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Home My WebLink About226334 11/19/2013 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1 ONE CIVIC SQUARE HENRY SCHEIN INC CARMEL, INDIANA 46032 DEPT CH 10241 CHECK AMOUNT: $1,721.40 PALATINE IL 60055-0241 CHECK NUMBER: 226334 CHECK DATE: 11/19/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 102 4467006 5718883-01 642 . 52 EMS EQUIP 102 4239011 5741918-01 788 . 78 SPECIAL DEPT SUPPLIES 102 4467006 5741918-01 262 . 50 EMS EQUIP 102 4239011 8804235-01 27 . 60 SPECIAL DEPT SUPPLIES Please detach here and mail the above with your payment HSI ORDER# ORDER DATE IDUE DATE 13994739 11/05/13 12/05/13 D&B#:01-243-0880 WHSE DEA# RHO162494 Fed ID: 1 1-3 136595 WPM OTICE OF THE DISCOUNT VALUE. ACCORDINGLY, YOU SHOUL RETAIN THESE RECORDS. ortheast D stribution Center 1 WEAVER R AD DENVER, PA 17517 MERCHANDI E TOTAL 642.52 Invoice Date + 30 days 642.52 lease remi payments only to the following a dress: Henry Schei , Inc. Dept CH 102 1 Palatine, IL 60055-0241 BILL TO SHIP TO INVOICE INVOICE AMOUNT ITEM STATUS KEY REM KEY 1308571 1308572 B-Backordered:Item will follow SK-School Kit 5718883-01 6 4 2 .5 2 D-Discontinued:bear no longer available NC-No Charge F-Special Schein Free Goods H I OPDER# ORDER DATE IAN I E DATE # OF 3OXES M-Manufacturer will ship Item directly to you 11/05/13 4 P-Prescription 1)ug:Return Authorization Required 13994739 11/05/13 R-Refrigerated Item:May he shipped separately $ -Special Schein Pricing CUSTOMER PA E T-Taxable Item U-Temporarily unavailable:please reorder MARK 2 OF 2 * -Item has MSDS Payment rms; ......._. .. .. ..... - 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: 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 YOM'Order To Your Open Account choice. Simply call o;z u r customer service department within 30 days Available to licensed practitioners in the US.Ali invoices are of receipt of the merchandise to arrange for the return. Fora payable within 30 days. warranty repair or if 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 II 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 verify 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 9,1-800-845-3550. LP300 HSI ORDER# ORDER DATE DUE DATE 13994045 11/05/13 12/05/13 D&B#:01-243-0880 WHSE DEA# RH0162494 Fed ID: 11-3136595 im This order as been processed by our MIDWEST D.C. 5315 WES 74TH 3TREET INDIANAP LIS,IN 46268 1 101-5979 6/BX CLOTH SURGICAL TAPE 2"X10YD 12 12 7.77 93.24 8 2 648-9088 12RL/BX MEDIRIP BANDAGE 211X5YD 6 6 21.93 131.58 8 3 107-0530 100/BX PURPLE NITRILE PF GLOVE LARGE 40 40 *C 8.61 344.40 4 ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. 4 890-4524 EA KERLIX GAUZE RL STER 6PLY 4.5X4.1 100 100 C 1.28 128.00 5 ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. 5 120-2066 EA QUIK-CARE FOAM SANITZR OD 150Z 12 12 *C 7.63 91.56 6 ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. 6 602-8100 EA COLLAR STIFNECK SELECT ADULT 50 50 C 5.25 262.50 7 ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. HE PRICES STATED ABOVE MAY REFLECT A DISCOUN OR BE SUBJECT TO A REBATE YOU UST FULLY D ACCURATELY REPORT THIS STATED ISCOUN PRICE, OR IF APPLI ABLE, Y NET PRI ING, AFTER GIVING EFFECT TO ANY REBATES, TO MEDICARE, MEDICAID, RICARE AND ANY OTHER FEDERAL OR STATE PROGRAM UPON ZEQUESI BY ANY SUCH PROGRAM. IT ISYOUR ESPONSIBILITY TO REVIEW ANY AGREE ENTS OZ OTHEF DOCUMENTS APPLICABLE TO THESE P ZICES TO DETERMINE IF THEY ARE SUB TECT TO A REB TE. THE FEDERAL