not )rae sinipi•call; Rx Products & Controlled Substances Matrx Medical 1-800-845-3550 R e u I a I i o: o q j L I S to 1 i Mh'Ile s a,:e;f Rx and.,o r ro;I I,,d substances oriv m -egistered, icensed health;rare professionals, I-'you are a-gew cus�-cmer oe'have r&,,e:tly moved,please fu. :s?l us�odth a copy y of your LJI'Mated state regstra.-Jon. F-c-r nor:r,)Iled substarlces,f,:rnish a copy of ,,our DEA certificate,veerify;ng yot shipping address, Class 11 drums can be orderoo only by—ail, International Orders Please Note. Wo proudly ser,,,haalt',:, re )rof(,:,,;k%naIsand governmonts t-rouqhout f:i�,,vor:d. o pace o,-,J?rs or or ':q, :es on export c:edit.but will be repa:ed or roplaco;d in acc-ordanc&,,,:,h terms arse or-.6fions.olease con act nou. Ir em-atonal manutaolurer warranties,Be!ore ooening ha~dpiecesor eauipment,',V0 S::QQn.St that you.heck he shipping cor.-ainer -800-845-335550 arms packing list to 'er:",that YOU'laVe'eCeiwPC exactlyprhat you ordered.Opened Computer Software is not returnable. Prescription Drug Returns Instructions Other restrictions may also apply A 9e: 1rn Aut„orization is Required or all`rescpfion Drugs .&'1PI'v call our Custonlpr Servic?Depat-ment 1-800-844-3550 HSI ORDER 4 ORDER DATE IDUE DATE 04265093 10/15/12 1 11/14/12 D&B#-01 243-0880 WHSE DEA# RHO162494 Fed ID- 11 3136595 4p, r7 .............. ;BOLL, rhis order has been processed by our MIDWEST 1) C 5315 WES" 74TH 3TREET INDIANAP LIS,IN 46268 V[ARK 317-27 .-2663 1 499-6926 PU EA SALT AIRWAY 10 10 C 20 28 202 80 1 CASE GOOD IFEM MAY BE SHIPPED SEPARATELY 2 644-3135 5/BX QUIKCLOT 25GM 2 2 33 10 66 20 2 F YOU ARE DARTICIPATING IN A DISCOUNT PROGRAM (E G , POINIS, GIFTS OR OTHER PECIAL AWAZDS ("DISCOUNT")) , WITH THIS PURC SE YOU HAVE EARNED A CREDI" TOWARD GOODS OR S]RVICES RECEIVABLE OR REDEEMABLE IN ACCOZDANCE WITH DISCOUNT PROGRAM RULES UPG1 DISCOUNT RECEIPT OR REDEMPTION, 'IOU ARE RECEIIING OR WILL RECEIVE \JOTICE OF TIE DISCOUNT VALUE FROM TIME TO TI E, MEDECARE MEDICAID TRI ARE OR DTHER PAYER MAY REQUEST INFORMATION REGARDING SUCH VALUE, PND UPON ANY STCH REQUEST SU-H VALUE MUST BE DISCLOSED AS A DI COUNT AGAINS I THE PURCHASES THAT EARNED SUCH VALUE ACCORDINGLY YOU SHOULD RE"AIN THESE RECORDS MERCHANDI E TOTAL 269 00 Invoice Date + 30 days 269 00 BILL TO SHIP TO INVOICE# INVOICE AMOUNT ITEM STATUS KEY r—K-E—M_KEY 1308571 1308572 4746529-01 269 00 13 Backordered:Item will follow SK School Kit HSI ORDER# ORDER DATE INVOICE DATE # OF BOXES Discontinued:Item no longer available NC No Charge Special Schein Free Goods M Manufacturer will ship Item directly to you 04265093 10/15/12 10/15/12 2 11 Prescription Drug,Return Authorization Required CUSTOMER PO# R Refrigerated Item:May be shipped separately PAGE# $ Special Schein pricing U Temporarily unavailable,please reorder MARK 1 OF 2 T Taxable Item Continued on Next Page LP300 j HENRY SCHEINO E � SHIP TO/SOLD TO OICE Carmel Fire Dept Head Quarters MI 135 Duryea Road, Melville, NY 11747 2 civic Sq Carmel IN 46032-2584 0100001308571047465291100100000002690010151127 BILL TO Carmel Fire Dept MI 2 Civic Sq Carmel IN 46032-7543 Carmel Fire Dept BILL To I SHIP To I INVOICE AMOUNT 2 Civic Sq Carmel, IN 46032-7543 1308571 1 1308572 269 00 INVOICE# INVOICE DATE 4746529-01 10/15/12 CUSTOMER PO MARK Please detach here and mail the above with your payment HSI ORDER# I ORDER DATE IDUE DATE 04265093 10/15/12 11/14/12 D&B#O1 243-0880 WHSE DEA# RHO162494 Fed ID- 11 3136595 :. W . .m < ::. :Y .. ,.... ..�.... .•., �"y� tit {"a. ,. i � LEASE NOTE NEW REMIT TO ADDRESS Please remi payments only to the following address ENRY SCHEIi INC EPT CH 10211 ALATINE, I 60055-0241 B LL To SHIP TO INVOICE#INVOICE INVOICE AMOUNT ITEM STATUS KEY REM KEY 1308571 1308572 4746529-01 269 00 H Backordered:Item wiufollow SK school Kit D Discontinued:Item no longer available NC No Charge HSI RD R ORDER ATE INVOICE DATE: F B XE P Specal Schein Free Goods 0 4 2 6 5 0 9 3 10/15/12 10/15/12 2 P M Manufacturer will ship Item directly you Prescription Drug,Return Authorization Required CUSTOMER PO# PAGE# R Refrigerated Item:May be shipped separately $ Special Schein Pricing U Temporanly unavailable:please reorder MARK 2 OF 2 T Taxable Item LP300 r A HENRY SCREW`{: EMS Payment by CHECK or by the HENRY SCHEIN CREDIT CARD caia:na. I�,e reserve the right to make pride andjustMent's VISA,MASTERCARD,DISCOVER and AMERICAN EXPRESS fesporse to manufactzers orice.changes Guaranteed Satisfaction vrsn or If vou have t•lpd aOroduc�'a!:d it is delec,,ive of does 1.ot.,c)ertorn- satisrac,'-';rily we�,il:Proi,:de a credit,refund,of ex:hange-it s Vour Availabie to licensed Pracfi1:(,;r:e,cz:r-t:�,e U S A. jc,o�s are cnojce Sim piv call our customer S,-. ice deoadrner',!'hin 30 days ot pavabo',xitf,-ir.30 days : 1�n arrange-or the ret-irn. F0 a 14,arrantv ';.clair or it von ,,vero sert something !ou aid riot orjat;: --pl,.,rall: Rx Products & Controlled Substances Matra Medical 1-800-845-3550 Regulations-oquirel US to ling: --ie saieut Rx anc roi°rolled .ubstarces o?-:y to registered, icpnsedhealthcare p,ofessionals. I`you are a qew customer or have reue'tly moved,please fu :s!i us odtl- a co-DV Of'."our updated state registration. F6•�Oruolled bubstances,tarnish acopy of your DEA ceiiqikafe,,Aerif'y:ng yot'r shipping address. Class 11 dru=s ran be orderoc only b' ail. y International Orders Please Note prrudly serve healt'are xafes�ionials and gowrnments UnMe.i avfinfluerel:1 led'o'r Of t'Ulf 0 r 'i credit.but vvill be r;;pa't_'d&replaced in accord"ance..,wh terms ai1c, C. ions.Tease ou. k-'erraJonal'L—)epainient: manufactu.)r waurant::.,,.Botore ooening ha.:dpeceS or -800-845-35 05, equipment,ere&,:west licit you;heck )e si;ppnq con,ainer and plaok:ng list to vi�—f!V I tria,ycai :ave rp.-cei'ea exactly ,,,,hat Prescription Drug Returns Instructions you ordered,Opened Computer Software is not returnable. Other restrictions may also apply A Return A0,orization is ReqUired.,or all 'escriprion r"rUgs C,�:Pl'v.,-all -ompr Serdcp Depar ment our 1-80(0 8aD-3550 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)) 4746529-01 $26900 4358006-01 $1 001 58 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 $1,27058 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO#/Dept. INVOICE NO ACCT#/TITLE I AMOUNT Board Members 1120 4746529-01 102-390 11 j $26900 1 hereby certify that the attached invoice(s), or 1120 4358006-01 102-39011 $1,001 58 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 V -- 5 2012 Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund