HomeMy WebLinkAbout234868 07/16/14 CITY OF CARMEL, INDIANA VENDOR: 357526
4
ONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: $*"**"505.93*
a� CARMEL, INDIANA 46032 DEPT CH 10241 CHECK NUMBER: 234868
PALATINE IL 60055-0241 CHECK DATE: 07/16/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 4239011 16880861 -526.02 SPECIAL DEPT SUPPLIES
102 4239011 1710906-01 701.36 SPECIAL DEPT SUPPLIES
102 4239011 3386686-01 23.75 SPECIAL DEPT SUPPLIES
102 4239011 5746170-02 25.80 SPECIAL DEPT SUPPLIES
102 4239011 8186058-01 61.92 SPECIAL DEPT SUPPLIES
102 4239011 9613461-01 219.12 SPECIAL DEPT SUPPLIES
Please detach here and mail the above with your payment
ORDER ORDER DATE DUE DATE
19537695 05/22/14 06/21/14
D&B#:01-243-0880
WHSE DEA# RHO162494 Fed ID: 11-3136595
DESCRIPTIONITEM UNIT
NO CODE __Avu • . • ,
his order ias been processed by our MIDWEST D.C.
5315 WES 74TH 3TREET
INDIANAP LIS,IN 46268
OM SMALL 05/22/14
17-571-260
----- ------------- -------
1 499-2923 10/CA GRAHAM MEGA MOVER 1500 4 4 C 175.34 701.36 4
SE GOOD I EM, MAY BE SHIPPED SEPARATELY.
--- -------
LEASE REFEZ TO BACK OF PAPERWORK FOR DISCLOSJRES/TEZMS OF SALE
MERCHANDI E TOTAL 701.36
Invoice Date + 30 days 701.36
lease remi payments only to the following a dress:
enry Schei , Inc.
Dept CH 102 1
Palatine, I 60055-0241
ITEM STATUS KEY [;:M;,=;yD
1308571 1308572 1710906—O1 701.36 B-Backordered;Item will follow D-Discontinued;Item no longer available
F-Special Schein Free Goods
M-Manufacturer will ship Item directly to you
19537695 05/22/14 5/22/14 4PR_Prescription Dmg;Return Authorization Required
Refrigerated Item;May be shipped separately
$ -Special Schein Pricing
T-Taxable Item
TOM SMALL 0522 V-Temporarily unavailable;please reorder
1 •-Item has MSDS
UREUPP APPLIED TO
1 '4of 1 Account
p
1 4992923 10/Ca Graham Mega Mover 1500 3 1710906/19537695 175.34 526.02
05/27/14 Order # 9729380 1 000 ;_ TOM�SMALL 0522
Credit,amo'untx . . . . . . . 526.02
Sub Nei Total . . . . . . . 526.02
Tot
al'":Credit.= 526.02
N
ACCOUNT TOTAL CREDIT
1308571 526 . 02 r
CREDIT MEMO CREDIT MEMO DATE �� �" .�i a' 4 ^t ,.,., i,.€� 1�, " -v
16880861 06/03/14
PAGECREDIT APPLIED TO
1 of 1 Account
20056112 06/12/14 07/17/14
D&B#:01-243-0880
WHSE DEA# PG0229321 Fed ID:11-3136595
WTI
MOKX
gamI
This order has been processed by our GIV D.C.
80 SUMMI" VIEW E
BASTIAN VA 2431.4
1 499-2106 EA AC POWER CORD 1 1 25.80 25.80 1
LEASE REFEZ TO BACK OF PAPERWORK FOR DISCLOS ES/TEZMS OF SALE
MERCHANDI E TOTAL 25.80
Invoice Date + 30 days 25.80
Please remi- payments only to the following aldress:
Henry Scheii, Inc.
