232230 05/07/14 %'.s�gMfi CITY OF CARMEL, INDIANA VENDOR: 357526
j; ONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: $*******647.25*
CARMEL, INDIANA 46032 DEPT CH 10241 CHECK NUMBER: 232230
'M«oN-�.� PALATINE IL 60055-0241 CHECK DATE: 05/07/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 4239011 2092818-01 647.25 SPECIAL DEPT SUPPLIES
QRDER# I ORDER DATE DUE DATE
18662734 1 04/21/14 1 05/21/14
D&B#:01-243-0880
WHSE DEA# RH0162494 Fed ID: 11-3136595
r s ® e 11 K, i P :s
X..MIN Hall MOW ;11
his order has been processed by our MIDWEST D.C.
5315 WES 74TH 3TREET
INDIANAP LIS,IN 46268
OM SMALL 01-21-14
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1 107-0530 100/BX PURPLE NITRILE PF GLOVE LARGE 50 50 *C 8.63 431.50 5
SE GOOD I EM, MAY BE SHIPPED SEPARATELY.
2 107-0540 90/BX PURPLE NITRILE PF GLOVE X-LARGE 25 25 * 8.63 215.75 8
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LEASE REFE TO BACK OF PAPERWORK FOR DISCLOS ES/TE S OF SALE
---------- --------------------------------- ------ ----- ------------- -------
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MERCHANDI E TOTAL 647.25
Invoice Date + 30 days 647.25
lease remi payments only to the following a dress:
enry Schei , Inc.
Dept CH 10211
Palatine, I 60055-0241
LL INv cryo o ITEM STATUS KEY REM KEY
B-Backordered;Item will follow SK-School Kit
1308571 181710 2 2092818-01 6 4 7.2 5 D-Discontinued;Item no longer available NC-No charge
E E DATE INVOICE DAT BOXES F-ManuSpecial Schein Free ship
Goods
M-Manufacturer will ship Item directly to you
P-Prescription Drug;Return Authorization Required
18662734 04/21/14 4/21/14 8 R-Refrigerated Item;May be shipped separately
$ -Special Schein Pricing
CUSTOMER PO# PAGE T-Taxable Item
I TOM SMALL 0421 1 OF 1 U-Itemporatilyunavailable;pleasereorder
*-Item has MSDS
pointstcredits redeemable for certain goods or services,in accordance with discount program
rules.Upon discount receipt by redemption of your earned points/credits,you are receiving or Equipment:
will receive notice of the discount value.Accordingly,you should retain these records. Opened and used equipment may not be returned for credit.Before opening
equipment,we suggest that you check the shipping container anti packing list to
DELIVERY TERMS: ensure that you are getting exactly what you ordered.Equipment must be returned
Unless otherwise ar reed,freight terms are FOB Shipper's Duck Ex Works"outside in the original unopened packaging,unmarked and properly packaged.Speical order
North America).Tire passes at the tune the shipment is loaded at the shipper's dock, equipment is not returnable.Airequiprnent returns are subject to a restocking fee.
Equipment is barked by the manufacturer's repair or replacement warranty.Please
Continental U.S.: read and return all warranty,information required immediately upon taking delivery of
All orders will be subject to a handling charge.This charge includes freight,except for your new equipment.Open or defective equipment is subject to the manufacturers
additional carrier charges related to special delivery services and hazardous material warranty.
shipments.Special orders are subject to additional freightcharges. Prescription Dwa Returns:
Alaska.Hawaii&Pacific Protectorates: Please note that,in order to rumply with Federal and State Pedigree requirements,
Standard shipping methods provide direct.reduced cost,expedited air delivery Henry Schein's policy on the return of Rx Drugs is as follows:
service to all accounts in Alaska and Hawaii.Customers in the Pacific Protectorates Rx Drugs which Henpv Schein has purchased from wholesalers are not returnable.
are offered direct surface transport,or postal seivices for reliable.delivery. These items will be identified in your irnrou:e with the code WH.
No additional surcharges apply,except when special services are requested. Rx Drugs which are purchased lig Henry Schein directly from the manufacturer may
Low-level hazardous items(dangerous goods in accepted quantities and Consumer be returned providing that the following key elements are met:
Commodity ID 8000)are now available via LIPS 2nd-d,rd air.
