216067 01/09/2013 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1
ONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: $344.20
CARMEL, INDIANA 46032 DEPT CH 10241
PALATINE IL 60055-0241 CHECK NUMBER: 216067
CHECK DATE: 1/9/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 4239011 5282140-01 344 .20 SPECIAL DEPT SUPPLIES
HSI ORDER# ORDER DATE IDUE DATE
05703849 12/07/12 01/06/131
D&B#i01-243-0990
WHSE DEA# RHO162494 Fed ID: 11-3136595
N11
e
gM, F
his order has been processed by our MIDWEST D.C.
5315 WES" 74TH STREET
INDIANAP)LIS,IN 46268
AARK 317-423-8784
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1 890-6868 3/PK LIFEPAK 12 PAPER EKG 30 30 10.54 316.20 1
2 499-0813 24/CA INSTANT SUMMER HOT 4 4 7.00 28.00 1
--------------------------------- ------ -
IF YOU ARE ?ARTICIPATING IN A DISCOUNT PROGRAM (E.G. , POINqS, GIFTS OR OTHER
SPECIAL AWA DS ("DISCOUNT")) , WITH THIS PURCHASE YOU HAVE EARNED A CREDI" TOWARD
GOODS OR SIRVICES, RECEIVABLE OR REDEEMABLE IN ACCO DANCE WITH DISCOUNT PROGRAM
RULES. UP04 DISCOUNT RECEIPT OR REDEMPTION, OU ARE RECEI%ING OR WILL RECEIVE
\TOTICE OF T DISCOUNT VALUE. FROM TIME TO TIME, MEDICARE, MEDICAID, TRI ARE 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 AGAINS I THE PURCHASE!; THAT
EARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE-AIN THESE RECORDS.
- ----------
MERCHANDI E TOTAL 344.20
Invoice Date + 30 days 344.20
LEASE NOTE NEW REMIT TO ADDRESS
Please remi: payments only to the following aldress:
HENRY SCHEIN INC.
DEPT CH 10241
PALATINE, 1, 60055-0241
SHIP TO INVOICE INVOICE AMOUNT ITEM STATUS KEY FkENI KEY
1308571 1817102 5282140-01 344 .20 B-Backordered:Item will follow SK-School Kit
1)-Discontinued:Item no longer available NC-No Charge
H QRDER# ORDER DATE INVOICE DATE # OF BOXES F-Special Schein Free Goods
M_Manufacturer will ship Item directly to you
05703849 12/07/12 12/07/12 2 P-prescription Drug:Return Authorization Required
R-Refrigerated Item:May be shipped separately
CUSTOMER PO# PA # $-Special Schein Pricing
U-Temporarily unavailable:please reorder
MARK 1 OF 1 T-Taxable Item
Ne make every effort to maintain prices for the duration ofa 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
I VISA
Guaranteed Satisfaction:
It you have tried o product and his defective or does not perform or
satisfactorily,we will provide a credit,refund,or exchange;it's your Bill Your Order 1'o Your Open A�.c,,)unt
Available to licensed practitioners in the U.S.All invoices are
choice. Simply call our customer service department withi 30 days payable within 30 days.
of receipt of the merchandise tn arrange for the return, For
warranty repair ord 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 ofRx and controlled
substances only to registered,licensed healthcare professionals.
|i 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—��'h 8hma/epnesm&nu|sandQwmmments -
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omdh.bu\wi||beropai�dnrr�p|eu*dinoncu�anoewi1h �mmandmmdihono |eeennn1��our|��m�inn�Depa�me��
u�o� warranties.8e� i ', �
"�, '"' `='" "° '^,p"^'�^°^~r~^^""' 1�OO'O4S'3BO
equipment, �� �o�� � container
and packing list o verify that you have received exactly what Prescrj��j�� [�YW� ����Qr�� �M8%���ti���'
you o�emd Software is notro1urnmbAa ' '
Other restrictions meya|sompp|y.
A Return Authorization in Required for all Prescription Drugs.Simply call
our Customer Service DepaUm*nt @1-8OU-84S-3550.
'
Al�
VOUCHER NO. WARRANT NO.
ALLOWED 20
Henry Schein
IN SUM OF $
Dept Ch 10241
Palatine, IL 60055
$344.20
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
-�K
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1120 I 5282140-01 1 102-390.11 I $344.20 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
JAN -7 2013
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
vhom, 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))
5282140-01 EMS Supplies $344.20
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