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Home My WebLink About215042 12/04/2012 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1 ONE CIVIC SQUARE HENRY SCHEIN INC CARMEL, INDIANA 46032 DEPT CH 10241 CHECK AMOUNT: $3,159.67 PALATINE IL 60055-0241 ,o„ a CHECK NUMBER: 215042 CHECK DATE: 12/4/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 102 4239011 2643991-01 197 . 95 SPECIAL DEPT SUPPLIES 102 4239011 8237662-01 44 . 00 SPECIAL DEPT SUPPLIES 102 4239011 8794248-01 2, 917 . 72 SPECIAL DEPT SUPPLIES Hsi ORDER ORDER DATE��. D.I. 05250113 11/19/12 12/19/12 D&B#:01-243-0880 WHSEDEA# RHO162494 Fed ID: 11-3136595 CONTAINS MULTIPLE INVOICES M�.. T'W"OK11 ........... .................... AM This order has been processed by our MIDWEST D.C. 5315 WE SrL 74TH TREET INDIANAPoLIS,IN 467268 iARk 317-57L-2663 1 692-4964 EA FIRST AID KIT50 PERSON OD WTRPRF 10 10 15.15 151.50 1 2 777-4466 12/BX COBAN SELF ADH WRAP 3X5 NEON 1 1 21.25 21.25 1 3 777-2865 30/BX COBAN SELF-ADH WRAP BLUE 1"X5YD 1 1 25.20 25.20 1 IF YOU ARE 3ARTICIPATING IN A DISCOUNT PROGRA31 (E.G. POIN'lS, GIFTS OR OTHER SPECIAL AWA DS ("DISCOUNT")) , WITH THIS PURCHASE YOU HAVE EARNED A CREDI TOWARD GOODS OR SERVICES, RECEIVABLE OR REDEEMABLE :N ACCOZDANCE WITH DISCOUNT PROGRAM RULES. UPOR DISCOUNT RECEIPT OR REDEMPTION, IOU ARE RECEI`,ING OR WILL RICEIVE NOTICE OF THE DISCOUNT VALUE. FROM TIME TO TI E, 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 DI COUNT GAINS l THE PURCHASE THAT EARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE-AIN THESE RECORDS. MERCHANDI E TOTAL 197.95 Invoice Date + 30 days 197.95 13ILL TO -SHIP TO INVOICE# INVOICE AMOUNT ITEM STATUS KEY f— REM KEY 1308571 1308572 2643991-01 197 .95 B-Backordered:Item will follow SK-School Ki t H ORDER# ORDER DATE INVOICE DATE # OF 13OXES D-Discontinued:Item no longer available NC-No Charge F-Special Schein Free Goods M-Manufacturer will ship Item directly to you 05250113 11/19/12 11/19/12 1 11-prescription Drug:Return Authorization Required R-Refrigerated Item;May be shipped separately CUSTOMER PO# PAGER $-Special Schein Pricing U-Temporarily unavailable:please reorder MARK 111912 1 OF 2 T-Taxable Item Continued on Next Page.......... LP300 ENI Y SCHEIN E SHIP TO/SOLD TO: Carmel Fire Dept Head Quarters MI 135 Duryea Road, Melville, NY 11747 2 Civic Sq INVOICE Carmel,IN 46032-2584 0100001 30857102643991110010000000197951119120 BILL TO: Carmel Fire Dept MI 2 Civic Sq Carmel, IN 46032-7543 Carmel Fire Dept BILL To I SHIP TO INVOICE AMOUNT 2 Civic Sq Carmel, IN 46032-7543 1308571 1308572 1 197 .95 INVOICE# INVOICE DATE 2643991-01 11/19/12 CUSTOMER PO MARK 111912 Please detach here and mad the above with your payment HSI ORDER# I ORDER DATE DUE DATE 05250113 11/19/12 12/19/12 D&B#:01-243-0880 WHSE DEA# RHO 162494 Fed ID: 11-3136595 ,s ....._.....:: :$'= €rw # �:. . �: : ..«s LEASE NOTE NEW REMIT TO ADDRESS Please remi payments only to the following address: ENRY SCHEI INC. EPT CH 10211 ALATINE, I 60055-0241 BILL TO SHIP TO INVOICE# INVOICE AMOUNT ITEM STATUS KEY [7REM KEY 1308571 1308572 2643991-01 19 7.95 13-Backordered;Item will follow school Kit D-Discontinued:Item no longer available NC-No Charge H I ORDER# ORDER DATE INVOICE DATE # OF BOXES F-Special Schein Free Goods 19 12 11/19/12 1 M-Manufacturer will ship Item directly to you 05250113 11 / / 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 111912 2 OF 2 T-Taxable Item LP300 ................. ..... ...... HENRY CHEIN ERAS < .... . .................................. ...... ............ . ....... make every off{ `.fo.maint<:n prices for the d€ur at'o of a Payment by CHECK or by the HEN Y S tfEIN CREDITCARD, catalog,' >r,evs , r.e reserve t n riuht to roe ri e j ustMen s in VISA,MASTERCARD,DISCOVER and AMERICAN EXPRESS response fo manufacti<rers`price chances Guaranteed Satisfaction: If voE;have tried a uroduc:and it is defective or rues got erfor,; sates actoril.#,Yve wil orcv:rte a credit, refund,or exchange-it s vour or .. choice, it .p y rat our cu td er Sen.'ice departr ent 1.'i°her, .3 days Available:to licensed practitioners in the U.S.All invoices are of re-cei;t of the rnerc�a d:se to arrange or the retum. far a pa;<;b —ith r ;d<;.'s. 14'arrant°x r€zc3air or it vo:.:;';ere sent somcthi ng you did riot ord#: , :iir'ply call. x Products & Controlled Substances: Matrx Medical 1-80w - 0 Regulatio s require us to limit the sale of Rx and;nrltrolle d substances oily to registered,licensed healthcare professionals. I3 you are a new customer or have recently moved,please fur,:Sh us,,r,#ith a copy of your ul„ ated state registration. For controlled substances,l<rnish a copy of your DEA certificate,verifyir°g yo:,:r shipping address. Glass ll dru=gs car:be ordered only by -.ail. International Orders: Please Note. ---------------- O'er?ed f and 1e 8S and equipment r"S` riot be returned for `Yre proudly serve healthcare frcfessionais and governments Opened. p y throughout the world, To place orders or for it rtuiries on export credit:but vrvitl be r£epa red or replaced in actor=dance.=dish manufantr r,r 4"arrant e•s.Before wening handPecas or terms ar!5 t3550t v"S.uleaSe CCrI[aSt C;U'I"erf`ati 3 Sal E�a'trTl?rlt; e=.:uipment,we siuggeSt that,,'ou:.heck the shipping co lain;r .-8{C3-84.��V ar#d ua;kind list tc`,te'ify t.at you nave received exactly;what yo:r ordered.Opened Computer Software is not returnable, rescri icon drug e urns lr� tru tic�n : Other restrictions may also apply. A return Authorization:is Required for all Pres ription i:.3rugs.Si iply call our Customer Service Department t-800-845-3550, M................ _.......k:<::_:_..:......................................... .. ,. .....,.. ..<.<.....,...................�.<..... < x:. or ........................,�...i..._..iili?lliil€ill s:...€ ...,.. .... :. ......«.......................,._.._.. ......:::::<........ ....�.�.:.:.:.:..:.: ::...._:.< .. .. ....,..... ...3........:.�:iii:c'.^.�::��:.::�y: ...... r.�..<`.... Please detach here and mail the above with your payment HSI ORDER# ORDER DATE IDUE DATE 05284871 11/20/12 12/20/12 D&B#:01-243-0880 WHSE DEA# RHO]62494 Fed ID:04-2527923 M1, IS ' �N 1111ifiv Vl-;` his order as been processed by our MIDWEST D.C. 5315 WES" 74TH 3TREET INDIANAP LIS,IN 46268 1 153-6648 100/BX BIOHAZARD BAG 23X23 RED 23"X23" 4 4 C 11.00 44.00 1 —ASE GOOD IrEM, MAY BE SHIPPED SEPARATELY. IF YOU ARE PARTICIPATING IN A DISCOUNT PROGRAI (E.G. POINIS, GIFTS OR OTHER SPECIAL AWA DS ("DISCOUNT") ) , WITH THIS PURCHASE YOU HAVE EARNED A CREDI TOWARD GOODS OR SERVICES, RECEIVABLE OR REDEEMABLE IN ACCORDANCE WITH DISCOUNT PROGRAM RULES. UPOR DISCOUNT RECEIPT OR REDEMPTION, OU ARE RECEI-vING OR WILL R17CEIVE OTICE OF T DISCOUNT VALUE. FROM TIME TO TIME, MED-CARE, MEDICAID, TRICARE OR DTHER PAYER MAY REQUEST INFORMATION REGARDING SUCH V%LUE, PND UPON ANY STCH REQUEST, SU-H VALUE MUST BE DISCLOSED AS A DI COUNT %GAINS r1 THE PURCHASE!; THAT EARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD kE-AIN THESE RECORDS. MERCHANDI E TOTAL 44.00 nvoice Date + 30 days 44.00 LEASE NOTE NEW REMIT TO ADDRESS Please remi: payments only to the following aldress: HENRY SCHEI4 INC. DEPT CH 10211 PALATINE, 1, 60055-0241 BILL TO SHIP TO INVOICE INVOICE AMOUNT ITEM STATUS KEY REM KEY 1308571 1308572 8237662-01 44 .00 B-Backordered;Item will follow SK-School Kit H�l ORDERIf ORDER DATE INVOICE DATE # OF BOXES D-Discontmued;Item no longer available NC-No Charge F-Special Schein Free Goods N1-Manufacturer will ship Item directly to you 05284871 11/20/12 11/20/12 1 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 HULETT 1 OF 1 T-Taxable Item LP300 We make evervo��tomninfaiin &urahmo t Payment by CHECK or by the HENRY SCHEIN CREDIT CARD, bg.howove:wemnxmthe right sko make Price adjuaknonisi: VISA,MASTERCARD,DISCOVER and AMERICAN EXPRESS response tomanufa,-�turem`phneuhangoa Guaranteed Satisfaction: or K vu,have(:edepmduC�and i{indofodivenrdneonotpednrn: ooUS�8doh|y.w,ewi||pmvidne credit,refund,nrexnhange it's your Available to licensed pradifionors:n the US,All invoices are ohninn, Simply oa||nurcustumerun w\ ithin30day � payable idthin 30 days, ��oiot of the mumhaod|now arrange for the return. Fora wunany ircvityoownro sent something you did not orda/. S:mply Rx Products & Controlled Substances: MatKx Medical 1~800-845~3550 Rngu|ahn»omquim Lis(o limit the sale of Rx and nnn|m||od substances u:|yto r-aidemd.|ioonaed healthcare Professionals. V you are a new cuu|ume'or have moenU;moved,please furnish un*itha co pyu(youruildatads4ateegistmhnn, Furunn|mUed substances,[:misha copy o|ynu/DEA certificate,varity|ngyn:r shiypingaddreo , Class Udrugooanbaordered only b'ymai). Please Note: International Orders: enedhandp�000endnquipmen�mayooibae8:med|nr Wepmud|;aoneho��rx�pm�y �na|n and governments credit'bu��iUborepa|�adorrop!a�odinaccc�ancuwi|h |hmuQhuutthe wor!d, Tu place o�o'onrinr|:qo/�|ennnexpn� -- ' terms and uondi1ioonp|ooyncon�u\uor|n�omahnno|Depa�moo�, manufacturer warranUeo,Bo|nronpnoinUha�dpien000r 1'8O0'D45'3560 ' eqxipmont.weooggen1\h�youchonk the nh|p | ioer ondpaoking list tuver|ty\h�you have received exmoUywh� �mo�nredl�'anodCom \oSoftwareianotr*turnab|e. Prescription Drug Returns Instructions: Other restrictions may also apply, ARe|um Authorization isRoquimUfor all Preao'iphnnDmge Sin:p/yne|} our Customer Service Department 1-800'84�''3560, AE HSI ORDER# ORDER DATE IDUE DATE 05160436 11/14/12 12/14/12 D&B#:01-243-0880 WHSEDEA# RHO]62494 Fed ID: 11-3136595 621:1 his order as been processed by our MIDWEST D.C. 5315 WES" 74TH TREET INDIANAP LIS,IN 46268 14ARK 317-423-8784 = -------------------------------------- ------------- ------- ---------- 1 338-2276 PU 100/CA EXTENSION SET STD BORE UL 3 3 C 224.00 672.00 3 CASE GOOD ICEM, MAY BE SHIPPED SEPARATELY. 2 602-8100 EA COLLAR STIFNECK SELECT ADULT 100 100 C 5.75 575.00 5 CASE GOOD IPEM, MAY BE SHIPPED SEPARATELY. 3 496-6428 100/BX LANCET SURGILANCE GRAY 23G 1.8 4 4 10.00 40.00 12 4 120-8808 EA COMBITUBE ROLL-UP KIT 41FR 6 6 40.96 245.76 12 5 555-1166 PU EA, PROTECTIV ACUVNC SFT CATH 18X1.25 150 150 2.73 409.50 12 6 555-5396 PU EA PROTECTIV ACUVNC SFT CATH 20X1.25 200 200 C 2.73 546.00 7 'ASE GOOD IFEM, MAY BE SHIPPED SEPARATELY. 7 499-6154 EA NONREBREATHER MASK W/VENT PEDI 100 100 C 1.26 126.00 9 CASE GOOD IrEM, MAY BE SHIPPED SEPARATELY. 8 499-5736 EA MASK MED 02 &TUBG&NOSECLP PEDIATR 50 50 0.85 42.50 12 9 120-2066 EA QUIK-CARE FOAM SANITZR OD 150Z 24 24 C 7.63 183.12 11 CASE GOOD ITEM, MAY BE SHIPPED SEPARATELY. 10 507-8362 100/BX NACL PREFILL SYRINGE 10ML ST 2 2 38.92 77.84 12 BILL TO SHIP TO INVOICE14 INVOICE AMOUNT I ITEM STATUS KEY r7iRTM KEY 1308571 1817102 8794248-01 2917 .72 H-flackordcred:Item will follow SK-School Kit HSI ORDER# ORDER DATE INVOICE DATE # OF BOXES D-Discontinued.item no longer available NC-No Charge F-Special Schein Free Goods M-Manufacturer will ship Item directly to you 05160436 11/14/12 11/14/12 13 11-Prescription Drug:Return Authorization Required R-Refrigerated Item:May be shipped separately CUSTOMER PO# PAQE# $-Special Schein Pricing U-Temporarily unavailable:please reorder MARK 1 OF 2 T-Taxable Item Continued on Next Page.......... LP300 REENRY SCHEIN' A� SHIP TO/SOLD TO: EMSCarmel Fire Department MI 135 Duryea Road, Melville, NY 11747 INVOICE 540 W 136 St Station 46 Michael Kaufmann Carmel,IN 46032-8806 0100001308571087942481 100100000029177211114125 BILL TO: Carmel Fire Dept MI 2 Civic Sq Carmel, IN 46032-7543 Carmel Fire Dept BILL TO SHIP To INVOICE AMOUNT 2 Civic Sq Carmel, IN 46032-7543 1308571 .817102 2917.72 INVOICE INVOICE DATE 8794248-01 11/14/12 CUSTOMER PO MARK --- Picase detach here and mail the above with your pa}'mcni — HSZ ORDER# ORDER DATE DUE DATE 05160436 1 11/14/12 1 12/14/12 D&B#:01-243-0880 WHSE DEA# RHO 162494 Fed ID: 1 1-31 36595 �b, -,•E;'x'' "' Y .Hf;:^;..i ,3, =< ��',��/ w,�»•:b,(';=`F',e�.�` =,.<_' `:' �$ F'i' ='Z lf .p `�� '�u1•^,., f-. •,�i?'i. .o �g'r 4$`�','='• •j4�,,,p.. ``,v',!=r. "•"`'-.+:-�' :sm 14N - PEDIGREE ITEM. DC:6380701 010 ---------- --------------------------------- ------ ----- ------------- ------- ---------- --------------------------------- ------ ----- ------------- ------- F YOU ARE ARTICIPATING IN A DISCOUNT PROG (E.G. POIN S, GIFTS OR OTHER PECIAL AWA DS ("DISCOUNT")) , WITH THIS PURL SE YOU HAVE EARNED A CREDI TOWARD GOODS OR SERVICES, RECEIVABLE OR REDEEMABLE IN ACCORDANCE WITH DISCOUNT PROGRAM RULES. UPOq DISCOUNT RECEIPT OR REDEMPTION, OU ARE RECEI ING OR WILL R CEIVE OTICE OF T E DISCOUNT VALUE. FROM TIME TO TIME, MED CARE, MEDICAID, TRI ARE OR THER PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, PND UPON ANY S CH REQUEST, SUM VALUE MUST BE DISCLOSED AS A DI 3COUNT