233757 06/18/14 CITY OF CARMEL, INDIANA VENDOR: 357526
j ONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: $*****1,185.14*
CARMEL, INDIANA 46032 DEPT CH 10241 CHECK NUMBER: 233757
MUTON PALATINE IL 60055-0241 CHECK DATE: 06/18/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 4239011 2125613-01 431.50 SPECIAL DEPT SUPPLIES
102 4239011 2642466-01 753.64 SPECIAL DEPT SUPPLIES
-------------------
ORDER# ORDER DATE IDUE DATE
19648579 05/28/14 06/27/14
D&B#:01-243-0880
WHSEDEA# RHO162494 Fed ID:11-3136595
'w n
INM
BEER,
was
This order has been processed by our MIDWEST D.C.
5315 WES" 74TH 3TREET
INDIANAPOLIS,IN 46268
Tom SMALL
1 107-0530 100/BX PURPLE NITRILE PF GLOVE LARGE so 50 *C 8.63 431.50 5
:!ASE GOOD ICEM, MAY BE SHIPPED SEPARATELY.
-------------
PLEASE REFEZ TO BACK OF PAPERWORK FOR DISCLOSITRES/TE ZMS OF SALE
MERCHANDI! E TOTAL 431.50
Invoice Date + 30 days 431.50
Please remi payments only to the following aldress:
Henry Schei Inc.
Dept CH 10211
Palatine, I60055-0241
BILL TO SHIP TO INV CE INVOICE AMOU11 NT 11 ITEM STATUS KEY REM KEY
B-Backordered;Item will follow SK-School Kit
1308571 1817102 212S613-01 431.50 D-Discontinued;Item no longer available NC-No Charge
F-Special Schein Free Goods
ORDER# ORDER DATE INVOICE bATE # OF BOXES M-Manufacturer will ship Item directly to you
P-Prescription Drug;Return Authorization Required
19648579 05/28/14 5/28/14 5 R-Refrigerated Item;May be shipped separately
$ -Special Schein Pricing
CUSTOMER Dna PAGE# T-Taxable Item
U-Temporarily unavailable;please reorder
TOM I OF Item has MSDS
LP300
poirdsicredits 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 equip merit may not be returned for credit.Before opening
equipment,we suggest that you cheek the shipping container and packing list in
DELIVERY TERMS: ensure that you are getting exactly what you ordered.Equipment must be returned
Unless otherwise agreed,freight terms are FOB Shipper's Dock "Ex Works"outside in the original unopened packaging,unmarked and properly packaged.Speical order
North America).Title passes at the time 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 warrant;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 manufacturer's
additional carrier charges related to spacial delivery services and hazardous material warranty.
shipments.Special orders are subject to additionalfreight charges. Prescription Drig Returns:
Alaska.Hawaii&Pacific Protectorates: Please note that.in order to comply 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 Henry Schein has purchased from wholesalers are not returnable.
are offered direct surface transport,or postal services for reliable delivery. These items will be identified in your invoice with the code bt/H.
No additional surcharges apply,except vrhen special services are requested. Rx Drugs which are purchased by Henry Schein directly from the manufacturer may
Low-level hazardous items(dangerous goods in accepted quantities and Consumer be returned providing that the fuflowing key elements are met:
Commodity ID 5000)are now available via LIPS 2nd-day air.
1 Only returns clue to error in order 0r 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.This charge includes freightthraugh 0f receipt of[tie 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 Rx 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 or weight requires that the healthcare entity returning Rx Drugs dorurnent that the product
applies.Speak to your International Representative 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 form and proper return
Outside U.S.(50 states): authorization,please contact Customer Service.
If your order is being shipped outside the U.S.(50 states),please refer to the 4)In addition,Pedigree regulations require that the healthcare entity returning
International Terms&Conditions at henryschein.com.Unless otherwise agreed, =product
certifies
freight terms are FOB Shipper's Dock("Ex Works"outside North America). that the product being returned is the Baine exact product 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. tampered with,are out of date or where the labeling has been altered in any way.
RX PRODUCTS & CONTROLLED SUBSTANCES: _CHOOSEYOUIR- AYMENT METHOD
R _
egulations require us to lirniffhe sale of F6 an rd .onrailedsubstsnces only to registered, 2%Gash 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:1.866.398.9296 or online
please furnish us witti a copy of your updated state DEA registration.For controlled www.hen sclhein.coni/creditcard Reduce the cost and administration of a in
substances,furnish a copy of your DEA registration verifying your shipping address. ry p y g
Please notethat all orders for controlled substances are subjectto a due diligence review Henry Schein-Pay electronically(ACH Debit)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
wti%w.he4rdsrhein.com/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.Invoices are payable within agreed
Loral regulatory requirements may apply to use or installation of certain products. terms of sale.
Be sure to understand and comply with arry 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 340B Program Henry Schein Medical/EMS
Customer Service: 1.800.472.4346 Sam-9pm,et. Customer Service: 1.877.344.3402 8:30ani-5 10prn,el. Customer Service: 1.800.845.3550 8:30am-5:30prn,et
Place an Order: 1.800.772.4346 Sam-9pm,et. Place an Order 1.877.344.3402 8:30arn-5:301mh,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.henrVschein.com/medical E-Commerce Support: 1.800.711.6032 Sam-bpm,et. Internet: www_henryschein.com/ems
E-Mail: custsery@henryschein.com Internet: wyay.henryschein.com/3406 E-Mail: scott.bruner@henryschein.com
E-Mail: custom eesupport@henryschein.coin
Please see:http://wtvw.Henryschein.com/US-EN/Medical/LegalTerms.ASPX for Conditions&Exceptions.
0 HENRY SCHEIN
SHIP TO/SOLD TO:
EMSCarmel Fire Dept Head Quarters MI
135 Duryea Road, Melville, NY 11747 INVOICE 2 Civic Sq
Carmel,IN 46032-2584
010000130857102642466110010000000753640604142 BILLTO:
Carmel Fire Dept MI
2 Civic Sq
Carmel, IN 46032-7543
Carmel Fire Dept
2 Civic Sq BILL TO 1 SHIP TO INVOICE AMOUNT
Carmel, IN 46032-7543 1308571 1308572 753.64
INVOICE# I INVOICE DATE
2642466-01 6/04/14
CUSTOMER PO
TOM SMALL
Please detach here and mail the above with your payment
ORDER# ORDER DATE DUE DATE
19839206 06/04/14 07/04/14
D&B#:01-243-0880
WHS;E DEA# RH0162494 Fed ID: 11-3136595
�'y-�.<y3 i t - ,¢ j.�: �_, t ; u,�g �` a ,r ..a•..,�:n'q
•B§,�.�. S u, `'....4$ ,�_. p�FY h W� h". & iz° ."� .lm^� '• ....".�2:.sz,'2c< * 3:,�'�, N.`8
Please remi payments only to the following address:
enry Schein, Inc.
ept CH 102 1
alatine, I 60055-0241
BILL P INVOICE INVOICE AMOUNT ITEM STATUS KEY REM KEY
1308571 1308572 2642466-01 753 .64 B Backordered;Item will follow SK-SchoolKit
D-Discontinued;Item no longer available NC-No Charge
RD RDE DATE INV ES F-Special Schein Free Goods
M-Manufacturer will ship Item directly to you
P-Prescription Drug;Return Authorization Required
19839206 06/04/14 6/04/14 6 R-Refrigerated Item;May be shipped separately
T ME PO PAGE $ -Special Schein Pricing
T-Taxable Item
TOM SMALL 2 F 2 U-Temporarily unavailable:please reorder
• -Item has MSDS
Medical Terms & Conditions
THE HENRY SCHEIN PRICE POLICY: RETURNS:
WE CANNOT ACCEPT ANY RETURNS WITHOUT PRIOR
We endeavor to maintain prices for the duration of a catalog,but we AUTHORIZATION.
reserve the right to make price adjustments in response to manufacturers' To arrange for a return,simply call our Customer Service department or contact
price increases or extraordinary circumstances.Prices are subject to your Sales Consultant.The following conditions most be complied with:
change without notice. •All returns must be.accompanied by a ropy of your invoice and a reason for
Henry Schein,Inc..("Henni Schein")and customer agree that the terms and conditions the return.
herefrialter set forth shall govern the relationship between Henry Schein and the •Merchandise must be returned in its original unopened container,unmarked,and
customer to'the.extent that the parties do not have a written agreement in effect that properly packaged.
conflicts with such teens and conditions.Customer acknowledges and accepts all •Returned products roust have been purchased within the previous thirty(30)days.
such terms and conditions by planing an order for goods with Henry Schein,and upon Any returns past thirty(30)days are subject to a restocking fee.
Hennr Schein's delivery of the orderto the customer. •Shortages or errors in shipments must be reported within seven(7)days of invoice
date to issue credit(if applicable).
DISCOUNTS •Shipping charges will apply on all returns.
