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Home My WebLink About215334 12/11/2012 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1 ONE CIVIC SQUARE HENRY SCHEIN INC CARMEL, INDIANA 46032 DEPT CH 10241 CHECK AMOUNT: $1,645.21 PALATINE IL 60055-0241 CHECK NUMBER: 215334 CHECK DATE: 12/1112012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 102 4467006 46967495-01 1, 645 . 21 EMS EQUIP A HENRY SCHEIN SHIP TO/SOLD TO: EMSCarmel Fire Dept Head Quarters MI 135 Duryea Road, Melville, NY 11747 INVOICE 2 Civic Sq Carmel,IN 46032-2584 010000130857104696495110010000001645211127123 BILL TO: Carmel Fire Dept MI 2 Civic Sq Carmel, IN 46032-7543 Carmel Fire Dept BILL TO SHIP TO 2 Civic Sq INVOICE AMOUNT Carmel, IN 46032-7543 1308571 1308572 1645.21 INVOICE# INVOICE DATE 4696495-01 11/27/12 CUSTOMER PO MARK Please detach here and mail the above with your payment _ HSI ORDER# ORDER DATE IDUE DATE 05395110 11/27/12 12/27/12 D&B#:01-243-0880 WHSE DEA# RHO162494 Fed ID: 11-3136595 r. x, .... .... ,... �.........:.rte...... ..r..............r.....1„ ....r[.....r Y' .5 .s` .:................ » , . x .... ....•a.. ........................k........................✓.. ......,..... .�... >. ..r .. ..,X?"". ................s? s....f.•.i.s :... ^ ^.5#'Y :N?33L�rriEt[r .... ..#:..... .... s.�.�.'�...�... .............. .:.,,..mom:..:<cr.. .3, .o zr MERCHANDISE TOTAL 1645.21 invoice Date + 30 days 1645.21 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 sxlP To INVOICE# INVOICE AMOUNT ITEM STATUS KEY REM KEY 1308571 1308572 4696495-01 16 4 5.21 B-6acl:ordered:Item will follow sK-school Kit D-Discontinued:Item no longer available NC-No Charge HSI ORDER# ORDER DATE INVOICE DATE it OF BOXES P-special Schein free Goods M-Manufacturer will ship Item directly to you 05395110 11/2 7/12 11/27/12 3 P-Prescription Drug:Return Authorization Required R-Refrigerated Item:May be shipped separately CUSTOMER PO# PAGE $-special Schein pricing MARK 2 �F 2 T-Te able r lm unavailable:please reorder LP300 ..................... .............................................. ............... ................................. . ..... ..... ................................................ .................. ... .......... �N CHEW EMS � u �....:. EE < , ....... .................._ __ .. . ......... ....... ...... ............ ..................... .. . :",fe make e very 00 t rraintain prices for the durafioi of a Payment by CHECK or by the HENRY SCHEIN CPCIIIT CARD, cataioe�,he r, ve,title reserve the right to make rice adjustments it VISA,MAST 'CARD, ISCOV R and MERICA " P S response to manufactr<rers`price d�lanoes Guaranteed Sati f ctiow vrsa Jf you hate tried a orodu;,t and it is defective'or does g of oerfornii �� st tisfactorily<1i+'e vvili provide a credit,refund,or exchange-,it's your r ; A,vai:able to licensed practitior ors r #:e U.C.Aii ir1voi,DA are c� is . inip�,all ,ur costa::: r se:five decartr er ::hi c'C ays pa'«ble,rri#bin:J 9a;s, of receipt of the rner ha-i-4se to arrange for the return. For a 1.'arranty repair or it you ,;ere sent something yo:l+id of or4er> S: ply call: &x Products Controll d Substances: ( trx Medical °1-800-845-3550 Regulat o s regke r s to lim t'he sa of �x anc controlled substances oniv to registered,Ilcensed healthcare professionals, I'you are a neDw customer or have recentlyl moped,'-lease furnish us i�.ith:.a copy of.tour updated state registration. Ecr controlled substantces,furnish a cop±{of your