OVERNMENTI POSES CERTAIN RESTRICTIONS ON, AN REQUI ES PU LIC REPORTING OF, RANSFERS O VALUE TO A PRACTITIONER. IF YOU A E PARTICIPATING IN A PROMOTIONAL BILL TO SH P TO INVOICElf INVOICE AMOUNT ITEM STATUS KEY REM KEY 1308571 18 1710 2 B-Backordered;Item will follow SK-School Kit 5 7 41918- 1 10 51 .2 8 D-Discontinued:Item no longer available K-No Charge P-Special Schein Free Goods H I OPDER# ORDER DATE INVOICE DATE # OF 13OXES M-Manufacturer will ship Item directly to you 1'-Prescription Drug:Return Authorization Required 13994045 11/05/13 11/05/13 8 R -Refrigerated Item:May be shipped separately T MER P $ -Special Schein Pricing P E T-Taxable Item U-Temporarily unavailable:please reorder MARK 1 OF 2 I em has MS DS I Continued on Next Page.......... HENRY SCHEIN't EIS SHIP TO/SOLD TO: II Y V®I�E Carmel Fire Department MI 135 Duryea Road, Melville, NY 11747 540 W 136th St Station 46 Michael Kaufmann Carmel,IN 46032-8806 01 000013085710574],9118110010000001,051,281105135 BILL TO: Carmel Fire Dept MI 2 Civic Sq Carmel, IN 46032-7543 Carmel Fire Dept BILL To I SHIP To I INVOICE AMOUNT 2 Civic Sq Carmel, IN 46032-7543 1308571 1817102 1051 .28 INVOICE# I INVOICE DATE 5741918-01 11/05/13 CUSTOMER PO MARK Please detach here and mail the above with your payment HSI ORDER# ORDER DATE DUE DATE 13994045 11/05/13 12/05/13 D&B#:01-243-0880 WHSE DEA# RH0162494 Fed ID: 11-3136595 • ,. R WE �l a. w 6 "" x m ISCOUNT PR GRAM (E.G. POINTS, DISCOUNT REDEMPTIONS OR OTHER SPECIAL AWARDS) , ITH YOUR P RCHASES YOU MAY EARN POINTS/CREDI S REDEEMABLE FOR CERTAIN GOODS OR ERVICES, Ii ACCORDANCE WITH DISCOUNT PROGRAM RULES. UPON EISCOUNT RECEIPT BY EDEMPTION F YOUR EARNED POINTS/CREDITS, YOU ARE RE'-EIVINC OR WILL RECE VE OTICE OF TIE DISCOUNT VALUE. ACCORDINGLY, YOJ SHOUL RETAIN THESE RECOR S. MERCHANDI E TOTAL 1051.28 Invoice Date + 30 days 1051.28 Please remi payments only to the following a dress: enry Schei , Inc. Dept CH 102 1 Palatine, IL 60055-0241 BILL To SHIP TO INVOICE4 INVOICE AMOUNT ITEM STATUS KEY [REM KEY 1308571 18171 02 13-Backordered:Item will follow SK-School Kit 5 741918—01 10 51.2 8 D-Discontinued:Item no longer available NC-No Charge -Special Schein Free Goods H I RDER ORDER DATE INVOICE DATE F B XE P M-Manufacturer will ship Item directly to you 11/05/13 $ P-Prescription Drug:Return Authorization Required 13 9 9 4 04 5 11/0S/13 R-Refrigerated Item:May be shipped separately CUSTOMER P P E $ -Special Schein Pricing T-Taxable Item MARK U-Temporarily unavailable:please reorder 2 OF 2 Item has MSDS ......... ...... ........ ; i _ ! Ma HENRY SCHEIN" EMS FRMS----------------- ------- ..................... .Payr rent Terms: ... 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: If you have tried a product and it is defective or does not perform Bill Your Order en Account satisfactorily,we 1.1111 provide a credit, refund,or exchange;it's your Available to licensed practitioners in the U.S.All invoices are choice. Simply call our customer service department within 30 days payable within 30 days. of receipt of the merchandise to arrange for the return. For a warranty repair or if 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 li drugs can be ordered only by mail. International Orders: Please_ !Vote: 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 su gg est that y ou check the shipping container 1-800-845-3550 and packing list to verify 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 Doll our Customer Service Department @ 1-800-845-3550. LP300 HENRY E N" SHIP TO/SOLD TO: EMSCarmel Fire Dept Head Quarters MI 135 Duryea Road, Melville, NY 11747 INVOICE 2 civic Sq Carmel,IN 46032-2584 0100001308571057188831 10010000000642521,105131 BILL To: Carmel Fire Dept MI 2 Civic Sq Carmel, IN 46032-7543 Carmel Fire Dept BILL TO 1 SHIP TO INVOICE AMOUNT 2 Civic Sq Carmel, IN 46032-7543 1308571 1308572 642 .52 INVOICE# INVOICE DATE 5718883-01 11/05/13 CUSTOMER PO# MARK HSI ORDER# I ORDER DATE DUE DATE 13994739 11/05/13 12/05/13 D&B#:01-243-0880 WHSE DEA# RHO]62494 Fed ID: I1-3136595 CONTAINS MULTIPLE INVOICES 3�.� ,,,- �, i 8> •�y�� t �,-�r Prey r � ...... , __�� =... a � M his order as been processed by our MIDWEST D.C. 5315 WES 74TH 3TREET INDIANAP LIS,IN 46268 RK 317-57 -2663 1 499-0765 EA GAUGE & FOR 740 SERIES 2 2 32.64 65.28 3 2 677-4617 EA MAGNUM BRASS REG W/FLOW 2 DISS 2 2 74.10 148.20 3 3 677-4617 EA MAGNUM BRASS REG W/FLOW 2 DISS 1 1 74.10 74.10 4 HIS PRODUCT IS BEING SHIPPED FROM OUR NORTHEAST DIS RIBUT ON CENTER. 4 109-8454 EA OMNI BLS/ALS TOT SYST BAG EMPTBAG 2 2 C 177.47 354.94 2 PRODUCT IS BEING SHIPPED TO YOU DIRECTLY FROM THE Mk4UFACTLRER. ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. HE,PRICES TATED ABOVE MAY REFLECT A DISCOUN OR BE SUBJECT TO A REBATE YOU UST FULLY D ACCURATELY REPORT THIS STATED DISCOUN PRIG , OR IF APPLI ABLE, ZLNY NET PRI ING, AFTER GIVING EFFECT TO ANY REBATES, TO MEDICARE, MEDICAID, RICARE AND ANY OTHER FEDERAL OR STATE PROGRAM UPON ZEQUESI BY ANY SUCH PROGRAM. IT ISYOUR ZESPONSIBILITY TO REVIEW ANY AGREEMENTS OZ OTHER DOCUMENTS APPLICABLE TO THESE P ICES TO DETERMINE IF THEY ARE SUBJECT TO A REB TE. THE FEDERAL OVERNMENTI 1POSES CERTAIN RESTRICTIONS ON, AND REQUI ZES PUE LIC REPORTING OF, RANSFERS 0 VALUE TO A PRACTITIONER. IF YOU ARE PARTICIPATING IN A PROMOTIONAL ISCOUNT PR GRAM (E.G. POINTS, DISCOUNT REDEMPTIONS DR OTHER SPECIAL AWA DS) , ITH YOUR P RCHASES YOU MAY EARN POINTS/CREDI S REDEEMABLE FOR CERTAIN GOODS OR ERVICES, 14 ACCORDANCE WITH DISCOUNT PROGRAM RULES. UPON JISCOUNT RECEIPT BY EDEMPTION F YOUR EARNED POINTS/CREDITS, YOU ARE RE EIVIN OR WILL RECEIVE BILL TO SHIP TO INVOICE# INVOICE ITEM STATUS KEY REM KEY 1308571 1308572 H-Backordered;Item will follow SK-School Kit 5 7 1 8 8 8 3—0 1 6 4 2 .5 2 D-Discontinued:Item no longer available NC-No Charge P-Special Schein Free Goods H I RDER ORDER DATE INVOICE DATE F B XE M-Manufacturer will ship Item directly to you P-Prescription Drug:Return Authorization Required 13994739 11/05/13 1 1/0 5/13 4 R-Refrigerated Item:May be shipped separately T MER P PA $ -Special Schein Pricing T-Taxable Item MARK *�-Tem has MSDSavailablc:please reorder 1 OF 2 Continued on Next Page.......... VOUCHER NO. WARRANT NO. ALLOWED 20 Henry Schein IN SUM OF $ Dept Ch 10241 Palatine, IL 60055 $1,693.80 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO#/Dept. INVOICE NO. ACCT#!TITLE AMOUNT Board Members 1120 5718883-01 102-670.06 $642.52 1 hereby certify that the attached invoice(s), or 1120 5741918-01 102-670.06 $262.50 bill(s) is (are) true and correct and that the 1120 I 5741918-01 1 102-390.11 I $788.78 materials or services itemized thereon for l which charge is made were ordered and received except NOV 18 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)) 5718883-01 $642.52 5741918-01 $262.50 5741918-01 I I $788.78 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 HSI ORDER# ORDER DATE DUE DATE 13994045 11/05/13 12/06/13 D&B#:O 1-243-0880 WHSE DEA# RHO]62494 Fed ID: 11-3136595 g i "t sit o:,r„• n•;::: { '; '�. '3 3: .k to�'Eyw,. ��•:� •:xt _ .a T Y, ' �%.m ;,-. .