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Home My WebLink About224520 09/25/2013 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1 ONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: $99.50 4,=0 CARMEL, INDIANA 46032 DEPT CH 10241 '''<•uH Zo� PALATINE IL 60055-0241 CHECK NUMBER: 224520 CHECK DATE: 9/25/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 102 4239011 8298613-02 99 . 50 SPECIAL DEPT SUPPLIES HSI ORDER# I ORDER DATE IDUE DATE 12235391 1 08/28/13 D&B#:01-243-0880 WHSE DEA# RHO162494 Fed ID: 11-3136595 ,W. 0 ma This order has been processed by our MIDWEST D.C. 5315 WES'' 74TH 3TREET INDIANAP LIS,IN 46268 1 499-8529 EA BVM RESUSCITATOR DISP ADULT 10 10 C 9.95 99.50 1 ASE GOOD ICEM, MAY BE SHIPPED SEPARATELY. THE PRICES 3TATED ABOVE MAY REFLECT A DISCOUN" OR BE SUBJECT TO A REBATE YOU 4UST FULLY D ACCURATELY REPORT THIS STATED UISCOUNF PRIC , OR IF APPLI('ABLE, kNY NET PRI-ING, AFTER GIVING EFFECT TO ANY REBATES, TO MEDICARE, MEDICAID, rRICARE AND ANY OTHER FEDERAL OR STATE PROGRAII UPON ZEQUESq BY ANY SUCH PROGRAM. IT ISYOUR ZESPONSIBILITY TO REVIEW ANY AGREEMENTS OZ OTHEF DOCUMENTS APPLICABLE TO THESE PZICES TO DETERMINE IF THEY ARE SUBJECT TO A REBPTE. THE FEDERAL OVERNMENTIIPOSES CERTAIN RESTRICTIONS ON, AN REQUIZES PUELIC REPORTING OF, TRANSFERS OFVALUE TO A PRACTITIONER. IF YOU ARE PART ECIPATING IN A PROMO DISCOUNT PR GRAM (E.G. POINTS, DISCOUNT REDEMPTIONS )R OTHER SPECIAL AWAImS) , RITH YOUR PJRCHASES YOU MAY EARN POINTS/CREDIS REDEEMABLE FOR CERTAIN GOODS OR SERVICES, 14 ACCORDANCE WITH DISCOUNT PROGRAM RULES. UPON EISCOUNT RECEIPT BY REDEMPTION )F YOUR EARNED POINTS/CREDITS, YOU ARE RE"EIVING OR WILL RECEIVE .\IOTICE OF T DISCOUNT VALUE. ACCORDINGLY, YO J SHOULD RETAIN THESE RECORDS. N - HENRY =EIN, INC. HAS PURCHASED THE SPE'IFIC IT OF THE PRESCRIPT ON DRUG DIRECTLY FROM THE MANUFACTURER. ------------- MERCHANDI E TOTAL 99.50 Invoice Date + 30 days 99.50 BILL TO SHIP TO INVOICE INVOICE AMOUNT ITEM STATUS KEY KEY 1308571 1817102 B-Backordered:Item will follow K-S hotd K it 8298613-02 99.50 1)-Discontinued:Item no longer available I_ free Goods NC-No Charge Special Schein I- U I Coo a 11 HSI QRDER#< ORDER DATE INVOICE DATE # OF BOXES M-Manufacturer will ship Item directly to you 1) Prescription Drug:Return Authorization Required 12235391 08/28/13 8/30/13 1 R Refrigerated Item:May be shipped separately - $ Special Schein Pricing CUSTOMER PO PAGE T Taxable Item U-Temporarily unavailable:please reorder MARK 1 OF 2 -hem has MSDS Continued on Next Page.......... LP300 �',"r�HEN R I SCHEIN"' SHIP TO/SOLD TO: EMSCarmel Fire Department MI 135 Duryea Road, Melville, NY 11747 ® 0®� 540 w 136th St yy Station 46 Michael Kaufmann Carmel,IN 46032-8806 0100001308571082986131],0020000000099500830137 BILL TO: Carmel Fire Dept MI 2 Civic Sq Carmel, IN 46032-7543 Carmel Fire Dept BILL To I SHIP TO INVOICE AMOUNT 2 Civic Sq Carmel, IN 46032-7543 1308571 1817102 99 .50 INVOICE# INVOICE DATE 8298613-02 8/30/13 CUSTOMER PO# - - MARK- - - — �- please detach here and mail the above with your payment HSI ORDER# I ORDER DATE IDUE DATE 12235391 08/28/13 09/29/13 D&B#:O 1-243-0880 WHSE DEA# RHO162494 Fed ID: 11-3136595 ;: 3- '' .:3?'13 �•�•.= t1', .: a ��-:.�£t•yt £ui:25r' ; ,; ..�..,, .�nre s-,* .•s....ss.:::... _. „••.••,,.,�,rI.t:=K ' •..w•••...:. ��r( hl� .... ::w.,� s�c^�xe,.,.!2��1 �.axx y.�tl Ltt - � ;.:,� .£F. �.a;;:' Please remi payments only to the following a dress: enry Schein, Inc. ept CH 102 1 Palatine, I 60055-0241 LH ILL T.0 SHIP TO INV ICE INVOICE AMOUNT ITEM STATUS KEY 7REM KEY 0 8 5 71 181710 2 8 2 9 8 613-0 2 9 9 .5 0 H Backordered:ucm will follow chool Kit D-Discontinued:Item no longer available No Charge P Special Schein Free Goods �� R DER ORDER ATE INVOICE DATE 4 OF BOXES M-Manufacturer will ship Item directly to you P-Prescription Drug:Return Authorization Required 12235391 08/28/13 8/3 0/13 ] R -Refrigerated Item:May be shipped separately C T MER Pb4 PAGE $ -Special Schein Pricing T-Taxable Item U-Temporarily unavailable:please reorder MARK 2 OF 2 Rem has MSDS LP300 ......... ......... ......... ....... ......... ..... . . .. .. ......... .--.... ._........... ..... ......... ....._... __._. ...... ......... ........... ........ .. ......... ......... ......... ... ..._ ..... .. .......... HENRY Imo` EMS ......... .... ..... ..... .... ......... ......... ......... ...._._.. _._._ ........... ...... ......... ......... .................... ......... ......_........................... .,`V'e make very`r ff,rt i„ ainfain prices`:,r the duratinn,;f a Payment by CHECK or by the HENRY`"SCHEIN CREOIT CARD, ata o,however,we reserve the right to make price adjustments VISA,MASTERCARD,DISCOVER and AMERICAN EXPRESS response to manufacturers`price l-ianges Guaranteed Satisfaction, vfsn or If ycu'have tied a oroduct and it is defecfive or does not oerforn Bill �r �t€s`a 'orilY: �,,e 4��ill urcmde a credit,refund,or exchange;it ;Dirt e r6 yr�e r: t. :,x-: ,ai'ab e to licensed practif.t?r ors i t.w U.S.A1....rvoi es are choice, inVv pall our customer service de,;art:y:en:-Y hin�'0 days a <b r ;rithin;? days, of r,c=i^t^t fti rrierc:a.-dise to arrange:for the return. Fora � ' warrant,-Y:''erialr or it vo::were sen°somolfi Ig you did n;t ureter, dimply call: Px Products €stroll d Substances: latrx Medical 1-800-845-3550 Regulations require€;s to limit the sale of P x and c=ontr lk d substances only to registered,Been ed healthcare professionals. If you are a new customer or have recently moved,please fUMish us with.a copy of tour updated s°ate reg stratlon. For Controlled substances,f irni h a copy of±four DEAD certificate,verifyir q your shipping address, Class Il drt(.;s can be ordered only ib �m:ail. International Orders: Pilease Notes _..._...___...I.._............. vv`e proudly servo healthcare r)rofassionals an!governments Opened hand;feces and equipment may not be reLimed for �, - �,,. � credit;bu`Kraal buy repaired or replaced in accordancr �.�,i h t roughout the,vorid, :�pace,;rd.�rs or f r r-quir es on export terms and conait ons.olease contact our l n errlational ,epart€��ent: f c,a el of ' manuf<<li: r��;rrantis�s.B �,rr;�p�fning handf.iEC;s or `-8CU-845-�,,v�u equipment,vve s ggeQ—t that,Yc;u::hecK`,e s ,p?ng container and packing list to+. ri'y t~af „you eye received.exactly what Prescription Drug Returns Instructions: VU r erdered.Cpened Computer Software is not returnable. Other restrictions may also apply. A t9eturn;hut,orizat:on is Required for all Presuipikon"DrUgs.&r�ply call our Euston er Service Depa rnent 1 X00-84 VOUCHER NO. WARRANT NO. ALLOWED 20 Henry Schein IN SUM OF $ Dept Ch 10241 Palatine, IL 60055 $99.50 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1120 I 8298613-02 1 102-390.11 I $99.50 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 EP G 3'2013 Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund Drescribed 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)) 8298613-02 $99.50 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