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Home My WebLink About221078 06/18/2013 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1 ONE CIVIC SQUARE HENRY SCHEIN INC CARMEL, INDIANA 46032 DEPT CH 10241 CHECK AMOUNT: $849.40 PALATINE IL 60055-0241 CHECK NUMBER: 221078 CHECK DATE: 6/18/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 102 4239011 2733362-01 595 .40 SPECIAL DEPT SUPPLIES 102 4239011 3567089 254 . 00 SPECIAL DEPT SUPPLIES Please detach here and mail the above with your payment HSI ORDER# ORDER DATE DUE I DATE I 10185772 06/06/13 07/06/13 D&B#:01-243-0880 WHSEDEA# RHO162494 Fed ID: 11-3136595 4 V k al his order as been processed by our MIDWEST D.C. 5315 WES" 74TH 3TREET INDIANAPOLIS,IN 46268 1 499-7780 EA TOURNIQUET COMBAT APP. ORANGE 20 20 29.77 595.40 1 PRODUCT IS 3EING SHIPPED TO YOU DIRECTLY FROM THE MkTUFACTLRER. OUR ORDER L0185772 HAS BEEN SPLIT INTO MULTI LE SHI MENTS. CERTAIN ITEM! WILL BE SHIPPED SEPARATELY. YOU WILL BE BILLED FOR THESE TEMS HEN THEY ARE ! HIPPED. IF YOU ARE DARTICIPATING IN A DISCOUNT PROGRA11 (E.G. POINIS, GIFTS OR OTHER rPECIAL AWAZDS ("DISCOUNT")) , WITH THIS PURL SE YOU HAVE EARNED A CREDI 11 TOWARD GOODS OR S ERVICES, RECEIVABLE OR REDEEMABLE N ACCOZDANCE WITH DISCOUNT PROGRAM RULES. UPON DISCOUNT RECEIPT OR REDEMPTION, OU ARE RECEI%ING OR WILL RECEIVE NIOTICE OF THE DISCOUNT VALUE. FROM TIME TO TI E, MEDICARE, MEDICAID, TRICARE OR DTHER PAYER MAY REQUEST INFORMATION REGARDING SUCH VALUE, PND UPON ANY STCH :ZEQUEST, SU H VALUE MUST BE DISCLOSED AS A DI COUNT GAINS rl THE PURCHASE THAT ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE'AIN THESE RECORDS. MERCHANDI E TOTAL 595.40 Invoice Date + 30 days 595.40 Please remi: payments only to the following a(ldress: Henry Scheii, Inc. Dept CH 10211 Palatine, 1, 60055-0241 BILL TO -SHIP TO INVOICE# INVOICE AMOUNT ITEM STATUS KEY FTRENf KEY 1308571 1308572 I-Backordered:Item will follow SK-School Kit 2733362-01 S95.40 :)-Discontinued:Item no longer available NC-No Charge F-Special Schein Free Goods HSI ORDERIf ORDER DATE INVOICE DATE # OF BOXES M-Manufacturer will ship Item directly to you 11 Prescription Drug:Return Authorization Required 10185772 06/06/13 6/06/13 1 R Refrigerated Item:May be shipped separately $ Special Schein Pricing CUSTOMER PO# PAGE# T Taxable Item Temporarily unavailable:please reorder MARK 1 OF 1 hem has MSDS LP300 ---------- -------- Payinnient rerins: 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: I-T-15-A-1 If you have tried a product and it is defective or does not perform or satisfactorily,we will provide a credit,refund,or exchange;it's your Bill Your Order To Your Open Account choice, Simply call our customer service department within 30 days Available to licensed practitioners in the U.S.All invoices are of receipt of the merchandise to arrange for the return. For a payable within 30 days. 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 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: Opened handpieces and equipment may not be returned for We proudly serve healthcare professionals and governments credit,but will be repaired or replaced in accordance with throughout the world. To place orders or for inquiries on export manufacturer warranties.Before opening handpieces or terms and conditions,please contact our International Department: equipment,we suggest that you check the shipping container 1-800-845-3550 and packing list to verity 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. 0 i4 5k7 7; X4 � please detach here and mail the above with your payment 09790OS1 05/24/13. 06/23/139 oau#:n/'zm'uoxo wxssoaA# nx0162494 Fed: ||-313o5p 10 NOW 95T.NK This order has been processed by our MIDWEST D.C. 5315 WES" 74TH 3TREET 7ASE GOOD I PEM, MAY BE SHIPPED SEPARATELY. F YOU ARE ARTICIPATING IN A DISCOUNT PROGRk11 (E.G. POINrIS, GIFTS OR OTHER PECIAL AWARDS ("DISCOUNT") ) , WITH THIS PURCM�SE YOU HAVE EARNED A CREDI" TOWARD GOODS OR SERVICES, RECEIVABLE OR REDEEMABLE _N ACCORDANCE WITH DISCOUNT PROGRAM RULES. UP04 DISCOUNT RECEIPT OR REDEMPTION, IOU ARE RECEIIING OR WILL RECEIVE OTICE OF TiE DISCOUNT^ TIIE, / THER PAYER MAY REQUEST INFORMATION REGARDING SUCH V%LUE, PND UPON ANY S CH EQUEST, SU-H VALUE MUST BE DISCLOSED AS A DICOUNT AGAINSI THE PURCHASE, THAT ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE-AIN THESE RECORDS. MERCHANDI ;E TOTAL 254.00 Invoice Date + 30 days 254.00 Please remi: payments only to the following aldress: Dept CH 10211 Palatine, 1, 60055-0241 BTLL TO SHIP TO INVOICE# INVOICE AMOUNT ITEM STATUS KEY REM KEY I-13ackordered:Item will follow SK-School Kit 1308571 1817102 3567089-01 254 .00 �)- )iscontinued:Item no longer available NC-No Charge JJSI ORDER4 ORDER DATE INVOICE DATE # OF BOXES F -Special Schein 1--me Goods M-Manufacturer will ship Item directly to you 13 Prescription Drug:Return Authorintion Required 09790OS1 05/24/13 S/24/13 2 R Refrigerated ltcm�May he shipped separately CUSTOMER PO# PAGE# S Special Schein pricing T Taxable Item Temporarily unavailable:please reorder MARK 1 OF 1 Item has NISDS We make every effo! °o pint:l prices for the durafion ot a Payment by CHECK or by the HENRY SCHEIN CREDIT CARD, catalog,:however,we reserve the right to make orice adjust~tints ill VISA,MASTERCARD,DISCOVER and AMERICAN EXPRESS response to manufact;.:rers'price,--�lianfi-es Guaranteed Satisfaction: or If you have tried aoroduct and it is defedive or doesnot pod orm r3ifl Y�An I-Ir der."ra Qpcn satisfactorily. rily,,we will a credit,refund,or exchange-,it'syo; r Availab'e to licensed practifioniors:n the U.S.Anvoicos are choice. Simpiv call our customer service cleoartmen�,0hin 30 dais pavablo within 30 days, of receipt of the morch,andso to arrange for the return. Fora ,,arraril'y,repair or it you were sent,something you did not order, simply call: Rx Products & Controlled Substances: Matrx Medical 1-800-845-3550 Regulafio ns 1 require us to limit the sale of Rx and controlled substance.^s only to registered,licensed healthcare professionals. If you are a new customer or have rece;ntly moved,please furn;ish; us with a copy of your updated state registration. For controlled substances,furnish a copy of your DEA certificate,verifying yo::r shipping address. Class 11 ,,can drugs be ordered onIv b mail, - can I y International Orders: Pause Note: ............................ We proudly serve healthcare professionalsand governments Opened handpieces and equipment may not be ret: rned for r0 ;d. piece or for credit,but vvill be repaired or replaced. in accordance v,,`h t:! ughout the wor, on export rnanufacturer,warrant:es.Before opening ha:ndpeueS or t:terms and condiflons,please contact our Ir"'ern0onal Depairtment- 1-800-845-3540 e().Uiprnent,we suggest th'at you check ihe shipping contiiner and packing list to verify that you eve received exactly what you ordered.Opened Computer Software is not returnable. Prescription Drug Returns Instructions: Other restrictions may also apply. A Return Authorization is Required or all Prescription Drugs.Simply call off'Customer Service.Department I@'1800-84'5-3550 w. 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)) 2733362-01 $595.40 3567089 $254.00 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 VOUCHER NO. WARRANT NO. ALLOWED 20 Henry Schein IN SUM OF $ Dept Ch 10241 Palatine, IL 60055 $849.40 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO#/Dept. INVOICE NO. I ACCT#/TITLE I AMOUNT Board Members 1120 2733362-01 j 102-390.11 j $595.40 1 hereby certify that the attached invoice(s), or 1120 3567089 102-390.11 $254.00 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 1-11JN 1 7 2013 Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund