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Home My WebLink About217667 02/26/2013 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1 �tONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: $2,582.43 o CARMEL, INDIANA 46032 DEPT CH 10241 PALATINE IL 60055-0241 CHECK NUMBER: 217667 CHECK DATE: 2/26/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 102 4239011 164506-01 2, 107 .43 SPECIAL DEPT SUPPLIES 102 4239011 2449188-02 475 . 00 SPECIAL DEPT SUPPLIES HSI ORDER# ORDER DATE DUE DATE 07322657 02/14/13 03/16/13 D&B#:01-243-0880 WHSE DEA# RHO]62494 Fed ID: 1 1-3136595 s� Pei z,N e y,y .,., z.e'»y', 1 :,�.z. .. `;G`;T...,;, —M O":°.¢.•�i' :1„ ',jIRL'• '�A C C 0. his order ias been processed by our MIDWEST D.C. 5315 WES 74TH STREET INDIANAP LIS,IN 46268 17-571-266 RK ---------- --------------------------------- ------ ----- ------------- ------- 1 507-0791 PU EA IV ADMIN SET 15DROP W/NDL INJ SIT 300 300 C 1.47 441.00 6 ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. 2 507-8362 PX 100/BX NACL PREFILL SYRINGE 10ML ST 4 4 39.00 156.00 21 N - PEDIGR E ITEM. DC:6380701 010 3 153-6483 RX 250ML/BT STERILE WATER FOR IRRIG 250ML 48 48 C 1.18 56.64 8 14N - PEDIGR E ITEM. ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. .IIDC:0033800)402 4 840-2661 250/BX PROBE COVER SURETEMP 2 2 7.96 15.92 22 DUE TO MANU ACTURER NO RETURN POLICY THIS ITEI IS NO RETU NABLE 5 648-9088 12RL/BX MEDIRIP BANDAGE 2"X5YD 6 6 21.93 131.58 22 6 648-7048 24RL/BX MEDIRIP BANDAGE 1"X5YD 3 3 22.50 67.50 22 7 496-6428 100/BX LANCET SURGILANCE GRAY 23G 1.8 2 2 10.00 20.00 22 8 120-8808 EA COMBITUBE ROLL-UP KIT 41FR 8 8 C 40.95 327.60 10 ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. BILL To SHIP TO INVOICEit INVOICE AMOUNT ITEM STATUS KEY REM KEY 11308571 1817102 164506-01 2107 .43 n-Backordered:hcm will follow SK-School Kit D-Discontinued:Item no longer available NC-No Charge I RDER ORDER DATE INVOICE DATE F BOXES P-Special Schein Free Goods NI-Manufacturer will ship Item directly to you 07322657 0 2/14/13 2/14/13 22 P-Prescription Drug:Return Authorization Required CUSTOMER Poll FA R-Refrigerated Item;May be shipped separately $-Special Schein Pricing U-Temporarily unavailable;please reorder MARK 1 OF 3 T-Taxable Item Continued on Next Page.......... LP300 HENRY SCHEIN" SHIP TO/SOLD TO: EMS Carmel Fire Department MI 135 Duryea Road, Melville, NY 11747 INVOICE 540 W 136 St Station 46 Michael Kaufmann Carmel,IN 46032-8806 010000130857100164506110010000002107430214132 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 1817102 2107 .43 INVOICE# INVOICE DATE_—] 164506-01 2/14/13 CUSTOMER PO MARK - HSI ORDER# T ORDER DATE DUE DATE 07322657 02/14/13 03/16/13 D&B#:01-243-0880 WHSE DEA# RHO162494 Fed ID: 11-3136595 r( ;A "� ,s= r_ ®• k....;... SIR R{ t^ i�E :r.; ' "s a mid }'.. <93bra £&n .Y % '�' `�•a :a ::z-'.' yy }y^yy �`p�}r k q'y •lx^ z.��ry ...-, �:.—,�..,. n s, a•fiiia.N§"e`d•. ��^ ° Sz.:r �'9 y4a §« il^ .. ... ..x,.. v 9 220-2270 EA THOMAS HOLDER F/ET TUBE ADULT 25 25 2-71 67.75 21 10 112-6133 100/BX BANDAGE ADHESIVE STRIP 1 1IX3" 12 12 0.97 11.64 22 LEASE NOTE 9004500 IS NOW 1126133 11 857-0680 EA BERMAN AIRWAY 80MM SZ 3 24 24 0.30 7.20 22 12 857-6255 EA BERMAN AIRWAY 90MM SZ 4 24 24 0.30 7.20 21 13 857-9780 EA BERMAN AIRWAY 100MM SZ 5 24 24 0.30 7.20 22 14 499-0386 PU EA FS NEBULIZER W/T MOUTHPC &02 RES 150 150 C 0.94 141.00 13 ASE GOOD ITEM, MAY BE SHIPPED SEPARATELY. 15 107-0530 100/BX PURPLE NITRILE PF GLOVE LARGE 60 60 C 8.60. --516.00 --19 ASE GOOD ITEM, MAY BE SHIPPED SEPARATELY. 16 499-6393 EA EASY GRIP BVM ADULT 12 12 C 11.10 133.20 20 ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. F YOU ARE DARTICIPATING IN A DISCOUNT PROG (E.G. POIN S, GIFTS OR OTHER PECIAL AWARDS ("DISCOUNT") ) , WITH THIS PURL SE YOU HAVE EARNED A CREDI TOWARD GOODS OR SERVICES, RECEIVABLE OR REDEEMABLE IN ACCO DANCE WITH DISCOUNT PROGRAM RULES. UPOR DISCOUNT RECEIPT OR REDEMPTION, OU ARE RECEI ING OR WILL RECEIVE OTICE OF T E DISCOUNT VALUE. FROM TIME TO TI E, MED CARE, MEDICAID, TRI ARE OR THER PAYER MAY REQUEST INFORMATION REGARDING SUCH VALUE, PND UPON ANY S CH REQUEST, SU H VALUE MUST BE DISCLOSED AS A DISCOUNT AGAINSq THE PURCHASEs THAT EARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN THESE RECORDS. N - HENRY 3CHEIN, INC. HAS PURCHASED THE SPE IFIC UVIT OF THE PRESCRIPTION DRUG BILL TO SHIP TO INVOICE# INVOICE AMOUNT ITEM STATUS KEY REM KEY 1308571 1817102 164506-01 2107.43 B-Backordered:Item will follow SK-School hit D-Discontinued:item no longer available NC-No Charge HSI ORDER ORDER DATE INVOICE DATE F BORE F Special Schein Frec Goods M-Manufacturer will ship Item directly to you 07322657 0 2/14/13 2/14/13 2 2 1'-prescription Drug:Return Authorization Required R-Refrigerated Item:May be shipped separately CUSTOMER PO# PA E $-Special Schein Pricing U-Temporarily unavailable:please reorder MARK 2 OF 3 T-Taxable Item Continued on Next Page.......... LP300 HENRY SCHEINg 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 010000130857100164506110010000002107430214132 BILL TO: Carmel Fire Dept MI 2 Civic Sq Carmel, IN 46032-7543 Carmel Fire Dept BILL To I sxlP To INVOICE AMOUNT 2 Civic Sq Carmel, IN 46032-7543 1308571 1817102 2107.43 INVOICE# I INVOICE DATE 164506-01 2/14/13 CUSTOMER PO MARx Please detach here and mail the above with your payment — HSI ORDER# ORDER DATE DUE DATE 07322657 02/14/13 03/16/13 DB B#:O1-243-0880 WHSE DEA# RHO]62494 Fed ID: 1 1-31 36595 p} „ (�y s DIRECTLY FROM THE MANUFACTURER. MERCHANDI E TOTAL 2107.43 Invoice Date + 30 days 2107.43 LEASE NOTE NEW REMIT TO ADDRESS Please remi payments only to the following a dress: HENRY SCHEI4 INC. DEPT CH 10211 ALATINE, I 60055-0241 BILL To SHIP TO INVOICE4 INVOICE AMOUNT ITEM STATUS KEY REM KEY 11308571 18 1710 2 164506-01 2107.43 B-Backordered,Item will follow SK-School hit H I RDER ODER 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 0 7 122617 0 2/14/13 2/14/13 22 1'-Prescription Drug:Return Authorization Required R-Refrigerated Item;May be shipped separately CUSTOMER PO# PA $-Special Schein Pricing U-Temporarily unavailable:please reorder MARK 3 OF 3 T-Taxable Item LP300 -—--—--------- -------- HENRY SCHEIN il, , J I J EMS --------------- ----------------------............ ............. ------------------------ ----------------- We make every effort to maintain prices for the duration or a Payment by CHECK or by the HENRY SCHEIN CREDIT CARD, catalog,h v,rever. rVe reSe.,Ve the right to make price adjustments in i F VISA,MASTERCARD,DISCOVER and AMERICAN EXPRESS price cechanges Guaranteed Satisfaction: yrsA If you have tried a product and it is detective or does not perform or satisfactorily,we will provide a credit,refund,or exchange;it's your Bill Yrmi 0i trier To Open zuot Available to hcensed practitioners in the J.S.All invoices are- choice. Simply call our customer service department within 30 days of receipt of the mer payable within 30 days. ,chandise to arrange for the return, For a warranty repair or it you were sent something you did not order, simply call: 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. It you are a new customer or have recently moved,please furnish us with a copy of your updated slate 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 serve healthcare professionals and ,overnments ' : N throughout the world. To place orders or for inquiries oil 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 1-800-8405-3550 equipment,we suggest that you check the shipping container and packing list to verify that you have received exactly what Prescription Drug Returns Instructions: you ordered.Opened 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. ................ I)L aj HENRY SCHEWW) SHIP TO/SOLD TO: EMSCarmel Fire Dept Head Quarters MI Sq 135 Duryea Road, Melville, NY 11747 INVOICE 2 civic Carmel,I N ry N 46032-2584 01,00001,308571024491,881],0020000000475000201138 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 1308572 475 .00 INVOICE# INVOICE DATE 2449188-02 2/01/13 CUSTOMER PO# MARK HSI ORDER# ORDER DATE DUE DATE 06956057 01/31/13 - 03/03/13 D&B#:01-243-0880 WHSE DEA# RHO 162494 Fed ID: 1 1-3136595 • i Rai 7 3�bf %.:. EEAA33 � .:. ,, 6 p ..,.... r •Wii .QY.Y A: `1°9 g`s 'Y"��C �~ '°V r s Xa ne ss** n , �y A>p yy yy�� s E�¢ I'..f f�'."$ <'�a9� his order ias been processed by our MIDWEST D.C. 5315 WES 74TH 3TREET INDIANAP LIS,IN 46268 17-571-266 OFFICE 17-428-878 CELL RK 1 672-4224 EA FERNOTRAC SPLINT ADLT&PED 441 1 1 C 475.00 475.00 1 ASE GOOD I PEM, MAY BE SHIPPED SEPARATELY. F YOU ARE ARTICIPATING IN A DISCOUNT PROGRAM (E.G. POIN S, GIFTS OR O HER PECIAL AWA DS ("DISCOUNT")) , WITH THIS PURCHASE YOU HAVE EARNED A CREDI TOWARD GOODS OR S RVICES, RECEIVABLE OR REDEEMABLE N ACCO DANCE WITH DISCOUNT PROGRAM RULES. UPOI DISCOUNT RECEIPT OR REDEMPTION, IOU ARE RECEI ING OR WILL RECEIVE OTICE OF TIE DISCOUNT VALUE. FROM TIME TO TIME, MED CARE, MEDICAID, TRI ARE OR THER PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, D UPON ANY S CH REQUEST, SU H VALUE MUST BE DISCLOSED AS A DI COUNT GAINS THE PURCHASE THAT EARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN TH SE RECORDS. MERCHANDI E TOTAL 475.00 Invoice Date + 30 days 475.00 BILL TO SHIP To INVOI E INVOICE AMOUNT ITEM STATUS KEY REM KEY 1308571 1308572 2449188-02 475 . 00 n-Backordered:hem will follow SK-School Ku D-Discontinued:Item no longer available NC-No Charge H I ORDER ORDER DATE INVOICE I E DATE F BOXES P-Spenal Schein Free Goods M-Manufacturer will ship hem directly to you 106956057 � 01/31/13 2/01/13 1 P-Prescription Drug:Return Authorization Required R-Refrigerated Item:May he shipped separately CUSTOMER P PA E $-Special Schein Pricing U-Temporarily unavailable:please reorder MARK 1 OF 2 T-Taxable hem Continued on Next Page.......... Please detach here and mail the above with your payment HSI ORDER# ORDER DATE DUE DATE 06956057 01/31/13 03/03/13 D&B#:01-243-0880 WHSE DEA# RHO]62494 Fed ID: 11-3136595 g ',. r �.@1' "�';; ;.k,°3 ',.si. g� ¢ :.a wf, t`.dg` y�:sS. g i-F g ,,YY p ,a •§,> £'.� 1 � 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 INVOICE AMOUNT ITEM STATUS KEY REM KEY 1308571 1308572 2449188-02 475 .00 B-Backordered:Item wdlfollow Ss-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 M-Manufacturer will ship Item directly to you 069560571 01/31/13 2/01/13 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 2 0 F 2 T-Taxable Item - Nemukeevery effort Nmaintain prices for the duration ofa Payment by CHECK or by the HENRY SCHEIN CREDIT CARD, catalog,however,wm reserve the rightto make price adjustments in muponoeNmanufa�u�m'p�oock��ea VISA,MASTERCARD,DISCOVER and AMERICAN EXPRESS Guaranteed Satisfaction: |f you have tried a product and itin defective o/does not perform or uabs�actnh|y,we will provide ocredit,refund,or exchange;it's your n Available to licensed practitioners in the US,Ali invo'ces are hoica Simply call our customer oemioed rt t within 30 days payable Within 30 days, of receipt of the memhandiao1n arrange for the return. For *mr�n�mpeirorK you we�sent xnme�ingyou did n�n�er. simp|yuu||� Rx Products & Controlled Substances: Ma1rx Medical 1-000-845-3558 Regulations i to limit the sale ofRx and controlled substances only to registered,licensed healthcare pmfeaoinna|& |f you are a new customer or have recently moved, |aao furnish us with a copy of your updated state registration, For conttrolle� substances,fu mish a copy of your DEA certificate,verifying your shipping address. Class 11 drugs can be ordered onlyby mail. International Orders: Please Note: ----------- Opened handpieoen and equipment may not bereturned for We proudly serve healthcare professionals and governments throughout the world. To place Orders nr for inquiries onexport credit,but will be repaired or replaced in accordance with �nnuandnondihnnap|�menon��our|�om�mn�Depa�me�� manuioo�urarwmr�nhos�Be�omopaninghondpiecauor 1-800-845-3550' -80O-84S'35S8 ' � oquipmeniweuuggoatihut you check t6e shippin container and packing list to verify that you have received exactly what �mo�ored�pened Computer Software is not returnable. �r��r��j�� Drug Returns iQ�ƒ�� Other restrictions may also apply. A Return Authorization ix Required for all Prescription Drugs.Simply call our Customer Service Department @1-80U-845'35 50. ............ . � — Al �� 'R]�� '�`� | � VOUCHER NO. WARRANT NO. ALLOWED 20 Henry Schein IN SUM OF $ Dept Ch 10241 Palatine, IL 60055 $2,582.43 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO#/Dept. INVOICE NO. ACCT#!TITLE AMOUNT Board Members 1120 164506-01 102-390.11 $2,107.43 I hereby certify that the attached invoice(s), or 1120 2449188-02 102-390.11 $475.00 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 FEB 2 5 2013 W, ap- Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund Irescribed by State Board of Accounts City Form No.201 (Rev.1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL kn 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)) 164506-01 $2,107.43 2449188-02 $475.00 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