••.� <u:::::,M_ �- •)•?..,,,�, ,Sys x n . : :FG:<�� n r:.� �,y ::E.,,. € ;.r`z'wEirr, •.,. =s :nx:.3 l'% CIS �.x.xm ” >.::Ex� ...Ei:..xu� 's'E A':.E E :3.,y .. .- �f.LJ st" F�EF'.�� : This order has been processed by our MIDWEST D.C. 5315 WES 74TH 3TREET INDIANAP LIS,IN 46268 1 153-6483 RX 250ML/BT STERILE WATER FOR IRRIG 250ML 24 24 C 1.15 27.60 1 N - PEDIGREE ITEM. ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. .ITDC:003380OD402 HE PRICES PD ATED ABOVE MAY REFLECT A DISCOUN OR BE SUBJE T TO A REBATE YOU UST FULLY ACCURATELY REPORT THIS STATED DISCOUNC PRICE, OR IF APPLICABLE, Y NET PRI ING, AFTER GIVING EFFECT TO ANY REBATES, TO ME ICARE, MEDICAID, RICARE AND ANY OTHER FEDERAL OR STATE PROGRAM UPON ZEQUESq BY ANY SUCH PROGRAM. IT ISYOUR ZESPONSIBILITY TO REVIEW ANY AGREE ENTS OZ OTHER DOCUMENTS AP LICABLE TO THESE P ICES TO DETERMINE IF THEY ARE SUB ECT TO A REBA.TE. THE FEDERAL OVERNMENTI POSES CERTAIN RESTRICTIONS ON, AN REQUI ES PU LIC REPORTING OF, TRANSFERS O VALUE TO A PRACTITIONER. IF YOU A ZE PART ECIPATING IN A PROMOTIONAL ISCOUNT PR GRAM (E.G. POINTS, DISCOUNT REDEM)TIONS R OTHER SPECIAL AWARDS) , ITH YOUR P RCHASES YOU MAY EARN POINTS/CREDI S REDEEMABLE FOR CERTAIN GOODS OR ERVICES, 14 ACCORDANCE WITH DISCOUNT PROGRAM RULES. UPON EISCOUNT RECEIPT BY EDEMPTION F YOUR EARNED POINTS/CREDITS, YOU ARE RE]EIVINC OR WILL RECEIVE OTICE OF T E DISCOUNT VALUE. ACCORDINGLY, Y01J SHOUL RETAIN THESE RECORDS. N - HENRY 3CHEIN, INC. HAS PURCHASED THE SPE IFIC U4IT OF THE PRESCRIPTION DRUG DIRECTLY F OM THE MANUFACTURER. MERCHANDISE TOTAL 27.60 Invoice Date + 30 days 27.60 BILL TO SHIP TO INVOICE# INVOICE AM ITEM STATUS KEY REM KEY 13(]8 S 7 1 1817102 B-Backordered:Item will follow SK-School Kit 8 8 0 4 2 3 5—O 1 2 7 .6 0 D Discontinued:Item no longer available NC-No Charge P Special Schein Free Goods H SI ORDER# RDER DATE INVOICE DATE - # OF BOXES O M Manufacturer will ship Item directly to you P-Prescription Drug:Return Authorization Required 13 9 9 4 0 4 5 11/05/13 11/06/13 1 R-Refrigerated Item:May be shipped separately$ Special Sc CUSTOMER-PQ# PAGE T-Taxable Item n Pricing U-Temporarily unavailable:please reorder MARK 1 OF 2 * -Item has MSDS Continued on Next Page.......... MHENRYSCHEIND SHIP TO/SOLD TO: EMSCarmel Fire Department MI 135 Duryea Road, Melville, NY 11747 540 W 136th St INVOICE Station 46 Michael Kaufmann Carmel,IN 46032-8806 010000130857108804235110010000000027601,106136 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 27.60 INVOICE# INVOICE DATE 8804235-01 11/06/13 CUSTOMER PO MARK Please detach here and mail the above with your payment HSI ORDERq I ORDER DATE IQUE DATE 13994045 11/05/13 12/06/13 D&B#:01-243-0880 WHSE DEA# RHO162494 Fed 1D: H-3136595 ME 1� - _ ? 1 tt1 ru r•, ;., g: s> :;:r=.- 1:`r< fir,c,... ..m,_ .�, b b ,..F< ��•:A"`>`.4i:;.'�� ,ii..°.,<.4 i' ..k : ^ ^.a�o„u < : "-"�b.. 'a�b3;� °=� °.�.. f s,.w,St �x � n a k, t��;�� ' Please remi payments only to the following a dress: Henry Schein, Inc. ept CH 102 1 Palatine, I 60055-0241 BILI, To P71 SHIP INVOICE INVOICE AMOUNT ITEM STATUS KEY MREMkE 13 0 8 5 71 B Backordered:Item will follow 8 8 0 4 2 3 5-01 2 7.6 0 D Discontinued:Item no longer available P Special Schein hme Goods HSI-- RDER INV I E DATE F B ES M-Manufacturer will ship Item directly to you P-prescription Drug:Return Authorization Required 13 9 9 4 0 4 5 11/06/13 1 R-Refrigerated Item:May be shipped separately CUSTOMER PQ# PAGE $ -Special Schein pricing T-Taxable Item MARK U-Temporarily unavailable:please reorder 2 OF 2 ' -Item has MSDS �........r......,_+............................................... ........................... _......