Dept CH 10211
Palatine, 1, 60055-0241
Y
MEY
-M
F
RF
BILL TO SHIP TO INVOICE# INVO.ICE Ara Q_UNT ITEM STATUS KEY FS
1308571 1308572 5746170-02 25.80 B-Backordered;Item will follow 'K-School K i 1,
D-Discontinued:Item no longer available No C,
F-Special Schein Free Goods
- QRDER# ORDER DATE INVOICE DATE # OF BOXES M-Manufacturer will ship Item directly to you
P Prescription Drug;Return Authorization Required
20056112 06/12/14 6/17/14 1 R Refrigerated Item;May be shipped separately
$ Special Schein Pricing
CUSTOMER PO# PAGE T-Taxable Item
U-Temporarily unavailable:please reorder
—Tom 1 OF 1 -Itern has MSDS
LP300
rules.Upon discount receipt by redemption of your earned points/credits,you aro receiving or �uio
men
will receive notice of the discount value.Accordingly,you should retain these records. :pened and used equipment may not be returned for credit.Before opening
equipment,we suggest that you check 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 original unopened packaging,unmarked and properly packaged.Speical order
North America).Tula passes at the time the shipment is loaded at the shipper's dock. equipment is riot returnable.All 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 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 carder charges related to special delivery services and hazardous material warranty.
shipments.Special orders are subject to additional freight charges. Prescription Dnig 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 HenrySchein'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 WH.
No additional surcharges apply,except when 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 following key elements are mei:
Commodity ID 8000)are now available via LIPS 2nd-day air. 1 Only returns clue 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. Ihis 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 Art requires any customer returning Fix Druy s
• Special delivery orders and hazardous material shipments can be:shipped via United to complete and return a Prescription Drug Return Authorization form.Feclervlaw
Parcel Services(UPS)for an additional charge.No minimum order amount or weight 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
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 henrlyschein.com.Unless otherwise agreed, Rx Drugs certifies
freightlerms arc:FOB Shipper's Dock("Ex tiNorks"outside North America)• that the product being returned is the same exact product purchased from HSI.
Title passes at the fime the shipment is loaded at the shipper's dock. 5)Henry Schein will not issue credit for any returneA 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.
RXP_RODU_CT_S &_CDNTROLLED_SUBSTANCES:_ . _ vCHOOSEYOUR_PAYMENTMETHOD __
Regulations require us to limitthe sale of Rx and controlled substances only to registered, 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:1.860.398.9296 or online
please furnish cis with a copy of your updated state DEA registration.For controlled www,henryschein.com/creditcard Reduce the cost and administration of paying
substances,furnish a copy of your DFA registration verifying your shipping address. Henry Schein-Pay electronically(ACH Debit)or set up AutoPay.
Please notch that all orders for controlled substances are subject to a due diligence review
pprocess.Schedule II controlled substances can be ordered electronically or by mail. Please call Customer Service for details.
or information on our Controlled Substance Ordering System please visit For your convenience.,we.provide several payment alternatives.Orders billed to your
vvvAv.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 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
Local regulatory requirements may,apply to use or installation of certain products. terms of sale.
Be sure to understand and romply with any such requirements prior to purchase,use, Open Accounts Receivable:
or installation oI products. All unpaid accounts receivable past due are subject to a 1.5%finance charge.
To arrange for a product retum,simply call Customer Service as noted below:
Henry Schein Medical 3408 Program Henry Schein Medical/EMS
Customer Service: 1.800.472.4346 8am-9pin,et. Customer Service: 1.877.344.3402 8:30am-5:30prn,et. Customer Service: 1.800.845.3550 8:3lkim-5:30pin,et
Place an Order: 1.800.772.4346 Ban-9pm,et. Place an Order: 1.877.344.3402 8:30am-5:30pnh,et. Place an Order. 1.800.845.3550 8:30am-5:30pm,et
Fax an Order. 1-800.329.9109 24 Hours. Fax an Order 1.888.885.2253 24 flours. Fax an Order 1.800.533.4793 24 Hours.
Internet: www.henryschein.com/medical E-Commerce Support: 1.800.711.6032 8am--8pm,et. Internet: www.henryschein.coni/ems
E-Mail: custservs^henryschein.com Internet: iviray.henryschein.com/340B E-Mail: scott.bruner@henryschein.com
E-Mail: custoniecstipport@henryschein.coin
Please see:littp://www.Henryschein.com/US-EN,Medical/LegaiTerms.ASPX for Conditions&Exceptions.
