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Home My WebLink About216067 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 ----------======------------ 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 - — \hmughuutthe wudd Top|acen�emnr<urinquirioonnoxpo� 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