_........_............._.._........_.._._....................................._...._.. ............................................................................................................................................................. ...__............ -A HE . ...........�- M' EMS r ......................................................................................................................................... .............................................................................................................................................................................................................................................................................................................................................: We make r veryr eff=.,':,;,;maintainn Prices s f:,r the duration of a Payment by CHECK or by the HENRY SHIN CREDIT CARD, ata nu he,ewer,we reserve t a€fight to make price adjusf"ants i. VISA,MASTERCARD,DISCOVER and AMERICAN EXPRESS response to manufacturers`price chances Guaranteed Satisfaction: If 1licu.have tried a orcducf and it is detective or does not oerfor or r OLr �) der r � } rr safes actorily,we will Provide a credit, refund,or exchange:if s vo rr klailab o to licensed rant t.or:e., r t. U�.A....,; € «;s are choice, Sirnpiv call our customer service de;aarlmer;':rj:thin 30 days days, of recfeipt of file mercf ar dise to arrange for the return. For a pavab e within`0 da,rs, warranty recta€r or if von were sent something you didnotordeir, s nlpl call: x Products & Controlled Substances: Matrx Medical 1-800-845-3550 Regulations roquira us to lint the sate,of Rx and confrolle'd substances only to registered,licensed healthcare professionals. If you are a new customer or have recently moved,Please furn:'sh us with a copy of your uudafed state regisfration. For controlled substances,furnish a copy of your DEA certificate,verifying your shipping addrress, :lass 11 drua�s car:be ordered only by r-.ail. International Orders: ° equipment < - ''e proudy serve and governments handpieces are Yay not b,, `or throughout the cord, �o Place orders or for i€-rtuir es on export credit,brit a if be repaired or replaced in accomarce-with terms and coneit:o's,Please contact our International Department. manufactulFer warranties.Bef„re open€ng handpieces or. 1 8003-845-3315-u et,uipment, e.suggest that ou cheep the shipping container and oackinq i;;list to verify tha°you have received eXactly Nhat yo r ordered.Opened Computer Software is not returnable. Prescription Drug Returns Instructions: Other restrictions may also apply. A Return Authorization:is Required fur all Prescription Drugs.Simply call our Customer Service,Department 1-800-845-350. LP300 VOUCHER NO. WARRANT NO. ALLOWED 20 Henry Schein IN SUM OF $ Dept Ch 10241 Palatine, IL 60055 $27.60 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO#/Dept. INVOICE NO. I ACCT#/TITLE AMOUNT Board Members 1120 I 8804235-01 1 102-390.11 I $27.60 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 NOV 19 2013 pvt 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 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)) 8804235-01 $27.60 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