215886 12/25/2012 f CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1
0 ONE CIVIC SQUARE HENRY SCHEIN INC
CARMEL, INDIANA 46032 DEPT CH 10241 CHECK AMOUNT: $79.54
PALATINE IL 60055-0241 CHECK NUMBER: 215886
CHECK DATE: 12/25/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 4239011 4696604-02 79 . 54 SPECIAL DEPT SUPPLIES
LHsI ORDER ORDER DATE IDUE DATE:
o
5 39slio 11/27/12 01/02/139
D&B#:O 1-243-0880
WHSE DEA# PG0229321 Fed ID: 11-3136595
'M:
..........—'r-
. ... ....
'PM M
his order as been processed by our GIV D.C.
80 SUMMI" VIEW LANE
BASTIAN VA 2434
317-428-8781 MARK
----- -------=====-------
1 116-0999 EA DISPENSER F/EMESIS BAG 2 2 39.77 79.54 1
IF YOU ARE DARTICIPATING IN A DISCOUNT PROGRAM (E.G. POINTS, GIFTS OR OTHER
SPECIAL AWARDS ("DISCOUNT") ) , WITH THIS PURL SE YOU HAVE EARNED A CREDI" TOWARD
GOODS OR S,3RVICES, RECEIVABLE OR REDEEMABLE :N ACCORDANCE WITH DISCOUNT PROGRAM
RULES. UP04 DISCOUNT RECEIPT OR REDEMPTION, IOU ARE RECEI ING OR WILL RECEIVE
KOTICE OF T DISCOUNT VALUE. FROM TIME TO TIME, MEDECARE, MEDICAID, TRI('ARE OR
DTHER PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, TND UPON ANY STCH
REQUEST, SU"H VALUE MUST BE DISCLOSED AS A DI COUNT GAINS 7 THE PURCHASE, THAT
EARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE'AIN THESE RECORDS.
MERCHANDI ;E TOTAL 79.54
Invoice Date + 30 days 79.54
LEASE NOTE NEW REMIT TO ADDRESS
Please remi-_ payments only to the following aidress:
HENRY SCHEI4 INC.
DEPT CH 10211
PALATINE, 1, 60055-0241
BILL TO SHIP TO INVOICE# INVOICE AMOUNT ITEM STATUS KEY REM KEY
1308571 1308572 4696604-02 79.54 H-Backordered:Item will Jollo,v SK-School Kit J
HSI ORDER# ORDER DATE INVOICE DATE # OF BOXES 1)-Discontinued:Item no longer available NC-No Charge
F-Special Schein I-rce Goods
M_Manufacturer will ship Item directly to you
0 5 395110 11/27/12 12/03/12 1 11-Prescription Drug:Return Authorization Required
CUSTOMER PO# PAGE# R-Refrigerated Item:,\Iay be shipped separately
$-Special Schein Pricing
U-Temporarily unavailable:please reorder
MARK 1 OF 1 T-Taxable Item
We make e,very faffon lo rnaintan prices'or the clurafion ot a
Payment by CHECK or by the HENRY SHIN CREDIT CARD,
catai �i ; ;
q,1!oove'ver,'vve reserve the right to make price adjustments:r1
VISA,MASTERCARD,DISCOVER and AMERICAN EXPRESS
response to manufaictuorers'price changes
Guaranteed Satisfaction: vsa
If wcu have tried a product and it is defective or does not oerform or
0 d e y'o U'- C" C.r'
satis'adorilu,we orov:de a credit,refund,or exchange:
Available,to licensed practifiorlers:n t',.2 U.S.A'11'in vices arc.
M : "::
choice, Simply call w. r customer service deParlmeW,Ohin 30 days
payable within 30 days.
04 re-coj"t of the rnerc-42ndse to arrange for the return. For a
vl,arrant'repair or it you SEMIT:something you did..'lot order
&F-ply call:
Ix Products & Controlled Substances:
Matrx Medical 1-800-845-3550
Regulations require us to limit the sale of Rx and controlled
substances only to registered,"censed healthcare protessionals.
If you are a new customer or have recently moved,please fu.r!,::sh
us with a copy of your updated state registration. For o ntrodled
substances,fiUrnish a copy of your DEA certificate,verifying your
shipping address. Class 11 drugs can be ordered only by,,,%ail.
International Orders:
Please Note:
.........----------------------
'Ne pf oudly serve heaithua p i o fes�,,k-;n a;s and guve rnmi--rits--
Openeo hand pieces and equipmem may not be returned for
dd, iquines on exp
t' roughout the wor no Place orders or fior in 0 rt
credit:but 4Q II be repaired or replaced in accordance:y;h terms and conditions,Please contact our International Depa-ftent,
manufacturer warrant,r-s,Bfa'ore opening ha'd0eceS or
eoUipment,we su;ggest t'h'atyou check the shipping conlainer ;-800-845-3550
and pack hg list to verjy that you have received exactly what
you c'-dered.Opened Computer Software is not returnable. Prescription Drug Returns Instructions:
Other restrictions may also apply. A Return Authorization is Required for all Prescripti.on Drugs-Si:.mply call
our Customer Service DcPament 1-800-845-3550.
..........
T
gg N
N�
K
..A __W
ELM
-----------
R,
i _U�
RM
_2
..........
K .... ...... ............
LP300
VOUCHER NO. WARRANT NO.
ALLOWED 20
Henry Schein
IN SUM OF $
Dept Ch 10241
Palatine, IL 60055
$79.54
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1120 4696604-02 $79.54
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
DEC 17 2012
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
'rescribed 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))
4696604-02 $79.54
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
120
Clerk-Treasurer