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Home My WebLink About228555 1/28/2014 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1 ONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: $690.40 CARMEL, INDIANA 46032 DEPT CH 10241 a�`p PALATINE IL 60055-0241 CHECK NUMBER: 228555 CHECK DATE: 1/28/2014 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 102 4239011 1967180-01 690 . 40 SPECIAL DEPT SUPPLIES HENRYCHEW EMS SHIP TO/SOLD TO: INVOICE Carmel Fire Department MI 135 Duryea Road, Melville, NY 11747 540 W 136th St Station 46 Michael Kaufmann Carmel,IN 46032-8806 0100001,3085710196718011001,00000006904001113145 BILL TO: Carmel Fire Dept MI 2 Civic Sq Carmel, IN 46032-7543 Carmel Fire Dept GILL TO SHIP ff��6 OUNT 2 Civic Sq Carmel, IN 46032-7543 1308571 181710.40 �INVOICEINVOICE DATE 1/13/14 CUSTOMER PO# TOM 01/13/14 Please detach here and mail the above with your payment ORDER# ORDER DATE DUE DATE /14 15558886 01/13/14 02/12 D&B#:01-243-0880 WHSE DEA# RHO162494 Fed ID: 11-3136595 of ,; 3 .w ISCOUNT PR GRAM (E.G. POINTS, DISCOUNT REDEMPTIONS OR OTHER SPECIAL AWA DS) , ITH YOUR P RCHASES YOU MAY EARN POINTS/CREDI S REDE MABLE FOR CERTAIN GOODS OR ERVICES, 14 ACCORDANCE WITH DISCOUNT PROGRAM RULES. UPON EISCOUNT RECEI T BY EDEMPTION DF YOUR EARNED POINTS/CREDITS, YOU ARE RE-EIVINC. OR WILL RECE VE OTICE OF TIE DISCOUNT VALUE. ACCORDINGLY, YOJ SHOULD RETAIN THESE RECOR S. ortheast D stribution Center 1 WEAVER R AD DENVER, PA 17517 MERCHANDI E TOTAL 690.40 invoice Date + 30 days 690.40 lease remi payments only to the following a dress: enry Schei Inc. ept CH 10211 alatine, I 60055-0241 BILL To sxlP T INvoI E INVOICE AMOUNT ITEM STATUS KEY MREM1308571 1817102 1967180-01 690.40 x BacAordcrcd:Icmwiufou°"'D-Discontinued:Item no longer available RDER RIDER DATE INVOI E DATE F-Special Schein Free Goods F B xE M-Manufacturer will ship Item directly to you 15 5 5 8 8 8 6 01/13/14 1/13/14 8 p-prescription Drug:Return Authorization Required R -Refrigerated Item:May be shipped separately CUSTOMER P $ -Special Schein Pricing PA E T-Triable Item Temporarily unavailable:please reorder Item has MSDS r - _ FA tIENRY SCHEIN"-" j T t--, OF ' EMS -_� 3 ,.., a .. . _. .....__ _ __ ___ ___ ___ ..._ _ ____ — �_ ___- __ _ ---------—-----------I..................-__-.........__.._..................................._---........ _.............................._-__---......-_.....—.. ..._..___--------.._..-----� re n der Terris.. - 4Ne make every effort to maintain prices for the duration;of a Payment by CHECK or by the HENRY SC EIN 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: Mev or It you have tried a product and it is defective or does not perform Bill Your Order To Your Open Account satisfactorily,we will provide a credit,refund,or exchange;it's your choice. Simply call our customer service department within 30 days Avaiiabre to licensed practitioners in the J.S.All invoices are of receipt of the merchandise to arrange for the return. For a 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 neva 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 cerci#icatf3,verifying your shipping address. Class 11 drugs can be ordered only by mail. International Orders: Please Note; We proudly serve healthcare professionals and governments Opened handpieces and,equipment may not be returned for throughout the world. To place orders or for inquiries on export credit;but will be repaired or replaced in accordance with terms and conditions,please contactour International Department: manufacturer v.iarranties.Before opening handpieces or 1-800-845-3550 equipment,we suggest that you check the shipping container and packing list to verify that you have received exactly what Prescription Drug Returns Instructions: you ordered.O erred 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. LP300 QRDER# ORDER DATE IDUE DATE 15558886 01/13/14 1 02/12/14 D&B#:01-243-0880 WHSE DEA# RHO162494 Fed ID: 11-3136595 to R", Cyt ? Offiml- RN5gAM Is MEMO This order as been processed by our MIDWEST D.C. 5315 WES" 74TH ;TREET INDIANAPOLIS,IN 46268 Tom SMALL 317-416-085) CELL rSMALL@CARML.IN.GOV THANK YOU T)M. , JULIE BAKER 800-845-3550 X136 JULIE.BAKERDHENRYSCHEIN.COM 1 107-0530 100/BX PURPLE NITRILE PF GLOVE LARGE 50 50 *C 8.63 431.50 5 --ASE GOOD ITEM, MAY BE SHIPPED SEPARATELY. 2 107-0540 90/BX PURPLE NITRILE PF GLOVE X-LARGE 30 30 *C 8.63 258.90 8 THIS PRODUCT IS BEING SHIPPED FROM OUR NORTHEST DIS RIBUTION CENTER. CASE GOOD ITEM, MAY BE SHIPPED SEPARATELY. THE PRICES =TED ABOVE MAY REFLECT A DISCOUNOR BE SUBJECT TO A REBATE YOU AUST FULLY = ACCURATELY REPORT THIS STATED )ISCOUNI! PRICE, OR IF APPLI(ABLE, kNY NET PRI-ING, AFTER GIVING EFFECT TO ANY REBATES, TO MEDICARE, MEDICAID, FRICARE AND ANY OTHER FEDERAL OR STATE PROGRAM UPON ZEQUESq BY ANY SUCH PROGRAM. IT ISYOUR ZESPONSIBILITY TO REVIEW ANY AGREEMENTS OOTHEF DOCUMENTS APPLICABLE TO THESE PZICES TO DETERMINE IF THEY ARE SUBJECT TO A REB TE. THE FEDERAL aOVERNMENTI4POSES CERTAIN RESTRICTIONS ON, AND REQUIES PULIC REPORTING OF, TRANSFERS 07VALUE TO A PRACTITIONER. IF YOU A]ZE PART ECIPAT I NG IN A PROMO''IONAL BILL TO SHIP TO INVOICEINVOICE AMOUNT ITEM STATUS KEY B-Backordered; REM Item will follow S ru I 1308571 1817102 i I K-School Kit 1967180-01 690 .40 D Discontinued:Item no longer available NC-No Charge F Special Schein Free Goods ORDER# ORDER DATE INVOICE DATE # OF BOXES M-Manufacturer will ship Item directly to you 11 Prescription Drug:Return Authorization Required 15558886 01/13/14 1/13/14 8 R Refrieerated Item:May he shipped separately $ Special Schein Pricing CUSTOMER PQ# PAGE# T Taxable Item Temporarily unavailable:please reorder —TOM 0— 1 1/13/14 OF 2 Item has MSDS Continued on Next Page.......... VOUCHER NO. WARRANT NO. ALLOWED 20 Henry Schein IN SUM OF $ Dept Ch 10241 Palatine, IL 60055 $690.40 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO#/Dept. INVOICE NO. I ACCT#!TITLE I AMOUNT Board Members 1120 I 1967180-01 1102-390.11 I $690.40 I 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 21114 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)) 1967180-01 $690.40 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