QRDER# I ORDER DATE IQUE DATE
20055167 06/12/14 07/12/14
D&B#:01-243-0880
WHSE DEA# RH0162494 Fed ID: 11-3136595
N, ti
o _ c
�e
=mom..
his order as been processed by our MIDWEST D.C.
5315 WES 74TH 3TREET
INDIANAP LIS,IN 46268
OM 061214
17-571-260
1 499-2557 6/PK PENLITE DISP W/PUPILGAUGE 5 5 4.75 23.75 1
LEASE REFEZ TO BACK OF PAPERWORK FOR DISCLOSJRES/TEZMS OF SALE
MERCHANDI E TOTAL 23.75
Invoice Date + 30 days 23.15
Please remi payments only to the following a dress:
Henry Schei , Inc.
Dept CH 10211
Palatine, I 60055-0241
s TWOTCE AMOUNT ITEM STATUS KEY REM KEY
1308571 1308572 3386686-01 2 3.7 5 B-Backordered:Item will follow SK-School Kit
D-Discontinued;Item no longer available NC-No Charge
ORDER# ORDER DATE INVOICE DATE # OF BOXES F-Special Schein Free Goods
M-Manufacturer will ship Item directly to you
P-Prescription Drug:Return Authorization Required
20055167 06/12/14 6/12/14 1 R-Refrigerated Item;May be shipped separately
P PA E $ -Special Schein Pricing
CUSTOMER T-Taxable Item
U-Temporarily unavailable;please reorder
TOM 061214 1 OF 1 -Item has MSDS
poioli/credits redeemable for certain goodsorservices,inaccordancewith discount program E
rules.Upon discount receipt by redemption of your earned points/ Equipment:
credits,you are receiving or —.—
will receive notice of the discount value.Accordingly,you should retain these records. Opened antl used equipment may not be returned for credit.Before opening
equipment,we suggest that you check the shipping container and packing hst to
DELIVERY TERMS' ensure that you are getting exactly what you ordered.Equipment must be returned
Unless otherwise aggreed,freight terms are FOB Shipper's Dock('Ex Works'outside in the original unopened packaging,unmarked and pop
rl�'packaged.Speical order
North America).Tittle passes at the time:the shipment is loaded at the shipper's dock. equipment is not returnable.Allequipment returns are subfect to a restocking lee.
Equipment is backed by the manufacturer's repair or replacement warranty.Please
Continental U.S.: read and return all warranty intormation required immediately upon taking deliver 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 ad clitionaf freight charges. Prescription Drug Retums:
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 Henr�r Schein has purchased from wholesalers are not returnable.
ms
are offered direct surface transport,or postal services for reliable delivery. These itewill be identified in your irnroice with the rode WH.
No additional surcharges apF)ly,except when sp ecial 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 foflowing key elements are met:
Commodity ID 8000)are now available via UPS 2nd-dery air.
1 Only returns clue to error in order or delivery will be allowed.
Guam,Puerto Rico,U.S.Trust Territories&Virgin Islands: 2)Returns of Pox 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 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 arty 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 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 states
and during the return of the product.To get a copy of the form and proper return
If our order is beingshipped outside the U.S.(,50 states), lease refer to the authorization,please contact Customer Service.
PP ) P 4)In addition,Pedigree regulations require that the healthcare entity returning
International Terms&Conditions at henritschein.com.Unless otherMse agreed, Rx Drugs certifies
freightterms are FOB Shipper's Dock("Ex 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 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: CHOOSEYOUR PAYMENT METHOD J
Regulations require us to limit the sale of Rx and controlled substances only to registered, 2%Cash Back or Maximum Rewards on all purchases with the Henry Schein
licensed heafthcare 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 with a copy of your updated state DEA registration.For controlled www.henryscliein.com/creditcard Reduce the cost and administration of paying
substances,furnish a copy of your DEA registration verifying your shipping address.
Please note that all orders for controlled substances are siibje ctto a due:diligence review Henry Schein-Pay electronically(ACH Debit)or set up AutoPay.
pprocess.Schedule 11 controlled substances can be ordered electronically or by mail. Please call Customer Service for details.