1 Only returns due to error in order or delivery will be allowed.
Guam.Puerto Rico,U.S.Trust Territories&Virgin Islands: 2)Returns of Rx Drugs will only be accepted if HSI is notified within 14 calendar days
• All orders will be subject to a handling charge.phis charge includes freight through of receipt of the shipment and valid return authorization is issued by HSI.
the United States Postal Service(USPS). 3)The Prescription Drug Marketing Act requires any customer returning Fix Drugs
• Special delivery orders and hazardous material shipments can be shipped via United to complete and return a Prescription Drug Return Authorization form.Federal law
Parcel Services(UPS)for an additional charge.No minimum order amount orweight requires that the healthcare entity returning Rx Drugs document that the product
applies.Speak to your International Representative for details. was kept under proper storage and handling conditions while in their possession
Outside U.S. 50 slates): and during the return of the product.To get a copy of the form and proper return
(� authorization,please contact Customer Service.
If your order is bein shipped outside the U.S.(50 states);please refer to the 4)In addition,Pedigree regulations require that the healthcare entity returning
nternational Terms I Conditions at henRischein.cann.Unless otherwise agreed, Rx Drugs certifies
freight terms are FOB Shipper's Dock("Ex Works"outside North Ain erica)• that the product being returned is the same exact r.rodurt purchased from HSI.
Title passes at the time the shipment is loaded at the shipper's dock. 5)Henry Schein will not issue credit for any returned Rx Drugs which have been
Customer is responsible for compliance with any applicable import requirements. tamperers with,are out of date or where the labeling has been altered in any away.
RX PRODUCTS & CONTROLLED SUBSTANCES: CHOOSEYOUR PAYMENT METHOD_
—Rego abons require us tv hmif itf elate of Rx and con�rolted susst�nr s only to regisle-e- 2%Cash Back or Maximum Rewards on all purchases with the Henry Schein
licensed healthcare professionals.If you are a new customer or have recently moved, Credit Card.To apply now,call:1.860.396.9296 or online
please furnish us wsth a copy of your updated stale DEA registration.For controlled www.henrysclnein.com/crediteard Reduce the cost and administration of paying
substances,furnish a copy of your DEA registration veri44ng your shipping address. Henry Schein-Pay electronically(ACH Debit)or set up AutoPay.
Please note:that all orders for controlled substances are subject to a due diligence review
process.Schedule II controller]substances ran be ordered electronically or by mail. Please call Customer Service for details.
For information on our Controlled Substance Ordering System please visit For your corrrenience,we.provide several payment alternatives.Orders billed to your
mvvv.henrvschein corn/e222;if you prefer to continue using Federal 222 Forms to order account may be paid by ACH Debit,Check by Phone,or Check.If you prefer,
Schedule II controlled substances,please mail the form to: you may useyour Henry Schein Credit Card,American Express,Visa,MasterCard or
Henry Schein,Inc. • Suite 300,5315 West 74th Street • Indianapolis,IN 46268 Discover Card when placing your order.All sales are subject to our normal terms and
REGULATORY REQUIREMENT: conditions.All sales are subject to credit approval.Irnroices are payable within agreed
Loral regulatory requirements may apply to use or installabon of certain products. terms of sale.
Be sure to understand and comply with any such requirements prior to purchase,use, Open Accounts Receivable:
or installation of products. All unpaid accounts receivable past due are subject to a 1.5%finance charge.
To arrange for a product return,simply call Customer Service as noted below:
Henry Schein Medical 3408 Program Henry Schein Medical/EMS
Customer Service: 1.800.472.4346 Barri-�J)m,et. Customer Service: 1.877.344.3402 8:30am-5:30pm,et. Customer Service: 1.800.845.3550&Mun-5:30pin,et
Place an Order: 1.800.772.4346 Bani-9pm,et. Place an Order. 1.677.344.3402 8:30am-5:30pm,et. Place an Order 1.800.845.3550 8:30am-5:301)m,et
Fax an Order. 1.800.329.9109 24 Hours. Fax an Order. 1.888.885.2253 24 Hours. Fax an Order. 1.800.533.4793 24 Hours.
Internet: www.henryschein.com/modical E-Commerce Support: 1.800.711.6032 Barn-bpm,et. Internet: www.henryschein.cenr/ems
E-Mail: custsery@henryschein.com Internet: tvvrvv.henryschein.comA40H E-Mail: scott.bruner@henryschein.com
E-Mail: customer.stipport@henryschein.com
Please see:littp:/Mvtu.Henryschein.com/US-EN/Medical/LegalTerms.ASPX for Conditions&Exceptions.
LP300
VOUCHER NO. WARRANT NO. +
ALLOWED 20
Henry Schein
IN SUM OF$
Dept Ch 10241
Palatine, IL 60055
i
$647.25
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1120 2092818-01 102-390.11 $647.25 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
MAY 2014
J,14�jvllm A 44 e �__
d
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
I
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
2092818-01 $647.25
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