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Home My WebLink About232814 05/21/14 0CITY OF CARMEL, INDIANA VENDOR: 357526 +; ® ONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: S""`""'525.00* Q CARMEL, INDIANA 46032 DEPT CH 10241 CHECK NUMBER: 232814 9M�<<ON L0? PALATINE IL 60055-0241 CHECK DATE: 05/21/14 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 102 4239011 364774-01 525.00 SPECIAL DEPT SUPPLIES ORDER# ORDER DATE 1.11. DAT. 19083381 1 05/06/14 06/05/14 D&B#:01-243-0880 WHSEDEA# RHO162494 Fed ID: 11-3136595 .. ....... .. ... .......... V5 W ... . ... n ............ ,E*2 M�§'ff !.9-1 This order as been processed by our MIDWEST D.C. 5315 WES" 74TH STREET INDIANAPOLIS,IN 46268 TOM SMALL 5-6-14 317-571-260 1 602-8100 EA COLLAR STIFNECK SELECT ADULT 100 100 C 5.25 525.00 2 -ASE GOOD IUEM, MAY BE SHIPPED SEPARATELY. PLEASE REFE Z TO BACK OF PAPERWORK FOR DISCLOS JRES/TE S OF SALE MERCHANDI E TOTAL 525.00 Invoice Date + 30 days 525.00 Please remi payments only to the following a dress: Henry Schei-i, Inc. Dept CH 102 1 Palatine, IL 60055-0241 BILL TO SHIP TO INVOICE# INVOICE AMOUNT ITEM STATUS KEY REM KEY 1308571 130857213-Backordered:Item will follow SK-School Kit 3647774-01 525.00 D-Discontinued:Item no longer available NC-No Charge I- -Special Schein free Goods QRDER# ORDER DATE IN"VOICE Q TE # OF BOXES M-Manufacturer will ship Item direct]),to you 11 Prescription Drug:Return Authorization Required 19083381 OS/06/14 5/06/14 2 R Refrigerated ltcm:May he shipped separately $ Special Schein Pricing CUSTOMER PO PAGE# T Taxable Item U-Temporarily unavailable:please reorder TOM SMALL 5/6 1 OF 1 Item has MSDS LP300 (e.g.points,discount redemptions or other special awards).with your purchases you may earn •Items that cannot I.r.returned to the manufacturer•Any item marked none etutnable points/credits redeemable for certain goods or services,in accordance with discount program rules.Upon discourd 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. ' pined and used equipment may not be returned for credit.Before opening equipment.vie suggest that you che-,*[tie shipping container and packing list to DELIVERY TERMS: ensure that you are gaffing exactly what you ordered.Equipment must be returned Unless otherwise agreed,freight terms ate FOS Shipper's Dock("Ex works'outside in the original unopened }ackaging,unmarked and prnperly packaged.Speical order North America).Title passes at the time the.shipment is toadied at the.shipper's dock, equipment is riot returna le.Alrequipment returns are subject to a restocking lee. Equipment is backed by the manufacturer's repair or replacement vrarranty.Please Continental U.S.: read and return all war"rant;;inlormation required immediately upon taking delivery of All orders Will be,subject to a handling charge.This chargo includes freight,except for your ne,v equipment.GOpen or defective equipment is subject to the manufacturer's additional carrier charges related to special deliver'services and hazardous material vrarranty. shipments.Special orders are subject to additiona(tieighl charges. Prescription Dnig Returns: Alaska Hawaii&Pacilic Protectorates: Please note that,in order to comply with federal and Slate.Pedigree requirements, Standard shipping methods pro,,ide 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 Henry Schein has purchased from wholesalers are not returnable. are offered direct surface transport,or postal services for reliable delivery. These items Will f:)e identified in your invoice with the code WH. No additional surcharges apply,except vrhen special services are requested. Rx Drugs which are purchased 61,1 Henry Schein directly from the manufacturer may LOW-Ievel Ila7aidonS Itt-ITIS(dangel'ous goads in accepted quantities and Consumer be returned providing that the following key elements are met: Commodity ID 8004)are now availabiv via LIPS 2nd-day air. 1 Only returns clue to error in order or defi',:ely Will be allowed. Guam.Puerto Rico,11.5.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, ]his charge includes freight through of receipt of the shipment arid valid return authorization is issued by HSI. the United States Postal Service(USPS). 