`-or information on our Controlled Substance:Ordering System please visit For your convenience,we provide several payment alternatives.Orders billed to your
w%%m,.henryschein.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 planing your order.All sales are subject to our normal teams and
REGULATORY REQUIREMENT: c:onditions.All sales are subject to credit approval.Invoices are payable within agreed
Local regulatory requirements rnay apply to use or installation 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 fora product return,simply call Customer Service as noted below:
Henry Schein Medical 3408 Program Henry Schein Medical/EMS
Customer Service: 1.800.472.4346 8anr9pm,of. Customer Service: 1.877.344.3402 8:30am-5:30prn,el. Customer Service: 1.800.845.3550 8:30a i-5:30prn,et
Place an Order: 1.800.772.4346 Bani-9pni,et. Place an Order. 1.877.344.3402 8:30am-5:30pni,et. Place an Order 1.800.845.3550 8:30am-5:30pm,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 flours.
Internet: wmy.hemyschein.com/medical E-Commerce Support: 1.800.711.6032 Sam-bpm,et. Internet: www.henryschein.com/ems
E-Mail: custsery@henryschein.com Internet: tvvnv.henryschein.com/340B E-Mail: scott.bruner@henryschein.com
E-Mail: etistomersupport@henryschein.com
Please see:littp://www.Henryschein.com/US-EN/Medical/Lega[Terms.ASPX for Conditions&Exceptions.
LP300
20484770 06/30/14 07/30/14
D&B#:01-243-0880
WHSE DEA# RHO162494 Fed ID: 11-3136595
�: A, fi1 :1
ffi l
ffi 0111135.W's10
N
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N N
M 36
M
"A
rhis order has been processed by our MIDWEST D.C.
5315 WES— 74TH 3TREET
INDIANAPOLIS,IN 46268
rom SMALL 3L7-571-2600
1 360-1359 EA SAM SPLINT ORANGE/BLUE 36X4.25 24 24 6.55 157.20 9
2 499-5558 24/CA INSTANT COLD PACKS DISPOS 8 8 *C 7.74 61.92 8
�ASE GOOD IrEM, MAY BE SHIPPED SEPARATELY.
PLEASE REFEZ TO BACK OF PAPERWORK FOR DISCLOSURES/TE ZMS OF SALE
MERCHANDIIE TOTAL 219.12
Invoice Date + 30 days 219.12
., Please remi payments only to the following aldress:
Henry Schei , Inc.
Dept CH 10211
Palatine, I60055-0241
BILL TO SHIP TQ- INVo# INVOICE AMOUiiT ITEM STATUS KEY REM KEY
B-Backordered;Item will follow SK-School Kit
1308571 1308572 9613461-01 215.12 D-Discontinued:Item no longer available NC-No Charge
F_Special Schein Free Goods
ORDER# ORDER DATE INVOICE DATE 4 OF BOXES M-Manufacturer will ship Item directly to you
P Prescription Drug;Return Authorization Required
20484770 06/30/14 6/30/14 9 R Refrigerated Item:May be shipped separately
$ Special Schein Pricing
CUSTOMER PO AGE T-Taxable Item
TOM SMALL1 OF 1 Temporarily unavailable;please reorder
Item has MSDS
poinisferellits redeemarile lot certain gootisorservices,in accoruanc Equipment:
rules.Upon discount receipt by redemption of your earned points/credits,you are receiving ar Opened and used equipment may not be returned for credit.Before opening
will receive notice of the discount value.Accordingly,you should retain these records.
equipment,vie suggest that you check the shipping container and packing list to
DELIVERYTERMS: ensure that you are getting exactly what you ordered.Equipment must be returned
Unless otherwise ar f reed,freight terms are FOB Shipper's Dock('Ex Works"outside in Ute original unopened packaging,unmarked and properly packaged.Speical order
North America).Tine passes at the time the shipment is loaded at the shipper's dock. equipment is not returnable.Aliequiprnent returns are subject to a restocking fee.
p Equipment is backed by the manufacturer's repair or replacement warrant,,.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 freight charges. Prescription Drug 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 vour invoice with the code WH.
No additional surcharges apply,except when special services are requested. Rx Drugs which are purchased 61,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-day 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. 1 his charge includes tre ightthrocigh 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 or weight requires that the healthcare entity returning Rx Drugs document Viat 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 Ute U.S.(50 states),please refer to the 4)In addition,Pedigree regulations require that Vie healthcare entity returning
International Terms&Conditions at henrvschein.com.Unless otherwise agreed, Rx Drugs certifies
freight terms are FOB Shipper's Dock("Ex Works"outside North America). that the product being returned is the same exact product purchased from HSI.
TiUe passes at the time the shipment is loaded at the shipper's dock. 5)Henry Schein will not issue credit for arnf 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 PRO{3UCTS-&-CONTROLL-ED-SUBSTANCES:----- ---CHOOSEYOUR-PAYMENT-MET-HOD---- - ---
Regulations require us to limit the sale of Rx anti controlled substances only to registered, 20%Cash Back or Maximum Rewards on all purchases with the HenrySchein
licensed healthcare professionals.If you are a new customer or have rerentiy moved, Credit Card.To apply now,call:1.866.398.9296 or online 1
please furnish lis witli a copy of your updated state DEA registration.For controlled www.henryscliein.coitt/creditcard Reduce the cost and administration of paying
substances,furnish a copy of your DEH registration verifying your shipping address.
Please note:that all orders for controlled substance are subject to a due:diligence review Henry Schein-Pay electronically(ACH Debit)or set up AutoPay.
process.Schedule II 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
tvvyM1v.henrvschein.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 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 Barn-glom,et. Customer Service: 1.877.344.3402 8:30am-5:30pin,et. Customer Service: 1.800.045.3550 8:30am-5:30prn,et
Place an Order 1.800.772.4346 8anr9pm,et. Place an Order. 1.877.344.3402 8:30am-5:30pm,et. Place an Order. 1.800.045.3550 8:30am-5:30pm,eL
Fax an Order. 1.800.329.9109 24 Hours. Fax an Order. 1.888.8852253 24 liours. Fax an Order. 1.800.533.4793 24 Hours.
Internet: ►vwtv.henryscheiii.com/medical E-Commerce Support: 1.800.711.6032 Sam-bpm,et. Internet: www.lienrVscliein.com/ems
E-Mail: custserv@henryschein.corn Internet: wvnv.henryschein.com/34011 E-Mail: scott.bruner@heuryschein.com
E-Mail: customer.support@henryschein.com
Please see:http://wrvw.Henryschein.comgJS-EN/Medical/LegaiTerms.ASPX for Conditions&Exceptions.
LP300
ORDER# -ORDER DATE 1QUE-DATE
20314378 06/23/14 07/23/14
D&B#:01-243-0880
WHSE DEA# RHO162494 Fed ID:11-3136595
a.
-..ash P• -
his order has been processed by our MIDWEST D.C.
5315 WEST 74TH 3TREET
INDIANAP LIS,IN 46268
1 499-5558 24/CA INSTANT COLD PACKS DISPOS 8 8 *C 7.74 61.92 8
ASE GOOD I EM, MAY BE SHIPPED SEPARATELY.
LEASE REFEZ TO BACK OF PAPERWORK FOR DISCLOS RES/TE .S OF SALE,
MERCHANDI E TOTAL 61°.92'
Invoice Date + 30 days 61.92
Please remi payments only to the following a dress:
Henry Schei , Inc.
Dept CH 10211
Palatine, I 60055-0241.
BILL 710 SHTPINVOICE NV I E AMOUNT ITEM STATUS KEY REM KEY
B-Backordered;Item will follow SK-School Kit
1308571 1308572 8186058-01 61.92 D-Discontinued;Item no longer available NC-No Charge
ORDER# ORDER DATE INVOICE DATE # OF BOXES F-Special Schein Free Goods
M-Manufacturer will ship Item directly to you
P-Prescription Drug;Return Authorization Required
20314378 06/23/14 6/23/14 9 R-Refrigerated Item;May be shipped separately
$ -Special Schein Pricing
CUSTOMER
P PA E T-Taxable Item
U-Temporarily unavailable;please reorder
TOMA SMALL 1 OF 1 *-Item has MSDS
LP3
rules Upon discount receipt by redemption of your earned points/credits you are receiving or {=~finedand used equipment ma not be returned for credit.Before opening
will receive notice of the discount value.Accordingly,you should retain these records. Opened y p g
equipment,we suggest that you check the shipping container and packing list to
DELIVERY TERMS: ensure that you are getting exactly what you ordered.Equipment must he returned
Unless otherwise ar reed,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.All equipment returns are subject to a restorlang fee.
Equipment is backed by the manufacturer's repair or replacement warranty.Please
Continental U.S.: read and return all warranty information required immediately upon taking deliver 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 iy✓arranty.
shipments:Special orders are subject to additionaf freight charges. Prescription Dnrg 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 delivery. These items will be identified in your invoice with the code WH.
No additional surcharges apply,except when 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 foflowinq key elements are met:
Commodity ID BO00)are now available via LIPS 2nd-dav 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
o All orders will be subject to a handling charge.This charge includes freight through of receipt of Hie shipment and valid return authorization is issued by HSI.
the United States Postal Service(USPS). 3)The Prescription Drug Marketing Art 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 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
and during the return of the product.To get a copy of the farm arid 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 henryyschein.c:om.Unless other✓vise agreed, Rx Drugs certifies
freiht terms are FOB Shipper's Dock("Ex Works"outside North America). that the product being returned is the same exact product purchased from HSI.
titlegpasses 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.
_RXP_RO_}JJC_T_S_&CONTROLLED Sl11315TANCES: __ —GHOOSE_Y_O_UR_PAY-HENT—METHOD _
Regulations require us to limit the sale of Rx and controlled substances only to registered, 20/6 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:1.866.398.9296 or online
please furnish us with a copy of your updated state DEA registration.For controlled wtvw.henryschein.com/creditcard Reduce the cost and administration of paying
substances,furnish a copy of your DEA registration verifying 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 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
www.henryschein.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 rnail the form to: vote 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 planing your order.All sales are subject to our normal terms and
REGULATORY REQUIREMENT: conditions.All sales are subject to credit approval.Invoices are payablewithin agreed
Local regulatory requirements may apply to use or installation of certain products. terms of sale.
Be sure to understand and comply with anf such requirements prior to purchase,use, Open Accounts Receivable:
or installation of products. All unpaid accounts receivable past due are subject to a 1:50,�finance charge.
To arrange for a product return,simply call Customer Service as noted below:
Henry Schein Medical 340B Program Henry Schein Medlcal/EMS
Customer Service: 1.800.472.4346 8amn Spm,at. Customer Semite: 1.877.344.3402 8:30am-5:30pm,of. Customer Service: 1.800.845-3550 8:30am--5:30prn,at
Place an Order: 1.800.772.4346 8anr9pm,at. Place an Order: 1.877.344.3402 8:30am-5:30pni,et. Place air Order: 1.800.845.3550 8:30am-5:301)m,et
Fax an Order. 1.800.329.9109 24 flours. Fax an Order: 1.808.885-2253 24 Hours. Fax an Order. 1.800.533.4793 24 l=ours.
Internet: %vvnv.henryschein.com/medical E-Commerce Support: 1.800.711-6032 Sam—bpm,et. Internet: wwwAienryschein.com/ems
E-Mail: custserughenryschein.com Internet: ivirnv.henryschein.com/34011 E-Mail: scott.bruner@hearyschein.com
E-Mail: ecistontecstipportc2?heoryschein.com
Please see:Iittp://v✓wiv.Henryschein.com/US-EN/Medical/LegaiTerms.ASPX for Conditions&Exceptions.
VOUCHER NO. WARRANT NO.
ALLOWED 20
Henry Schein
IN SUM OF$
Dept Ch 10241
Palatine, IL 60055
$505.93
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1120 5746170-02 102-390.11 $25.80 1 hereby certify that the attached invoice(s), or
1120 16880861 102-390.11 ($526.02) bill(s) is (are)true and correct and that the
1120 9613461-01 102-390.11 $219.12 materials or services itemized thereon for
1120 3386686-01 102-390.11 $23.75 which charge is made were ordered and
1120 1710906-01 102-390.11 $701.36 received exceq#
2014
1120 8186058-01 102-390.11 $61.92 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))
1710906-01 $701.36
16880861 ($526.02)
8186058-01 $61.92
9613461-01 $219.12
3386686-01 $23.75
5746170-02 $25.80
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
120
Clerk-Treasurer