218082 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