3)The Prt:scription Drug Marketing Art requires any rlistomer returning Ftx Drugs • Special ddi,,rery orders and hazardous material shipments can he.shipped via United to complete and return a Piesc iiption Drug Return Authorization form.Federal IoW Parcel Services(UPS)for an additional charge.No minimum order amount or"o.,6ghl requires that the helifficare entity returning Rx Drugs document that the product applies.Speak to your International Represrxrtative for details. was kept under proper storage and handling conditions while in their possession and during the return of the product. to get a copy of the toren and ptoper return Outside U.S. 50 stalest: authori7atrnn,please(;ontart Customer Service. it your order is being shipped outside the U.S.(50 states),please refer to the 4)In addition,Podigrt:e regulations require that the healthcare entity returning nternational Terms Conditions at hon ryschein.coni.Unless otherwise agreed, Rx Drugs certifies freight germs are FC!13 Shipper's t?ock('Ex Works"outside North America). that[ha product being returned is the same exact product purchased from H51. 1"itle 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 bean Gustorner is responsible lot compliance With any applicable import requirements. tampered with,are out of date or Where the labeling has,been altered in anyway. RX PRODUCTS t& CONTROLLED "SUBSTANCES: CHOOSE YOUR PAYMENT METHOD Regulations require us to limit[he sale of Rx and controlled substances only to recjistered, 2%Cash Back or Maximum Rewards on all purchases with the Henry Schein licensed healthcare professionals.It you are a new rustomer or have,recently moved, Credit Card.To apply now,call:1.866.398.9296 or online please tumish us"+vitt[a copy of your updated slate DEA registration.For controlled wivw.henr schein.coni/creditcard Reduce the cost and administration of ni substances,furnish a copy of your DFA registration verifying vnrr shipping address. y paying Please note that all orders for controlled substances are subject to a due diligence review Henry Scheia-Pay electronically(ACH Oebil)or set up AutoPay. process.Schedule 11 controlled substances can be ordered electronically or by mail. Please call Customer Service for details. For Information on our Controlled Substance Ordering System please.visit For your convenience,We provide several payment alternatives.Orders billed to your a,� .hen rvschrin.com/e222:if you prefer to continue using Federal 222 forms 10 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 useyoui Henry Schein Credit Gard,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.Invoices are.payable Within agreed Local regulatory requirernen[s nay,apply to use or installation of certain produc[s. terms of sale. Be sure to understand and romply With arms such requirements prior to purchase,use, Open Accounts Receivable: or installation of products. All unpaid accounts receivable past due air,subject to a 1.5%finance charge. To arrange for a product return,simply call Customer Service as noted below: Henry Schein Medical 340B Program Henry Schein Medical/EMS Customer Service: 1.800.472.4346 Sam Spm.et. Customer Service: 1.877.344.3402 8:30am-5:30pm.el. Customer Service: 1.800.845.3550 8:3(kim 15:30pm,e1. Place an Order: 1.800.772.4346 8am-9pm,et. Place an Order: 1.877.344.3402 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: 1.686.885.2253 24 I loins. Fax an Ordor: 1.600-533A793 24 Hours. Internet: www.heiiryscheiii.com/medical E-Commerce Support: 1.800.711.6032 8am-8prii,et. Internet: www.hemyschein.coni/errs E-Mail: custsery@henryschein.com Internet: ivww.henryschein.com/340B E-Mail: scott.bruner@henryschein.com E-Mail: customer.support@henryschein.com Please see:littp://www.Henryschein.com,'US-EN,Medical/LegalTerms.ASPX for Conditions&Exceptions. Prescribed by State Board of Accounts City Form No.201 (Rev.1995) i 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)) 3647774-01 $525.00 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 VOUCHER NO. WARRANT NO. ALLOWED 20 Henry Schein IN SUM OF $ Dept Ch 10241 Palatine, IL 60055 $525.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1120 3647774-01 102-390.11 $525.00 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 4 >• > Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund