219345 04/24/2013 « CITY OF CARMEL, INDIANA VENDOR 357526 Page 1 of 1
ONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: $4,580.94
,1 p CARMEL, INDIANA 46032 DEPT CH 10241
PALATINE a 60055.0241 CHECK NUMBER: 219345
CHECK DATE: 412412013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 4467006 5125601-01 446 . 42 EMS EQUIP
102 4239011 5125604-01 3 , 117 . 92 SPECIAL DEPT SUPPLIES
102 4239011 5573274-01 84 . 40 SPECIAL DEPT SUPPLIES
102 4467006 9124090-03 900 . 60 EMS EQUIP
102 4239011 9841179-01 31 . 60 SPECIAL DEPT SUPPLIES
ONE
Ple Mach here and mad the aho.e anh our paMem
HSI ORDERE ORDER DATE DUE DATE
08551541 04/10/13 05/10/13
DRB#:01 243-0880
WHSE DFA# RHO]62494 Fed ID 11-3136595
MUM4'
his order ias been processed by our MIDWEST .C.
5315 WES 74TH TREET
INDIANAP LIS,IN 46268
17-571-266 MARK
____ ________________
1 253-7520 5/BG DIAPHR & RIM LTMN ASMB SMALL 1 1 28.00 28.00 1
2 777-0531 EA SLEEVES LIMN NONCHLL BELL CARDIII 1 1 3.60 3.60 1
F YOU ARE ARTICIPATING IN A DISCOUNT PROG 1 (E.G. POINTS, GIFTS OR 0 HER
PECIAL AWA DS ("DISCOUNTT")) , WITH THIS PURL SE YOU HAVE EARNED A CREDI TOWARD
GOODS OR S RVICES, RECEIVABLE OR REDEEMABLE N ACCO DANCE WITH DISCOUNT PROGRAM
RULES. UPO DISCOUNT RECEIPT OR REDEMPTION, rOU ARE RECEI ING OR WILL R CEIVE
OTICE OF T E DISCOUNT VALUE. FROM TIME TO T12, MED CARE, MEDICAID, TRI ARE OR
THER PAYER MAY REQUEST INFORMATION REGARDING SUCH VI.LUE, UPON ANY S CH
EQUEST, SU H VALUE MUST BE DISCLOSED AS A DI COUNT uGAINS1 THE PURCHASE THAT
-MRNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN TH SE RECORDS.
MERCHANDT E TOTAL 31.60
nvoice Date + 30 days 31.60
Please remi payments only to the following a dress:
enry Schei , Inc
Dept CH 102 1
Palatine, I 60055-0241
.. TO ITEM1I STA FUS KEY RCM KEY
13-BadoNemit Dcm x 1 ll loll— SK-Schaal Ku
1308571 1308572 9841179-01 31.60 n-D,KOnanaw.❑emn"Hrageraailatde ?C-No charge
F-S,r,.l Schein Free fwu.k
M1I-\lanufeclum will�hqr lmm directly io you
P-Pmmnpnan Drug,Remm,Wrhamaoon Reqmred
08551541 04110113 4/10/13 1 R-Refageraed Rem.\hy ne.mpped><parrdy
S -Spccmllum Yncmg
f-le\,immlm
-Temp as.kISunar a,hMq ple.ue rmrdcr
IypgK 1 • -hemw�aos
HEI ORDER ORDER DATE DUE DATE
08528993 04/03/13 05/03/13
I ,Rk 01-243-01530
N'HSE DEA4 RH0162494 Fed ID 11-3136595
W:T .a :'i.•C.Y' '•e1 a� r' :' i.,µ,.