REBATES AND DISCLOSURES:
The prices slated in the invoice orstatemenl may reflect a discount or he subjectto a rebate.
You must fully and accurately report thisstated discount price,or if applicable,any net pricing, Exceptions:
after giving effectto any rebates,to Medicare.Meticald,Tricare and any othertederal or The following special,customized,or government-regulated items are not returnable:
State program upon request by any such program.11 is your responsibility to review any •Immune globulin products*Special order items(products that vie do not ordinarily
agreements or other documents applicable to these prices to determine it they are subjectto a stock •Personalized and im rioted items•Opened cons computer hardware and
rebate.The federal government imposes certain restrictions on,and requires public reporting of, ) pp
transfers otvafue to a practitioner.It you are participating in a promotional discount program software*Controlled substances•Hazardous materials•Expired products
._(e.g_points,discount redemptions ouother.speciat awards),with your_purchases gna.may.earn----------- 1tems..that.cannot.ba-rettimed to the--manufacturer_•Any-item.marki,ci.nonreturnable _..-
poirdslcredits redeemable for certain goods or services,in accordance with discount program
rales.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 cheek the shipping container and packing list to
DELIVERY TERMS: ensure that you are getting exactly what you ordered.Equipment must be returned
Unless otherwise agreed,freight terms are FOB Shipper's Dock(Ex Works'outside in the oriuinal unopenedpacm
kaging,unmarked and properly packaged.Speical order
North America).Titre passes at the time the shipment is loaded at the shipper's dock. equipment is not returnable.Ali equipment 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 subjectto a handling charge.This charge includes freight,except for your new equipment.Open or defective equipment is subjectto the manufacturers
additional carrier charges related to special delivery services and hazardous material warranty.
shipments.Special orders are subject to additional freight charges. description Dn.ig Returns:
Alaska.Hawaii&Pacific Protectorates: Please note that,in order to comply 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 Henry Schein has purchased from wholesalers are riot returnable.
are offered direct surface transport,or postal services for reliable deliver`. These items will be identified in your invoice with thecode WH.
No additional surcharges apply,except when special services are requested. Rx Drugs iwhich are purchased by Henry Schein directly from the manufacturer may
Low-level hazardous items(dangerous goods in accepted quantities and Consumer be returned providing thatthe following key elements are met:
Commodity ID 8000)are now available via LIPS 2nd-day air.
1 Only returns due to error in order or delivery will be allowed.
Guam.Puerto Rico,U.S.Trust Territories&Urgin Islands: 2)Returns of Rx Drugs will only be accepted it HSI is notified within 14 calendar days
* All orders will be subject to a handling charge.This charge includes freightthrough 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 Rx Dru(S
• Special delivery orders and hazardous material shipments can be.shipped via United to complete and return a Prescription Drug Return Authorization form.Frtleralilaw
Parcel Services(UPS)for an additional charge.No minimum order amount orweight requires that the healthcare entity returning Rx Drugs docuinentthat the product
applies.Speak to your International Representative 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 form and proper return
Outside U.S.(50 states): authorization,please contact Customer Service.
It your order is being shipped outside the U.S.(50 states),please refer to the 4)In addition,Pedigree regulations require that the healthcare entity returning
International Terms&Conditions at henn.1scheih.com.Unless otherwise aareed, Rx Drugs certifies
freightterms are FOB Shipper's Dock(TE Works"outside North America)' that the product being returned is the same exact product purchased from HSI.
Title passes at the time the shipment is loaded at the shipper's dock. 5)Henry Schein will not issue creditt for any returned Rx Drugs which have been
Customer is responsible for compliance with any applicable import requirements. tampered with,are out of date or where the labeling has been altered in any way.
RX PRODUCTS & CONTROLLED SUBSTANCES: CHOOSEYOUR PAYMENT METHOD
Reg ulalionsraquire us-to-fimit'cthe sale of-Rx and-controlled substances only to registered;—2%Cash Back or Maxinnum-Rewards on-all-purchases-with the Henry-Schein - — -
licensed heatlhcrare professionals.it;iou are a nFx customer or thave recently moved, Credit Card.To apply now,call:1.866.398.9296 or online
please furnish its with a copse of your updated slate DEA registration.For controlled vnviv.henryschein.conl/creditcard Reduce the cost and administration of paying
substances,furnish a copy of your DEA registration verih4ng your shipping address.
Please note that all orders for controlled substances are subject to a due diligence review Henry Schein-Pay electronically(ACH Debit)or set up AutoPay.
process.Schedule II controlled substance can be ordered electronically or by inail. 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
w%tiM1v.henrysrhein.com/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 11 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.Invoices are payable within agreed
Loral regulatory requirements may apply to use or installation of certain products. terms of sale.
Be sure to understand and comply with arry such requirements prior to purchase,use, Ooen 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 3406 Proqram Henry Schein Medical/EMS
Customer Service: 1.800.472.4346 Sam-9pm,et. Customer Service: 1.877.344.3402 8:30am-5:30pm,et. Customer Service: 1.800.845.3550 8:30am-5:30prn,el
Place an Order: 1.800.772.4346 8anr9pm,et. Place an Order. 1.877.344.3402 8:30am-5:30pm,et. Place an Order 1.600.845.3550 8:30am-5:30pm,et
Fax an Order. 1.800.329.9109 24 Hours. Fax an Order 1.888.885.2253 24 liouis. Fax an Order. 1.800.533.4793 24 Hours.
Internet: wmv.henryschein_com/medical E-Commerce Support: 1.800.711.6032 Sam--Spm,et. Internet: wwwAienryschein.comJems
E-Mail: cuslservs@henryschein.corn Internet: www.henryschein.com/34013 E-Mail: scott.bruner@henryschein.com
E-Mail: customer.snpport@henryschein.com
Please see:littp://wi�nv.Henryschein.com/US-EN/Medical/LegalTerms.ASPX for Conditions&Exceptions.
LP300
ORDER# I ORDER DATE DUE DATE-
19839206 06/04/14 07/04/14
D&B#:01-243-0880
WHSE DEA# RH0162494 Fed ID:11-3136595
.t3,Jx•y.� £EF a .
R... :•r. 8 E w, .. ✓:u ••r......" .s ^" bdS'b g ce `$ ....L
This order as been processed by our MIDWEST D.C.
5315 WES 74TH 3TREET
INDIANAP LIS,IN 46268
OM SMALL
ONOTHAN AL ERSON
17-571-260
---------- --------------------------------- ------ ----- ------------- -------
---------- --------------------------------- ------ ----- ------------- -------
1 935-6155 50/PK BLUE SENSOR SP ELECTRODES 25 25 12.08 302.00 5
2 666-2575 EA SHARPS CONTAINER 2GAL 6 6 3.15 18.90 6
3 890-4792 EA SHARPSTAR SHARPS CONTAINE 5-QT 12 12 4.17 50.04 4
4 565-7365 100/BX NITRILE PF GLOVE BLACK MEDIUM 6 6 8.90 53.40 6
5 565-1031 100/BX NITRILE PF GLOVE BLACK LARGE 12 12 8.90 106.80 6
6 565-0811 100/BX NITRILE PF GLOVE BLACK X-LARGE 25 25 8.90 222.50 5
------------------
------ ----- ------------- -------
---------- --------------------------------- ------ ----- ------------- -------
LEASE REFEZ TO BACK OF PAPERWORK FOR DISCLOSJRES/TEZMS OF SALE
---------- --------------------------------- ------ ----- ------------- -------
MERCHANDI E TOTAL 753.64
nvoice Date + 30 days 753.64
s LL TC` SHIP TO INVOICE 1#` INVOICE AMOUNT ITEM STATUS KEY REM KEY
B-Backordered;Item will follow SK-School Kit
1308571 1308572 2642466-01 753 .64 D-Discontinued;Item no longer available NC-No Charge
.. - ...-.. .. - F-Special Schein Free Goods
RDE it ORD DATE NV > - TE' BOXES
�ES M-Manufacturer will ship Item directly to you
19839206 06/04/14 6/0 4/14 P-Refrigerated
prion Drug:RetMay
shipped
separately Required
6 R-Refri erased Bem;Ma be shi ed se aralel
$ -Special Schein Pricing
'-CUSTOMER PO# PAGE T-Taxable Item
"I-Item has MSDS unavailable;please reorder Continued on Next Page..........
TOM SMALL 1 OF 2 g
VOUCHER NO. WARRANT NO.
ALLOWED 20
Henry Schein
IN SUM OF$
Dept Ch 10241
Palatine, IL 60055
$1,185.14
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#!TITLE AMOUNT Board Members
1120 2642466-01 102-390.11 $753.64 1 hereby certify that the attached invoice(s), or
1120 2125613-01 102-390.11 $431.50 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
01wN A �P 1"1A
li
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
• 1
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))
2642466-01 $753.64
2125613-01 $431.50
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