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Home My WebLink About218082 03/13/2013 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1 ` ONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: $270.80 CARMEL, INDIANA 46032 DEPT CH 10241 o� PALATINE IL 60055-0241 CHECK NUMBER: 218082 CHECK DATE: 3/13/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 102 4239011 2449407-02 151 . 28 SPECIAL DEPT SUPPLIES 102 4239011 428963-01 119 . 52 SPECIAL DEPT SUPPLIES HSI ORDER# ORDER DATE DUE DATE 06956057 01/31/13 03/23/13 D&B#:01-243-0880 WHSE DEA# PG0229321 Fed ID: 11-3136595 CONTAINS MULTIPLE INVOICES . e �7 Eak •;1`w E"e abbr'. 6{�&.�.},Pi £ � ®b '«t .%' s. .i •; Q� p£',44;.I.sE. �j" p j.3a. .a far Cf � s I -,x his order has been processed by our GIV D.C. 80 SUMMI VIEW 1ANE BASTIAN VA 2431-4 17-571-266 OFFICE 317-428-8781 CELL vIARK 1 499-8321 EA OPTIMUM RESCUE VEST RED 2 2 75.64 151.28 1 F YOU ARE ARTICIPATING IN A DISCOUNT PROG (E.G. POIN S, GIFTS OR O HER PECIAL AWARDS ("DISCOUNT")) , WITH THIS PURCHASE YOU HAVE EARNED A CREDI TOWARD GOODS OR SERVICES, RECEIVABLE OR REDEEMABLE N ACCO DANCE WITH DISCOUNT PROGRAM RULES. UPON DISCOUNT RECEIPT OR REDEMPTION, 'IOU ARE RECEI ING OR WILL R CEIVE OTICE OF THE DISCOUNT VALUE. FROM TIME TO TIME, MEDICARE, MEDICAID, TRI ARE OR THER PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, PND UPON ANY S CH REQUEST, SU H VALUE MUST BE DISCLOSED AS A DI COUNT kGAINSq THE PURCHASET THAT EARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE PAIN THESE RECORDS. MERCHANDI E TOTAL 151.28 invoice Date + 30 days 151.28 BILL TO SHIP TO INVOICE# INVOICE AMOUNT ITEM STATUS KEY REM KEY B-Backordered:Item will follow SK_School Kit 2 4 4 9 4 0 7—0 2 151.2 8 D-Discontinued:Item no longer available _No ool 1308571 1308572 Kit F-Special Schein Free Goods HSI ORDER ORDER DATE INVOICE DATE 4 OF BOXES M-Manufacturer will ship Item directly to you P-Prescription Drug:Return Authorization Required "MAR 01/31/13 2/21/13 1 R -Refrigerated Item:May be shipped separately C ST MER PO PA E $ _Special Schein Pricing Taxable Item Temporarily unavailable:plcasc reorder 1 OF 2 Item has MSDS Continued on Next Page.......... LP300 Please detach here and mail the above with your payment =HSI O-ER# T--.-.R DATE DUE DIAT 5 03 704055 02/21/13 /223/113 D&B#:01-243-0880 WHSEDEA# RHO162494 Fed ID: 1 1-3136595 NO his order as been processed by our MIDWEST D.C. 5315 WES" 74TH 3TREET INDIANAPOLIS,IN 46268 1 113-5423 160/PK SUPER SANI-CLOTH LARGE 24 24 *C 4.98 119.52 2 --ASE GOOD ICEM, MAY BE SHIPPED SEPARATELY. IF YOU ARE ARTICIPATING IN A DISCOUNT PROGRAJI (E.G. POIN S, GIFTS OR OTHER SPECIAL AWARDS ("DISCOUNT")) , WITH THIS PURCHASE YOU HAVE EARNED A CREDI" TOWARD GOODS OR SERVICES, RECEIVABLE OR REDEEMABLE IN ACCORDANCE WITH DISCOUNT PROGRAM RULES. UP04 DISCOUNT RECEIPT OR REDEMPTION, 'IOU ARE RECEI ING OR WILL RECEIVE .40TICE OF TIE DISCOUNT VALUE. FROM TIME TO TI E, MEDICARE, MEDICAID, TRITARE OR DTHER PAYER MAY REQUEST INFORMATION REGARDING SUCH VkLUE, PND UPON ANY STCH REQUEST, SU--H VALUE MUST BE DISCLOSED AS A DI COUNT AGAINS l THE PURCHASES THAT EARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE MIN THESE RECORDS. MERCHANDI E TOTAL 119.52 Invoice Date + 30 days 119.52 LEASE NOTE NEW REMIT TO ADDRESS Please remi-- payments only to the following aldress: HENRY SCHEIN INC. DEPT CH 102 1 PALATINE, 1 , 60055-0241 BILL TO SHIP TO INVOICE lf INVOICE AMOUNT ITEM STATUS KEY FREM KEY 3-Backordered:11cm e,jll follow SK-School Kit 1308571 1817102 428963-01 119 .S2 �)-Discon inued:Item no longer available NC-No Charge HSI ORDER# ORDER DATE INVOICE DATE # OF BOXES 1;-Special Schc n Free Goods NI-Manufacturer will ship Item directly to you 11 prescription Drug:Return Authorization Required 07504055 02/21/13 2/21/13 3 R Refrigerated Item.May b,shipped separately CUSTOMER PO# PAGE J $ Special Schein Pricing T Taxable Item Temporarily unavailable:please reorder MARK 1 OF 1 I(cm has NISOS LP300 ...................................................................... —--------—------ Payin--t- ,eiais: We~rake every effort to maintain prices for the duration of a Payment by CHECK or by the HENRY SCHEIN CREDIT CARD, catalog,ho,,,v9ver,,We reset ve the right to make price adjustments in VISA,MASTERCARD,DISCOVER and AMERICAN EXPRESS response to manufacturers price changes Guaranteed Satisfaction: if you have tried a product and it is detective or does not perform or Bill yoor ort.ler 7_.1 0poo A : 'J'A safis`ac4orily,,,,ve�v,,ill provide R credit,refund,or exchange;it's your 1 : , Available to licensed practitioners in the J.S.Al:invoices are choice. Simply call our customer service department within 30 days payable within 30 days. of receipt of the merchandise 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: Matrx Medical 1-800-845-3550 Regulations require us to limit the sale of Rx and controlled .e U 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 state registration. For controlled substances,furnish a Copy of your DEA certiticaft,verifying your e shipping address. Class 11 drugs can be ordered only by mail. International Orders: Please Note: We proudly serve he-aithcalre professionals and governments Opened handpieces and equipment may not be returned for throughout the world. To place orders or for inquiries or,,export credit, butw:11 be repaired or replaced in accordance with terms and conditions,please contact our International Department, manufacturer warranties.Before opening handpieces or 1-800-8455-3550 equipment, =,e 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 Authorizations Required for all Prescription Drugs.S:rnply call our Customer Service Department @ 1-800-845-35% Z, "'11" 0 6 .-J VOUCHER NO. WARRANT NO. ALLOWED 20 Henry Schein i IN SUM OF $ Dept Ch 10241 Palatine, IL 60055 $270.80 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO#/Dept. INVOICE NO. ACCT#!TITLE AMOUNT Board Members 1120 428963-01 102-390.11 $119.52 I hereby certify that the attached invoice(s), or 1120 2449407-02 102-390.11 $151.28 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 MAR t, 12613 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)) 428963-01 $119.52 2449407-02 $151.28 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