AGAINSI THE PURCHASES THAT EARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN THESE RECORDS. N - HENRY 3CHEIN, INC. HAS PURCHASED THE SPE IFIC UqIT OF THE PRESCRIPT ON DRUG DIRECTLY F OM THE MANUFACTURER. MERCHANDI E TOTAL 2917.72 nvoice Date + 30 days 2917.72 LEASE NOTE NEW REMIT TO ADDRESS Please remi payments only to the following a dress: ENRY SCHEI4 INC. DEPT CH 10211 ALATINE, I 60055-0241 BILL TO SHIP TO INVOICE# INVOICE Am6uNT ITEM STATUS KEY REM KEY 1308571 1817102 8794248-01 2 917.7 2 s-backordered:Item will follow SIC-School Ki t D-Discontinued:Item no longer available NC-No Charge H I RDER ORDER DATE INVOICE DATE S XE 11-Special Schein Free Goods M-Manufacturer will ship Item directly to you 05160436 11/14/12 11/14/12 13 P-Prescription Drug:Return Authorization Required R-Refrigerated Item:May be shipped separately CUSTOMER PO# PAGE $-Special Schein Pricing U-Temper a nly unavailable:please reorder MARK 2 OF 2 T-Tasableltem LP300 3i ! i HENRY SCHEIN 0} 1 i EMS ��. `� ,)F AL ___-_____------------____-----.._._______........_____....~__________............____._____________......_______..___-----.._____.._........ i Payrnfli�i'Terrw,: 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: v►sa It you have tried a product and it is defective or does not perform or Dili Yorrr tt. er. Your Open per , .ot€rat satisfactorily,we will provide a credit,refund,or exchange;it's your choice. Simply call our customer service department within 30 days Available licensed practitioners in the U.S.All invoices are of receipt of the merchandise to arrange for the return. Fora payable within 30 clays. warranty repair or if you were sent something you did not order; simply calf: Rx Products & Controlled Substances: Matra 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 Note V"Ye proudly serve healthcare professionals and governments Opened t will beces and equipment may not rd returned for throughout the world. To place orders or for inquiries on export credit,but will be repaired or replaced in accordance with terms and conditions,please contact our International Department; manufacturer warranties, Before opening handpieces or 1-300-845-3550 equipment,,.,e suggest that you check the shipping con airier and packing list to verity that you have received exactly what Prescription Drug Returns Instructions: ycu ordered.tOpened 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. IPn.r_ VOUCHER NO. WARRANT NO. ALLOWED 20 Henry Schein IN SUM OF $ Dept Ch 10241 Palatine, IL 60055 $3,159.67 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO#/Dept. INVOICE NO. ACCT#!TITLE AMOUNT Board Members 1120 2643991-01 102-390.11 j $197.95 1 hereby certify that the attached invoice(s), or 1120 8794248-01 102-390.11 $2,917.72 bill(s) is (are) true and correct and that the 1120 I 8237662-01 1 102-390.11 I $44.00 materials or services itemized thereon for which charge is made were ordered and received except b Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund 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)) 2643991-01 $197.95 8794248-01 $2,917.72 8237662-01 I I $44.00 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