DEA certificate,verifyiYeg your shipping address. Class ll drr<r�s car;to ordered only b', r ail. Int rn tion l Orders: Please note: Cp p na, v Y fe proudly er`o healthcare prrefe:?sionals and governme nts ete� hand i es and er uipmen'r av riot be retr<r,ed f'„r t rcu bout t ie tix<�rrd. �o ace Urtf?rs or fDor .. �s on ex_v t credit;but:fill be repaired or replaced in accordance 0) g t�l gu r w D p ; terms anc conditions,please:,ont_.ct our In4ernational U partment, manufactu?,x;^arrant e�s,13fafore ope nirig hra dp eces or �C0 8�5 eo:,lpment, ,,e s:ggest that you c heck tiie siiipping containe r an d ducking list to yeti y that you i ave received exactly what r ��rl tl n �ru turn lrt tru tl n a you crdered.Opened Computer Software is not returnable. Other restrictions ray also apply. A:Return Authorization is Required for ati=res�.rrption-Drugs.&-ply call our Customer Service Department :1.8:03.845"..3550, ...................... <.. .�.. ::. ....a § 5�' `: . s 4 i. .............xk„a,..,�......<..x.v¢,,..... .. ......... ,nom....#... ... �, < .<.< s ......................................._ ....................... .<....... ... <ElAauf E #:['[[[ ... H—SI ORDER# I ORDER DATE 0 5395110 11/27/12 12/27/12 D&B#:01-243-0880 WHSE DEA# RHO]62494 Fed ID: 11-3136595 A r i- mW ,M �71 N This order has been processed by our MIDWEST B.C. 5315 WES" 74TH TREET INDIANAP LISJN 46268 317-428-878 MARK 1 590-3688 100/EX PURELL SANITIZING WIPE OD HANDS 1 1 3.71 3.71 3 2 499-0652 EA PENLIGHT METALITE 12 12 2.25 27.00 3 3 206-8985 EA WALL HOLDER F/690 THERMOM 2 2 33.25 66.50 1 4 120-8895 EA QUICK CARE HOLDER 15 OZ 12 12 2.75 33.00 3 5 220-1398 3/ST BODY STRAP SET DISP YELLOW 300 300 5.05 1515.00 1 YOUR ORDER )5395110 HAS BEEN SPLIT INTO MULTIPLE SHIDMENTS. CERTAIN ITEMS WILL BE SHIPPED 3EPARATELY. YOU WILL BE BILLED FOR THESE ITEMS VHEN THEY ARE sHIPPED. IF YOU ARE 3ARTICIPATING IN A DISCOUNT PROGRAII (E.G. , POINTS, GIFTS OR OTHER SPECIAL AWA DS ("DISCOUNT")) , WITH THIS PURCHASE YOU HAVE EARNED A CRED Ir.. TOWARD GOODS OR S RVICES, RECEIVABLE OR REDEEMABLE :N ACCORDANCE WITH DISCOUNT PROGRAM RULES. UP04 DISCOUNT RECEIPT OR REDEMPTION, 'IOU ARE RECEI ING OR WILL RICEIVE ITOTICE OF TIE DISCOUNT VALUE. FROM TIME TO TIME, MEDICARE, MEDICAID, TRITARE OR DTHER PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, PND UPON ANY SJCH EQUEST, SU,'H VALUE MUST BE DISCLOSED AS A DISCOUNT GAINS I THE PURCHASES THAT ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RETAIN TH SE RECORDS. BILL TO SHIP TO INVOICE INVOICE AMOUNT ITEM STATUS KEY REM KEY 1308571 1308572 4696495-01 1645 .21 H-Backordered;Item will follow SK-School Kit H ORD # ORDER DATE INVOICE DATE If OF BOXES D-Discontinued;Item no longer available NC-No Charge F-Special Schein Free Goods M-Manufacturer will ship Item directly to you 05395110 11/27/12 11/27/12 3 P-Prescription Drug:Return Authorization Required CUSTOMER PO# PA # R-RefriEcrated Item:May he shipped separately $-Special Schein Pricing U-Temporarily unavailable:please reorder MARK 1 OF 2 T-Taxable Item Continued on Next Page.......... LP300 VOUCHER NO. WARRANT NO. ALLOWED 20 Henry Schein IN SUM OF $ Dept Ch 10241 Palatine, IL 60055 $1,645.21 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 46967495-01 $1,645.21 I 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 DFC 1. 6 2012 r 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)) 46967495-01 $1,645.21 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