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Home My WebLink About221542 07/02/2013 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1 4J� ONE CIVIC SQUARE HENRY SCHEIN INC CARMEL, INDIANA 46032 DEPT CH 10241 CHECK AMOUNT: $2,486.80 PALATINE IL 60055-0241 CHECK NUMBER: 221542 CHECK DATE: 7/2/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 102 4239011 3280219-01 1, 143 . 30 SPECIAL DEPT SUPPLIES 102 4239011 3666872-01 1, 343 . 50 SPECIAL DEPT SUPPLIES yy b} t Please detach here and mail the above with your payment HSI ORDER# ORDER DATE DUE DATE 10185918 06/06/13 07/07/13 D&B#:O 1-243-0880 WHSE DEA# RHO162494 Fed ID: 11-3136595 v :a ' E'`� '¢;88 '" .. :. 04E 8 • 8. I.` »:r'r5 EQUEST, SU H VALUE MUST BE DISCLOSED AS A DI COUNT kGAINSI THE PURCHASE1 THAT EARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN THESE RECORDS. MERCHANDI E TOTAL 1143.30 invoice Date + 30 days 1143.30 lease remi payments only to the following a dress: enry Schei , Inc. ept CH 10211 alatine, I 60055-0241 I ILL H T INV IrrvolcE AMOUNT ITEM STATUS KEY REM KEY I3-Backordered;Item gill follow SK-School Kit 1308571 181710 2 3 2 8 0 219-01 114 3 .3 0 D-Discontinued:Item no longer available NC-No Charge S D R ORDER DATE NV ATE F -Special Schein Free Goods M-Manufacturer will ship Item directly to you P-Prescription Drug:Return Authorisation Required 10185918 06/06/13 6/07/13 14 R-Refrigerated Item:May be shipped separately CU OM ER PO p g $ -Special Schein Pricing T-Taxable Item jZI{ 2 OF 2 U-Temporarily unavailable:please:reorder * -Item has MSDS We make Etrery effort to aintain prices r the duration of a Payment by CHECK or by the HENRY SCHEIN CREDIT CARD, catalorr,ho;r ever,we reserve t!-e right to make price adjustments VISA,MASTERCARD.DISCOVER and AMERICAN EXPRESS response to manufact:,rers<price changes Guaranteed Satisfaction: or If you have tried a product and it is defective or does not oerfor Bill Your Ordl-r z Your 0" Pen A ;cei_lrrf satisfactorily,we viii provide a credit, refund,or Exchange;it's yortr Available to IicEnscad practitioner s in the U.S.All voices are choice. Simply call our custorr er service deoartmenit"hin 30 days Of receipt of th;;rnercha�dise to arrange',;r the return. Fora payable rlifhir:.30 days, g_, varranty r>mair or if you were sent something you did riot order, simply call; l air Medical 1-800-X45-35 0 lax Products & Controlled Substances: Regulations require us to limit the sale of fix and controlled substances only to registered,licensed healthcare professionals. It you are a new CUStomer or have t'ecE'tl;l moved,please fur?iSh us },pith a copy of your updated state registration. Fur centrollEd substances,hi.nish a copy of your DEA certificate,verifying yo:<r shipping address. Class Il drufm can,be orderod oniv b,::alt. International Orders: 'lease Note: We proudly serve healthcare professionals and governments Opened handpieces and equipment ay n.t be returned'.,or credit;but will be repaired or replaced in accordance:,th throughout the v o d -:o place orders or or rq�IriES on export terms and conditions,please contact our Inte,rnational DEpa tmEnt: manufacturer warranf es.FeforE opening handpieces or 1 800 845 35:0 equipment,we suggest that you check the shipping container and packing list to verify tfat You I-avE received Exactly what Prescription Drug returns Instructions: you ordered.Opened Computer Software is not returnable. Other restrictions may also apply. A Refum Authorization is Required for all Prescription Drugs.Sim ply call our Customer Service Department °1.300.845-3550. : ........ .. �... ..... ....I ................_...:.<.. .. : ^�....... 7..._....._ ...... ......:.+rte:"£!: ...ESa:... , ........<:.. LP300 HSI ORDER ORDER DATE DUE DATE 10185918 06/06/13 07/07/13 D&B#:01-243-0880 WHSE DEA# RH0162494 Fed ID: 11-3136595 ) .�. >.. .: a .: .. .. .... a. a s%".::.._... .....:�- ° ,., � ."a• a;�. :I-.•.fix 1:;` ,y x° ":^f • This order ias been processed by our MIDWEST D.C. 5315 WEST 74TH 3TREET INDIANAP LIS,IN 46268 ARK 317-57 --2663 1 507-8362 PX 100/BX NACL PREFILL SYRINGE 10ML ST 3 3 39.00 117.00 3 N - PEDIGR E ITEM. DC:6380701 010 2 555-1166 PU EA PROTECTIV ACUVNC SFT OATH 18X1.25 100 100 2.23 223.00 3 3 555-5396 PU EA PROTECTIV ACUVNC SFT CATH 20X1.25 400 400 C 2.23 892.00 2 ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. 4 654-1395 PU 50/BX PROTECTIV ACUVANCE SAFETY 24GX5/8 1 1 111.50 111.50 3 ------------- ------ ----- ------------- ------- ---------- --------------------------------- ------ ----- ------------- ------- OUR ORDER 0185918 HAS BEEN SPLIT INTO MULTIPLE SHI MENTS. CERTAIN ITEM WILL E SHIPPED EPARATELY. YOU WILL BE BILLED FOR THESE ITEMS WHEN THEY ARE HIPPED. F YOU ARE 3ARTICIPATING IN A DISCOUNT PROGRAM (E.G. POIN S, GIFTS OR OTHER SPECIAL AWA ZDS ("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. UP04 DISCOUNT RECEIPT OR REDEMPTION, OU ARE RECEI1,ING OR WILL R 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, PND UPON ANY S CH EQUEST, SU H VALUE MUST BE DISCLOSED AS A DI COUNT GAINSq THE PURCHA!!t THAT FILL To INV E Irrvol ITEM STATUS KEY REM KEY 13-Backordered:Item will follow SK-School Kit e1308571 181710 2 3 6 6 6 8 7 2-01 13 4 3 .5 0 D-Discontinued:Item no longer available NC-No Charge 1'-Special Schein free Goods INN TE H M-Manufacturer will ship Item directly to you P-Prescription Drug:Return Authorization Required 0 6/0 6/13 6/0 7/13 3 R-Refrigerated Item:May be shipped separately S -Special Schein pricing T ER O PAGE T-Taxable Item U-Temporarily unavailable:please reorder 1 OF 2 ` -Item has MSDS Continued on Next Page.......... MHENRYSCHEIN SHIP TO/SOLD TO: EMS INVOICE Carmel Fire Department MI 135 Duryea Road, Melville, NY 11747 540 W 136th st Station 46 Michael Kaufmann Carmel,IN 46032-8806 010000],30857103666872110010000001,34350060713], BILL To: Carmel Fire Dept MI 2 Civic Sq Carmel, IN 46032-7543 Carmel Fire Dept BILL TO SHIP TO INVOICE AMOUNT 2 Civic Sq Carmel, IN 46032-7543 1308571 1817102 1343 .50 INVOICE INVOICE DATE 3666872-01 6/07/13 CUSTOMER PO MARK # ___j Please detach here and mail the above with your payment HSI ORDER ORDER DATE DUE DATE 10185918 06/06/13 07/07/13 D&B#:01-243-0880 WHSE DEA# RHO162494 Fed ID: 11-3136595 T ; : Wig. r: EARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN THESE RECORDS. N - HENRY SCHEIN, INC. HAS PURCHASED THE SPECIFIC UqIT OF THE PRESCRIPT ON DRUG DIRECTLY F OM THE MANUFACTURER. MERCHANDI E TOTAL 1343.50 invoice Date + 30 days 1343.50 Please remi payments only to the following a dress: Henry Scheii, Inc. Dept CH 102 1 Palatine, IL 60055-0241 i BILL TO SHIP:TO INVOICE# INVOICE AMOUNT ITEM STATUS KEY REM KEY B-Backordered.Item will follow SK-School Kit 1308571 1817102 3666872-01 13 4 3 .5 0 D-Discommuod:Item no longer available NC-No Charge P-Special Schein Free Goods HS D R OR INVOICE ATE M-Manufacturer will ship Item directly to you 0 6 13 6/07/13 P-prescription Drug:Return Authorization Required 1018 5 918 0 6 / / 3 R -Refrigerated Item:May be shipped separately $ -Special Schein Pricing ER PA E T-Taxable Item MARK 2 �F 2 U-Temporarily unavailable:please reorder ' -Item has MSDS ............. ..................................................... ............................... ....................... ........ . ..................... .... ......... . ............ ............ ...... ............. ................... ..................... ............. ............... ............. . ........ ........ ....... ............ ...... ...... N HENRY SCHEIN T EMS ERMS 01-�' A ................ ........... . ............................. ...... ........... ........... ........... nyrment Ter ns-1 ,14c, make cvery fa'fol-t lo;rnainta:!;prices'or the durafio:,of a Payment by CHECK or by the HENRY SCHEIN CREDIT CARD, catalog, owever,we reserve the right to make oricre,adjust~ents'n VISA,MASTERCARD,DISCOVER and AMERICAN EXPRESS response manufacturers'price changes Guaranteed Satisfaction: or if you have tried a product and it is defective or does not perform 8H1 Your Order To Your ,,Dpen :Account satisfactorily we will provide a credit,refund,or exchange-,it's your Available to licensed practitioners r:.the U.S.All::,voices are choice. Sirnp::V call our customer service departmi-en'w4hin 3.30 days y payable.within 30 days, of recoiot of the nlem"a,dsfe to arrange for the return. Fora %.varrantre.Dair*or if yo w1 sent somothing you did not order, call: Rx Products & Controlled Substances: Matrx Medical 1-800-845-3550 RPOUlat:01"S,require us to limit the sale of Rx and controlled substances only to registered,licensed healthcare professionals. If you are anew customer or have recently moved.Pplease,Purr is us-will,,a copy of your undated state registration. For controlled g your ft mish acopy of tour DEA certificate,verify N. shipping address. Class 11 druasnan be ordered only by"fail., International Orders: Please Note: We proudly serve h(,;aItir,,jrp or.fessionals and governments Opened handpleces and equipment may not be returned'or orinquirlees on expo t1hroughout the�wor'd. �,o place orders or f ort credit,but vv:ll be repaired or replaced in accordance h terms and conditions,please contact our l M err aiional UE'e-partment.. manufacturer warrant,e,,>,Bo,'ore opening ha:ndpece-s or. 1-800-845-3550 equipment.vve suggest that you check the shipping co-ainer and.oack'na list to veWy that you Dave received exactly what Prescription Drug Returns Instructions: you ordered.Opened Computer Software is not returnable. Other restrictions may also apply. M. A Return Authorization is Required for all Prescription..rugs.S i 1ply call our Customer Service Department 4':1800-8453550. LP300