his order as been processed by our MIDWEST .0
5315 WES 74TH TREET
INDIANAP LIS,IN 46268
RK 319-57 -2663
--------------------_____________
_____________
1 602-5401 3/PK GLUTOSE GEL LEMON 15GM/TB 8 8 + 10.55 84.40 1
F YOU ARE ARTICIPATING IN A DISCOUNT PROG 7 (E.G. POIN S, GIFTS OR OTHER
RECTAL AWA IS ("DISCOUNT") ) , WITH THIS PURCH SE YOU HAVE EARNED A CREDI TOWARD
GOODS OR S RVICES, RECEIVABLE OR REDEEMABLE N ACCO DANCE WITH DISCOUNT PROGRAM
RULES. UPC' DISCOUNT RECEIPT OR REDEMPTTON, 'OU ARE RECEI ING OR WILL P- CEIVE
OTICE OF T E DISCOUNT VALUE FROM TIME TO TI E, MEDICARE, MEDICAID, TRI ARE OR
THER PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, IND UPON ANY S CH
EQUEST, SU H VALUE MUST BE DISCLOSED AS A DI COUNT EGAINSq THE PURCHASE THAT
EARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN THESE RECORDS.
_________________________ ______ _____ _____________
MERCHANDI E TOTAL 84.40
invoice Date + 30 days 84.40
lease remi payments only to the following a dress:
enry Schei I, Inc.
ept CH 102 il
Palatine, I 60055-0241
PSI IMV r e Iw I £ AM rr ITE\I ST:\TUS F:E1' REM F:EY 71 1308572 5573274-01 84 .40 ii "°°k°'d,,d M,.W R,1 EF R AT N I ATE Y \I-\IdnuldtlUlel Nlll,hll'ILLm JIreCll1'l0\UU
Ih,cnption Dmg kctum Alnhon]dfmn Regwmd
993 04/03/13 4/03/13 1 RRemgeraleJ❑rm.m,,>ne,nlRl�'a ar,drd�ey'
8 -SN,u,[Sche,n]'n.mc
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U-TCm M hm nnd,aILMc.plonk reorJCr
MARK 1 OF 1 -item❑em nom,Maus
Pay, wrou
-make e'•.r-r,.r'.i,r.!c rai v^paws ar tt e dinar o-v u Papiowd by CHECK or by the HENRY SCHJYi CREDIT CARD.
rata ng o e,;?- ViaSA, �,IASTERCARD. 01,:,COVER and AMEPrCAN EXPRESS
resp.rse°s m? rers'prise ctlr rUs
Guaranteed 5atisfactior;: W] IM L
ii yet.have t':,s:rrcduc:and it:s Mer-i:'e or roes -rt ps;fo^. or
sAdaJ Ofl ,,b to sk ornnde a creilk row-d,or Mange Cs vos '
Arai: :in li.:ensed Fractlt:o-rs r re U 5 R:, -ww wo a-
c7ac- �i�i:piy^'I air�usta^'e'si��i e deear(r*:er . •:nir t;�;; }s „
n api:.t V mys'a'idsa:'C,cnn f the rxim r C'a ra`daE0F!?rlih'P 3v days
.YarmnW i pair r-If yot Ser?:e! aC6l)'fd'7g you rid no v t
S-pl; all Rx Prod icts & Controlled Substances:
Matrx Mentcal 1-8008450550
Regale+o r' own es to lima w me d I arc co^wkj
sast3r Pc.:xj to eg:stFed, i'n:eQ 9d?ihJB'?pro!cssioials.
li you a'B a'a5v custorne'^-'•ic,tm ft:e-il i rnove ,DIet.E furr sl
US WItI'9;'.).:':,)f.cUl U:;eat�cl,'.a,e'drJ3lfailJn. F.:-:!,mclied
s1siarcrs,lurnish a cop+r'cf;JC DEA cell cat,s_ y-g yo.,
sfiFring:;'ir:;sa. Cassll r,aw teorderec°-tl'Q.°.ail.
Internaronal Orders:
Please t'crc
CCer-9 rlgn;jlJ ..�a arC e:{UUIT[r 'av not to ret..myu Mr 4':e t)Immy re kalhi e ( ,I^
G`muii CSC'v A P,Hpw,ecl Jr roomed 0 acc5xwe wn t:: movut me to A J r:a:e: :�c .,or'Jr.!%'?d'J"WPM
manuf olTr wrmim ms.Boron niowl hardpeces i r terms aPa 107dll 6°s;olea°o t'w'-'1 c6 I_•err'.a:r)w"1 epu A)ERt,
eCI:IFmFni,ert G gtj?5,t-at)-u C'tE�`k'dc'1 5'1 rip rg:;n:.°iIIP;r
Utt pal,ll;t M ver0va;YJ•.I -a2WaNn eXBdyso, PreSCr��ttOn I�rU� �:TtdrnS Instructions:
'.o.i o:de:s1.'7paned Computer:oft'arare is not returnable.
Other restricticos may also apply.
A Re•;m'',c,-orizate-is Pejcrn;;tct al!°,es:r p:IUr I?nigs S rply call
.^ur cu5u'm-.9rdi9 repay-aid"! c%1'82-845 3Y):I.
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LP300
HSI ORDER4 OPMER DATE oUE PATE
08437358 03/29/13 04/28/13
D&B#01-243-0880
WHSE DEA# RHO162494 Fed ID 11-3136595
his order ias been processed by our MIDWEST .0
5315 WES 74TH TREET
IIdDIANAP LIS,IN 46268
____________________===______ ______ _____ _____________ _______
1 890-6868 3/PK LIFEPAK 12 PAPER EKG 24 24 10 54 252 96 11
2 890-6800 EA SHARPS SHUTTLE SINGLE USE P2 24 24 1 57 37.68 11
3 107-0530 100/BX PURPLE NITRILE PF GLOVE LARGE 60 60 •C 8.60 516.00 6
ASE GOOD ITEM, MAY BE SHIPPED SEPARATELY.
4 900-4460 U 100/BX SYRINGE W/NEEDLE 3CC 23GX1" 2 2 5.17 10.34 11
5 555-5396 U EA PROTECTIV ACUVNC SFT CATH 20X1.25 150 150 2.23 334.50 9
6 338-2276 U 100/CA EXTENSION SET STD BORE UL 2 2 C 223.21 446.42 8
ASE GOOD I EM, MAY BE SHIPPED SEPARATELY
7 935-6155 50/PK BLUE SENSOR SP ELECTRODES ISO 150 11.94 1791.00 9
8 64B-9088 12RL/BX MEDIRIP BANDAGE 2"X5YD 6 6 21 93 131 58 11
9 648-7048 24RL/13X MEDIRIP BANDAGE 1"XSYD 2 2 21 93 43 86 12
__
--------____ __________________________________ -------------------------- _______
F YOU ARE PARTICIPATING IN A DISCOUNT PROGRAM (E.G. POIN S, GIFTS OR O HER
PECIAL ANA 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. UPO DISCOUNT RECEIPT OR REDEMPTION, "OU ARE RECEI ING OR WILL R CEIVE
;1308571 L I E ITEN1 STATUS KEY RE\1 KEY
I4-B1Ckordemd,Ilemxdllollmt SK-Sehmn Kn
1817102 5125604-01 3564 .34 u-Uwcommued.Item m, mger a.adable NC No Ch. ,
i'-SPCUeI Schem Fl,GL d>
NV I AT n Pm,,.,uon Umg.Rlmrn duWmZduml R,mred
7358 03/29/13 3/29/13 12 R -Remgmdmd ee..\u,he.h,,Md acpamlcly
S -S,oallcheml•tnmg
CUSTOMET, PO4 PAGE# T/Ft,dMe Ile.
I1-Ttm pomnly unm ailable please reorder
MARK 1 OF 2 ` -Item no MSIlS Continued on Nest Page
LP300
I
HENRY SCHEIN"
EMS SHIP TO/SOLD TO
^ Carmel Fire Department MI
135 Duryea Road, Melville, NY 11747 I N VO I l ,E Station 46 540 W 3SMichael Kaufmann
INVOICE Carmel,IN 46032-8806
010000130857105125604110010000003564340329135 BILL TO
Carmel Fire Dept MI
2 Civic Sq
Carmel, IN 46032-7543
Carmel Fire Dept BILL To I SHIP TO I AMDIINT
2 Civic Sq
Carmel, IN 46032-7543 1308571 1817102 3564 .34
INNOICE INVOICE DATE
5125604-01 3/29/13
CUSTOMER. PO
MARK
_ I'ICaic dciach hem and mail iM1e ahmewM)'nor pa)menl _
HSI ORDER4 ORDER DATE Oei PATE
08437358 03/29/13 1 04/28/13
D&B#01-243-OS90
WHSE DEA# RH0162494 Fed ID. I I-313699
J. i W1
OTICE OF TIE DISCOUNT VALUE. FROM TIME TO TIME, MEDICARE, MEDICAID, TRI ARE OR
THER PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, TND UPON ANY S ICH
REQUEST, SO H VALUE MUST BE DISCLOSED AS A DI COUNT kGAINSq THE PURCHASE THAT
EARNED SUCH VALUE ACCORDINGLY, YOU SHOULD RE AIN TH SE RECORDS.
__________ _________________________________ -------------------------- _______
MERCHANDI E TOTAL 3564.34
Invoice Date + 30 days 3564.34
lease remi payments only to the following a dress:
enry Scher , Inc.
Dept CH 10211
Palatine, I 60055-0241
BILL TO S... ry E NV I AM OUE7 ITEM STA'T'US KEY REN1 KEY
u-Ilac\mdcmd.I=w ill hdlow SK-School Ku
1308571 1817102 5125604—01 3564 .34 1,-Dncomiwed hrm nP l,mger a�ailabie NC-Nn Charge
P-Speoel Schein Pmo Gi,lda
C R RE ATE nN A M-Miatufacci rill,hip IlandimN)to)'uu
I' -ITnenpuon IN ,Remrn Amhonrauon Requited
084373581 03/2 9/1 3 3/29/13 1 2 R -Rerr,geremd ne,n Ma%be.h,pped cepamep
$ -S"ial SChcm lT"mg
CUST)MER PO4 PLQS2 T-Taiable Item
MARK 2 OF 2 U-Temphranl)unavad.dd,',Idtc,render
-hem has MSDS
LP300
HENRY SCHEIN"
EMS .. .....
E
:-^rr,ti.;;:, r:c'lo.''r Ma!r,r:'I;!:.,2s'r:r"e'JUr<;;. P,ayrne,t by CHECK cr L`y?he HENRY S:HLIN CREDIT CAHC.
ata.,^y,' ,v:• e .'v i?s ::z t :i.,'h':,make:;:i F r::;j:;t en': VISA, F'iASTERCARD. ViSCOVER and Ak. °RICAN EXPRESS
raspcnse'c.mr,nu(ac[.:rers'once ct enrae
Guarant d Satisfactk R:
it':et,haaF t'�,{=orrduc:a'd i(is J'�'ec:rre 9r do�� nr rin:^ l3 R
SalIS'aC:Jti y 1 ?*0 C!o'vde a c:b2:t, "eiv-d,or each^Py2 It C VGJ! Ayal ab 8 i011Cvnsed r'ra�htB^.'E'S r t"c I�.S✓Fi
C1GIC2, tip:c!'t . I JJr CUs}o°'°'S:";!:E d?Car(^'eri;C,'7;Jh'�C;Jays G?"F°b1E +41h r.3�d<•yS. .
o`r2cei;t c:I'.''merry^d Se tG a'i nca`or(he rc'arn. P —_--
h'arrarity y'0.;Yieto zen!SC niv ll9g YG.!CL'r.,;:brk,
s pl_:call: Rx Products & Controlled Substanc,as:
Matrx kicdcal 1-800-845-35x0
Regulat C;;,req j re us to lin'; : w,; d Rx are;)wall;d
substances. :.regst'ed, r•.red're;lthca p,, a jo.jsls,
l'YOU a'e r.dP;i CUSS Ofue C '1a"e te'X-f y'fi1C'i9r{.,*FSe iUr_,Sri
us will-,a u toy of your u;;catxi=a e reg streJon. FL.: ^c'P'rtled
�Ubs+anrp-,bunch a copy e` '., DEA ee•llf eats.,vb:ila'g yo:.'
sl'ip(im;,:4 t s. Class F dr;.cs to odetrd tic, ;,; ail.
