220641 06/04/2013 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1
ONE CIVIC SQUARE HENRY SCHEIN INC
CARMEL, INDIANA 46032 DEPT CH 10241 CHECK AMOUNT: $1,243.40
PALATINE IL 60055-0241 CHECK NUMBER: 220641
l QOM GO
CHECK DATE: 6/4/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 4239011 2141726-01 1, 243 . 40 SPECIAL DEPT SUPPLIES
HENRY 91 H I @
E \/ SHIP TO/SOLD TO:
INVOICE C Carmel Fire Department MI
135 Duryea Road, Melville, NY 11747 540 W 136 St
Station 46 Michael Kaufmann
Carmel,IN 46032-8806
010000130857102141726110010000001243400514135 BILL TO:
Carmel Fire Dept MI
2 Civic Sq
Carmel, IN 46032-7543
Carmel Fire Dept
2 Civic Sq BILL To I sxlP To INVOICE AMOUNT
Carmel, IN 46032-7543 1308571 1817102 1 1243 .40
INVOICE# INVOICE DATE
2141726-01 5/14/13
CUSTOMER PO
MARK
Please detach here and mail the above with your payment
HSI ORDER# I ORDER DATE IDUE DATE
09596892 05/14/13 06/13/13
D&B#:01?43-0880
WHSE DEA# RHO]62494 Fed ID: 11-3136595
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10 890-3903 12/BX CONFORM STRCH BANDAG STER 4X75YD 8 8 7.10 56.80 6
F YOU ARE ARTICIPATING IN A DISCOUNT PROG (E.G. POIN S, GIFTS OR OTHER
PECIAL AWA DS ("DISCOUNT") ) , WITH THIS PURCHASE YOU HAVE EARNED A CREDI TOWARD
GOODS OR SERVICES, RECEIVABLE OR REDEEMABLE N ACCO DANCE WITH DISCOUNT PROGRAM
RULES. UPOH DISCOUNT RECEIPT OR REDEMPTION, OU 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 VALUE, PND UPON ANY SUCH
REQUEST, SU H VALUE MUST BE DISCLOSED AS A DI COUNT kGAINS1 THE PURCHASEI THAT
EARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN THESE RECORDS.
---------- --------------------------------- ------ ----- ------------- -----
ortheast D stribution Center
1 WEAVER R AD
DENVER, PA 17517
Southeast D stribution Center
691 JESSE 3 SMITH CT
ACKSONVILL , FL 32219
ICENSE #: 2:01315
MERCHANDI E TOTAL 1243.40
Invoice Date + 30 days 1243.40
Please remi payments only to the following a dress:
Henry Schein, Inc.
Dept CH 102 1
Palatine, IL 60055-0241
BILL TO SHIP TO INVOICE INVOICE# INVOICE AMOUNT ITEM STATUS KEY REM KEY
1308571 1817102 B-Backordered:Item will follow SK-School Kit
21417 2 6-01 12 4 3 .4 0 D-Discontinued:item no longer available NC-No Charge
F-Special Schein Free Goods
HSI ORDER# ORDER DATE INVOICE DATE # OF BOXES M-Manufacturer will ship Item directly to you
14 13 5/14/13 $ P-Prescription Drug:Return Authorization Required
09596892 0 5
/ / R-Refrigerated Item:May be shipped separately
CUSTOMER PO PAGE $ -Special Schein Pricing
T-Taxable Item
U-Temporarily unavailable;please reorder
MARK 2 OF 2 Item has MSDS
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FAHENRY SCHEIN E
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;:.n..::-_ei .
We make every aff=.;'to maintai: pri;, s for thr dtaratio of a Payment by CHECK or by the HENRY SCHEIN CREW CARD,
rata n G,i.n,r,ever,v'.e reserve tl.e right to make price adjustments it VISA,MASTERCARD,DISCOVER and AMERICAN EXPRESS
response to man utautrers'price chances
Guaranteed Satisfaction:
if,00:have tried a product and it is defedi:%e or does noto.erform or
sans:a� rily,we vill pro4-ide a credit,refund,or exchange-,its your �r�s
_^t��t .�� x =t• < ., _� =. FF, .:;. :. .... .
Choice, Simply call o..-jr customer service deparlr ent r 4hh 0:lays
Available to licens>.,d practitioners nrU e U.S.All:nvoicr s are
of rect ipt of the rner4:ha dice to arrarage'or the return, For a
payable"within 3 days
warrant,,,,?eoair or if yo u were sent sorno ping you did not order,
r,
simply call: x Products & Controlled Substances:
latrx Medical 1-000-045-3550
Regulations require cis to limit the sa:o,of Rx and confr• lied
substances or;ly to registered,licensed healthcare professionals.
if you are anew customer or have recently moved,please fur,-:sly
us with a copy of your updated state registration, For controlled
substances,f:<rnish a cups;of your DEA cedificale,verifying yo:.r
shipping address, Class it dr<<rm can be orderod only b',-41,
International Orders:
.l.ease Pot
We proudly serve healthcare professionals and governments
Uperte'handpieces arts equipment may not be ref:rY,eJ far e
credit;but vil!be re or replaced d in accordar ce k,h tltrcugh ut tla >r rld, plan sd_rs or t r rtgu r as c kpo t
terms arty conditions,please contact o'ur ln�ernatlonal Depa tnaer7t:
manufacturer warrant es,Beforfe opening hia dpseces or 1 y 8 5,50
eF:.czrpm;;nt,;: s:gge st tr at y cca chew shipping comainer 8GC ��5'4
the sh
ar= asking list try verily the°you leave reoeired exactly what Proscription Drug Returns Instructions:
you ordered.Openedl Computer Softviare to not returnable.
Other restrictions may also apply.
A Return Authorization is Required fur at Prescription Drugs.Si?1ply call
our Customer Service Department 1-8000-845-3550,
FS„4� ............
LP300
VOUCHER NO. WARRANT NO.
ALLOWED 20
Henry Schein
IN SUM OF $
Dept Ch 10241
Palatine, IL 60055
$1,243.40
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
r
1120 I 2141726-01 1 102-390.11 I $1,243.40 1 hereby certify that the attached invoice(s), or
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
A� J '
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
4n invoice or bill to be properly itemized must show: kind of service,where performed, dates service rendered, by
Nhom, 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))
2141726-01 $1,243.40
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