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Home My WebLink About222984 08/13/2013 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1 ONE CIVIC SQUARE HENRY SCHEIN INC CARMEL, INDIANA 46032 DEPT CH 10241 CHECK AMOUNT: $433.00 PALATINE IL 60055-0241 CHECK NUMBER: 222984 CHECK DATE: 8/13/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 102 4239011 7667659 433 . 00 SPECIAL DEPT SUPPLIES Please detach here and mail the above with your payment HSI ORDER# ORDER DATE IDUE DATE L11419678 07/29/13 08/28/139 D&B#:01-243-0880 WHSEDEA# RHO162494 Fed ID: 11-3136595 NN ig 2 WIN f7-MY RM, fA1 .............. ELM— LIM do 2.2. This order has been processed by our MIDWEST D.C. 5315 WEST 74TH 3TREET INDIANAPOLIS,IN 46268 1 107-0530 100/BX PURPLE NITRILE PF GLOVE LARGE 40 40 *C 8.50 340.00 4 LASE GOOD ICEM, MAY BE SHIPPED SEPARATELY. 2 499-6737 EA NON-REBREATHER MASK ADULT 100 100 C 0.93 93.00 6 -ASE GOOD I 'EM, MAY BE SHIPPED SEPARATELY. IF YOU ARE ARTICIPATING IN A DISCOUNT PROGPAJI (E.G. POINqS, GIFTS OR O'HER SPECIAL AWARDS ("DISCOUNT")) , WITH THIS PURCHASE YOU HAVE EARNED A CREDI TOWARD GOODS OR S7RVICES, RECEIVABLE OR REDEEMABLE IN ACCORDANCE WITH DISCOUNT PROGRAM RULES. UPOW DISCOUNT RECEIPT OR REDEMPTION, 'IOU ARE RECEIwNG OR WILL R=IVE qOTICE OF T DISCOUNT VALUE. FROM TIME TO TI E, MEDLCARE, MEDICAID, TRIWARE OR OTHER PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, PND UPON ANY STCH REQUEST, SU-H VALUE MUST BE DISCLOSED AS A DI COUNT AGAINS I THE PURCHASES THAT EARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE-AIN THESE RECORDS. MERCHANDI E TOTAL 433.00 invoice Date + 30 days 433.00 lease remi-_ payments only to the following aldress: Henry Scheii, Inc. Dept CH 10211 Palatine, 11 60055-0241 BILL TO SHIP TO INVOICE# - INVOICE AMOUNT ITEM STATUS KEY RREM EM B-Backordered.Item will follow SK-,School Kit 1308571 1817102 7667659-01 433 . 00 1)-Discommuol:Item no longer available NC-No Charge 1'_Special Schein Free Goods HSI ORDER# ORDER DATE INVOICE DATE # OF BOXES M-Manufacturer will ship Item directly to you 11419678 07/29/13 7/29/13 6 11 Prescription Drug:Return Authorization Required R Refrigerated Item:May be shipped separately CUSTOMER PO# $ Special Schein Pricing PAGE T Taxable Item Temporarily unavailable:please reorder MARK 1 OF 1 licm has MS'DS v;re make every e`fo.- f o r~aintar"prices t;,r the duratio. ct a Payment by CHECK or by the HENRY SCHEIN CREDIT CARD, rata na,€hovr.e er,',.e reserve the riche to make rice unjust"ants VISA,MASTERCARD,DISCOVER and AMERICAN EXPRESS response fo manufacturers`price chanties Guaranteed Satisfaction: vsn. If vou.have tried a oroduct and it is defect-ive or does nc)t oerform or Bill satisfactorily,4ve,,ill prov?de a credit,refund,or exchange rCs roar !arlab.r to licensed rac.trt.or.cr.. r t tJ.S 4. ..i ic{s are choice, Simply ca l our cuslo,er service d4 aartn en;vu`hin 30 dais payable within 30 days, of recFeiat of the rnerc`har d se to arrange for the return. For a warranty repair or if yo.were sent something you did riot order, s r-ply call; x Products & Controlled Substances: trx Medical 1-800-845-3000 Regulatio?Is rorfu r,cis to limit the sale ot ax ar•:.d controlled substances only to registered,"ce-nsed healthcare professionals, If you are a new cus`omer or have recently moved,please fur h sn us with a coal of y^ur updated state rag?titrat ian, For controlled substances,furnish a copy of your DEA certificate,verify rg Your shipping address. D-lass 11 dru-gs can be ordered on1; b;Y r`ail, International Orders: Plea,e Cote. - - - E,proudly serve healthcare:professionals an!governments Opened handpieces and equipment rray not be returned for �,,, credit.t€`;rLii1 be rcepaired or replaced in accordance th throughout the vvorid, :o place orders or for hgu r;es on export terms and crrdit ons,please contact cur I:Mrnatlonal Department.- Manufacturer warrant es,Bo'ore n ee ning handp ecns or :-800-845-3550 equipment,we suggest that;Y a check the sh p sir g comaine r and pack no list to ven!v%tna°you!have exactly ghat you ardered,Opened Computer Software is not returnable. Prescription Drug Returns Instructions: Otter restrictions may also apply. A f9e4urn Authorization is Required for all:-Prescription Drugs.S.mply call cur Customer Senice Department 1-800.8415-3550, m::;;.emu......,.�.,x»;,�,a.,,,_._.w::.;;:�.,,. ,.,......�.�»,>,......,,,_.J:._>;;,. .«.-.._ -..- ...,.�.>,,,,:-....:::•.... �a„_,-•.-��;:f °'.� .,,,..; ,. � ,,,...�s,..,......_....,..,. Y_ _,_.,..,,,,.._....,,,_...a.,�....»...,..,,, _..._M.. ..................._.._„_,._�...,,. .......ice.....,.,,,, .,...>�..., _,......_,,,,,_ ..,._..,,,r,,,�,:.,:......_„__.�..> ,<.t�. LP300 VOUCHER NO. WARRANT NO. ALLOWED 20 Henry Schein IN SUM OF $ Dept Ch 10241 Palatine, IL 60055 $433.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1120 I 7667659 1 102-390.11 I $433.00 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 AUG 12 2013 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 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)) 7667659 $433.00 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