Internstional Order--,:
Pleasa 1`10:e:
_ 4`'!a pt01�ey cP"J?t:ialt"Gaff;;'r','e�gl' na 5 any 0?'ri''n ntS
{..(;Er eC tlati I;IP,:,r;3 df`C 2:{!l:orTai':r .l'y"1.9t t'E dill^yn":.n!r�'. "C�i tlC'� "EJirS Of'L'f "Cc'ro l•'.EYpG't
credr Lt`.,'11:G.:;pa'ed cr rs(,';,c in art;,;rda°cr; :h
i1Y3nUfacll, r=.1 ..,iriW rilng�a"dp eC^, "7i t"'_CiiS dr1 Cr"ii a"S;CIEds2.;:f4.Cl oL'i':Prl"d.iun;il ?Cpu•�q;?p(.
ecrapc?ent,+;;s r;g;at'rzi}ruch,e.rc:n=s�pG.°gcn�- aicer
arc,aa.4.ro1.-!tov,'y t'^.<::y^u e;ei:ecexacti" , 11f Prescription Drug Returns Instructions:
�roJ o'de'e::.Cpened Computer software is not re?urrable.
Other restrioticns may also aPply.
A Ret.un Aut°orizat:e.,is Pequu_n'c:1 =''es,,( on:guys a m,Fl;:;all
Our i us:Jm" 's 9roce Cepa!:M'nt
i s �°ry :9:°+ t t:/ 1.1. 1 E:..l.tSd3.`..'?. .. �t,.'ialF�tl.us C�v, ",'i.^�t.+�-4, 1_C . . E,St,t :.S�..j�•vf . .. .�E$cC kt�I_' .
Pleau detach here aM mail the abuse w&th your Paymcm
W11 ORDER ORDER DATE DUE DATE
04628073 10/25/12 11/29/12
DAB#:01?43-OS80
NHSEDEA# RH0162494 Fed ID. 11-3136595
ig&.�. . ,tea • . e
his order as been processed by our MIDWEST .C.
5315 WES 74TH TREET
INDIANAP LIS,IN 46268
1 862-2940 EA QUICKTRACH PEDIATRIC STER SINGUSE 6 6 150 30 900.60 1
F YOU ARE ARTICIPATING IN A DISCOUNT PROG. 1 (E.G. POIN S, GIFTS OR O 'ER
PECIAL AWA ZDS ("DISCOUNT") ) , WITH THIS PURCH BE YOU HAVE IARNED A CREDI TOWARD
GOODS OR S RVICES, RECEIVABLE OR REDEEMABLE N ACCO DANCE WITH DISCOUNT PROGRAM
RULES. UPOI DISCOUNT RECEIPT OR REDEMPTION, OU ARE RECEI ING OR WILL RECEIVE
OTICE OF TIE DISCOUNT VALUE. FROM TIME TO TII E, MEDICARE, MEDICAID, TRI ARE OR
THER PAYER MAY REQUEST INFORMATION REGARDING SUCH V UE, IND 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 =SE RECORDS.
/F: MARK H IETT
MERCHANDI E TOTAL 900.60
Invoice Date + 30 days 900.60
lease reml payments only to the following a dress-
enry Scheil, Inc.
Dept CH 102 1
Palatine, I 60055-0241
FI'17KI STATUS KEY REM1I KEY
R-Barlurdeml,item will lollou SA-school Au
1308571 1308572 9124090-03 900.60 D-Di.mmm N,hem m,lon6a asmlxble ��.uo charse
F-Special Schem Free(luu.0
M1I-Mdnulaaurer will.hip hem Juech}�o you
P-P ,enpuon Drag.Return Amhonzaaon R,ti ed
04 62 8073 10/25/121 10/30/12 1 R-Rdngcm¢d heat.May be chipped¢wrnely
S -SP mlSehem Pncmg
T-Iavblelmm
U-I emporanly uw.ailahle,pleacc rmMer
1 ' -hem has MSDS