The URL can be used to link to this page

218483 03/25/2013 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1 s 0 ONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: $120.22 CARMEL, INDIANA 46032 DEPT CH 10241 PALATINE IL 60055-0241 CHECK NUMBER: 218483 CHECK DATE: 3/25/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 102 4239011 1233839-01 36 .42 SPECIAL DEPT SUPPLIES 102 4239011 3120505-01 83 . 80 SPECIAL DEPT SUPPLIES HENRY S C H E I N to, SHIP TO/SOLD TO: EMS Carmel Fire Department MI 135 Duryea Road, Melville,NY 11747 ®® A C 540 W 136 St `f� Station 46 Michael Kaufmann Carmel,IN 46032-8806 010000130857103120505110010000000083800311133 BILL TO: Carmel Fire Dept MI 2 Civic Sq Carmel, IN 46032-7543 Carmel Fire Dept FILL TO SHIP TO I INVOICE AMOUNT 2 Civic Sq Carmel, IN 46032-7543 1308571 1817102 83.80 INVOICE INVOICE DATE 3120505-01 3/11/13 CUSTOMER MARK _. .. Please detach here and mail the abort with your payrnem -91 ORDER ORDER DATE DUE DATE 07921406 03/11/13 04/10/13 D&B#:01-243-0880 e 1YHSE DEA# RHO162494 Fed ID:11-3136595 his order ias been processed by our MIDWEST .C. 5315 WES 74TH TREET INDIANAP LIS,IN 46268 RK 1 890-4792 EA SHARPSTAR SHARPS CONTAINE 5-QT 20 20 C 4.19 83.80 1' SE GOOD I EM, MAY BE SHIPPED SEPARATELY. F YOU ARE ARTICIPATING IN A DISCOUNT PROD I (E.G. POI S, GIFTS OR 0 HER PECIAL AW S ("DISCOUNT")) , WITH THIS PURCHASE YOU HAVE EARNED A CREDZ TOWARD GOODS OR S RVICES, RECEIVABLE OR REDEEMABLE N ACCO P.NCE WITH DISCOUNT PROGRAM RULES. UPON DISCOUNT RECEIPT OR REDEMPTION, OU ARE RECEI ING OR WILL RECEIVE OTICE OF T E DISCOUNT VALUE. FROM.TIME TO TI E, MEDICARE, MEDICAID, TRICARE OR THER PAYER MAY REQUEST INFORMATION REGARDING SUCH V UE, UPON ANY S CH EQUEST, SU VALUE MUST BE DISCLOSED AS A DI COUNT AGAINSI THE PURCHASES THAT ED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN TH SE RECORDS. MERCHANDI E TOTAL 83:80 Invoice Date + 30 days 83.80 Please remi payments only to the following a dress: enry .Schei I, .Inc. Dept CH 10211 Palatine, Z 66055-0241 IRILL TO SHIP TO INVOICE AMOUNT ITEM STATUS KEY RENT KEY I-Hackordered:Item will follow SK-School Kit 1308571 1817102 3120505-01 83.80 D-Discontinued;Item no longer available FNC No Charge - I'-Special Schein Fox Goods HSI O D R R ER DATE 19MICE % N1-%ianufactumr will ship Item directly to you P-Prescription Dmg:Return Auihori�tion Required 07921406 0 3/11/13 3/11/13 1 R-Refrigmted❑em:May be shiprr 1 separately S -Special S06n Pricing T-Taxable Item U-Temporarily unavailable:please reorder MARK 1 0 F 1 " -Item has MSDS NAA HENRY SCHEIN@ EIS SHIP TO/SOLD TO: (vh INVOICE 2_a Fire Dept Head Quarters MI Civi 135 Duryea Road, Melville, NY 11747 z civic sq Carmel,IN 46032-2584 010000130857101233839110010000000036420308137 BILL TO: Carmel Fire Dept MI 2 Civic Sq Carmel, IN 46032-7543 Carmel Fire Dept BILL TO I SHIP-TO- INVOICE AMOUNT 2 Civic Sq Carmel, IN 46032-7543 1308571 1 1308572 36 .42 "INVOICE# INVOICE DATE 1233839-01 3/08/13 CUSTOMER MARY . . / NOT.-T) . Please detach hem and mail the above with your payment HSI ORDER- ORDER.DATE DUE DATE 07854524 03/08/13 04/07/13 D&B#:01-243-0880 WHSE DEA# RHO)62494 Fed ID: I1-3136595 CONTAINS MULTIPLE INVOICES ' a 3 — Qwvv = .zuK M �•. his order as been processed by our MIDWEST .C- 5315 WES 74TH 3TREET INDIANAPOLIS,IN 46268 1 567-7576 EA ONE TOUCH ULTRA MINI SYS 2 2 18-21 36.42 1 F YOU ARE iARTICIPATING IN A DISCOUNT PROGRAM (E.G. POINUS, GIFTS OR OTHER PECIAL AWARDS ("DISCOUNT")) , WITH THIS PURC E YOU HAVE EARNED A CREDI TOWARD GOODS OR SERVICES, RECEIVABLE OR REDEEMABLE IN ACCOZDANCE WITH DISCOUNT PROGRAM RULES. UPON DISCOUNT RECEIPT OR REDEMPTION, YOU ARE RECEIIvING OR WILL R CEIVE 140TICE OF T iE DISCOUNT VALUE. FROM TIME TO TILE, MED CARE, MEDICAID, TPICARE OR THER PAYER MAY REQUEST INFORMATION REGARDING SUCH VkLUE, IND UPON ANY S CH EQUEST, SU H VALUE MUST BE DISCLOSED AS A DI COUNT GAINS THE PURCHASE THAT EARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN THESE RECORDS. MERCHANDI E TOTAL 36.42 voice Date + 30 days 36.42 lease remi payments only to the following a dress: enry Schei , Inc. Dept CH 102 1 Palatine, I 60055-0241 BILL - HIP TI) rNVOICF# INVOICE ArtotRaT ITEM STATUS KEY REM KEY 1305571 1308572 1233839-01 36.42 D II Hackordcmd:Item ivillfollow SK-Set—AKit -Discontinued;Item no longer available NC-No Charge P-Special Schein I'me(mods H ORDLTR E D INVOICE B - M-Manufactunt hill ship Item directly to you P-Prescription Dmg:Rdurn Authorization Required 0 7 8 5 4 5 2 4 03/08/13 3/0 8/13 1 R-Refrigerated Item:May be shipped scparatcly CUSTOMER $ -Special Schein Pricing PAGE9 T-Taxable Item U-Temporarily unavailable:please reorder MARK / HOLD 1 OF 1 • -Item has MSDS Please detach here and mail the above with your payment HSI ORDER ORDER DATE DUE DATE 07921406 03/11/13 04/10/13 � D&B#:01-243-0880 WHSE DEA# RHO]62494 Fed ID: 1 1-3136595 L I s ° ° his order as been processed by our MIDWEST D.C. 5315 WES 74TH STREET INDIANAP LIS,IN 46268 RK 1 890-4792 EA SHARPSTAR SHARPS CONTAINE 5-QT 20 20 C 4.19 83.80 1 ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. F YOU ARE ARTICIPATING IN A DISCOUNT PROG (E.G. POIN S, GIFTS OR 0 HER PECIAL AWA S ("DISCOUNT")) , WITH THIS PURCH SE YOU HAVE RNED A CREDI TOWARD GOODS OR S RVICES, RECEIVABLE OR REDEEMABLE N ACCO DANCE ITH DISCOUNT PROGRAM RULES. UPO DISCOUNT RECEIPT OR REDEMPTION, OU ARE RECEI ING OR WILL R CEIVE OTICE OF T E DISCOUNT VALUE. FROM TIME TO TI E, MED CARE, EDICAID, TRI ARE OR THEIR PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, D UPON ANY S CH EQUEST, SU H VALUE MUST BE DISCLOSED AS A DI COUNT GAINS THE PURCHASE THAT ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN TH SE RECORDS. MERCHANDISE TOTAL 83.80 Invoice Date + 30 days 83.80 lease remi payments only to the following address: enry Schei Inc. ept CH 102 1 Palatine, I 60055-0241 LL HIP Irry r MEUN ITFM STATUS KEY 12EIvl KEY 13 0 8 5 71 181710 2 312 0 5 0 5—O 1 HBackordered:Item will foll°w SK-Shuol Kit D-Sp c ial Schei Item no longer availahle H I RD ORDER AT I OI E D E P-Special Schein Prec Goods Af-Manufacturer will ship Item directly to you 0 7 9214 0 6 0 3/11/13 3/11/13 P 1r acription Drug:Return Authorization Required R -Refrigerated Item;May be shipped separately $ -Special Schein Pricing T-Taxable Item MARK U-Temporarily unavailable:please reorder ' -Item has MSDS Payment Terms: We make every effort to maintain prices for the duration of a 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 VISA' V Guaranteed Satisfaction: or If you have tried a product and it is defective or does not perform gill Your Order To Your Open Account satisfactorily,we will provide a credit,refund,or exchange;it's your Available to licensed practitioners in the U.S.All 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 safe of Rx and controlled substances only to registered,licensed healthcare professionals. If 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 II drugs can be ordered only by mail. International Orders: Please Note: We proudly serve healthcare professionals and governments Opened handpieces and equipment may not be returned for throughout the world. To place orders or for inquiries on 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 1-800-845-3550 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. _ b- x i LP300 Please detach here and mail the above with your payment HSI ORDER ORDER DATE DUE DATE 07854524 03/08/13 04/07/13 D&B#:01-243-0880 WHSE DEA# RH0162494 red ID: 11-3136595 CONTAINS MULTIPLE INVOICES � o t � .t x .e 0 1.N:P Fm �� .•.. 4�1a P`: his order as been processed by our MIDWEST .C. 5315 WES 74TH TREET INDIANAP LIS,IN 46268 1 567-7576 EA ONE TOUCH ULTRA MINI SYS 2 2 18.21 36.42 1 ---- ------ F YOU ARE ARTICIPATING IN A DISCOUNT PROG (E.G. POIN S, GIFTS OR O HER PECIAL AWA DS ("DISCOUNT")) , WITH THIS PURC SE YOU HAVE RNED A CREDI TOWARD GOODS OR S RVICES, RECEIVABLE OR REDEEMABLE N ACCO DANCE ITH DISCOUNT PROGRAM RULES. UPO DISCOUNT RECEIPT OR REDEMPTION, OU ARE RECEI ING OR WILL R CEIVE OTICE OF THE DISCOUNT VALUE. FROM TIME TO TI E, MED CARE, EDICAID, 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 RE ORDS. MERCHANDI E TOTAL 36.42 Invoice Date + 30 days 36.42 lease remi payments only to the following a dress: enry Schei , Inc. ept CH 102 1 alatine, I 60055-0241 BILL T SHIP TO Irry I ITEM STATUS KEY REM KEY 1308571 13 0 8 5 7 2 1233839-01 3 6 .4 2 I3-Hackordered:Item will follow SK-School Kit D-Discontinued:hem no longer available NL-No Charee HSI RDE ORDER DATE INVOICE DATE BOXE I'-Special Schein Free Goods NI—Manufacturer will ship Item directly to you 07854524 03/08/13 3/08/13 1 13-IRescriptionD ug:Return Authorization Required R -Refrigerated Item:May be shipped separately MER P E S -Special Schein Pricing T-Taxable Item MARK / HOLD 1 O8 1 U-Temporarily unavailable:please reorder -Item has MSDS Payment Terms: We make every effort to maintain prices for the duration of a 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 Guaranteed Satisfaction: or If you have tried a product and it is defective or does not perform gill your Order To Your Open Account satisfactorily,we will provide a credit,refund,or exchange;it's your Available to licensed practitioners in the U.S.All 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 if 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 substances only to registered,licensed healthcare professionals. If 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: We proudly serve healthcare professionals and governments Opened handpieces and equipment may not be returned for throughout the world. To place orders or for inquiries on 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 1-800-845-3550 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. o y Msl LP300 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)) 1233839-01 $36.42 3120505-01 $83.80 I 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 VOUCHER NO. WARRANT NO. ALLOWED 20 Henry Schein IN SUM OF $ Dept Ch 10241 Palatine, IL 60055 $120.22 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1120 1233839-01 102-390.11 $36.42 1 hereby certify that the attached invoice(s), or 1120 3120505-01 102-390.11 $83.80 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 2 2 2013 Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund