HomeMy WebLinkAbout235414 07/30/14 +p�,C�Nb
CITY OF CARMEL, INDIANA VENDOR: 357526
„ ONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: $***"`3;146.38*
�; CARMEL, INDIANA 46032 DEPT CH 10241 CHECK NUMBER: 235414
.y,«oN'�° PALATINE IL 60055-0241 CHECK DATE: 07/30/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 4239011 3313830-01 590.00 SPECIAL DEPT SUPPLIES
102 4239011 3339872-01 625.00 SPECIAL DEPT SUPPLIES
102 4467006 3339872-01 1,852.94 EMS EQUIP
102 4239011 3436757-01 41.96 SPECIAL DEPT SUPPLIES
6 48 SPECIAL DEPT SUPPLIES
102 4239011 604668-02 3 .
_ -
i,jease uctacn nue anu ruanc aDOVe Wflu your payment
ORDER# ORDER DATE DUE DATE
20631378 07/07/14 08/10/14
D&B#:01-243-0880
WHSEDEA# RH0162494 Fed ID:11-3136595 CONTAINS MULTIPLE INVOICES
t s,
%
his order has been processed by our MIDWEST D.C.
5315 WES 74TH 3TREET
INDIANAP LIS,IN 46268
JOHN 317-407-3747
TALVERSON@CkRMEL.IN.GOV
O JOHN 070 714
1 153-6483 RX 250ML/BT STERILE WATER FOR IRRIG 250ML 24 24 C P 1.52 36.48 1
PEDIGR E ITEM.
CASE- GOOD I EM, MAY BE SHIPPED SEPARATELY.
.TDC:0033800)402
LEASE REFEZ TO BACK OF PAPERWORK FOR DISCLOS RES/TE S OF SALE
AN - HENRY 3CHEIN, INC. HAS PURCHASED THE SPECIFIC UNIT OF THE PRESCRIPTION DRUG
DIRECTLY F OM THE MANUFACTURER.
MERCHANDI E TOTAL 36.48
Invoice Date + 30 days 36.48
lease remi payments only to the following a dress:
Henry Schei , Inc.
Dept CH 10211
Palatine, I 60055-0241
BILL TO SHIP TO INVOICE# INVOTCE o ITEM STATUS KEY REM KEY
B-Backordered;Item will follow
REM
Kit
1308571 1817102 6 0 4 6 6 8-0 2 3 6.4 8 D-Discontinued;Item no longer available NC-No Charge
RDERORDER DATE INVOICE DA F-Special Schein Free Goods
M-Manufacturer will ship Item directly to you
P-Prescription Drug;Return Authorization Required
20631378 07/07/14 7/11/14 1 R-Refrigerated Item;May be shipped separately
CUSTOMERP p E $ -Special Schein Pricing
T-Taxable Item
U-Temporarily unavailable;please reorder
JOHN 070714 1 OF 1 *-Item has MSDS
IN a p .. .. _
(e.g.points,discount redemptions or other special awards),with your purchases you may earn •Items that cannot be returned to the manufacturer•Any item marked nonreturnable
points/credits redeemable for certain goods or services,in accordance with discount program
rules.Upon discount receipt by redemption otyour 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 original unopened ppackaging,unmarked and properK,packaged.Speical order
North America).Title:passes at the:lime the shipment is loaded at the shipper's dock. equipment is not returnahle.Aff equipment returns are subject to a restocking fee.
Equipment is barked by the manufacturer's repair or replacement warranN.Please
Continental U.S.: read and return all warranty information required immediately upon taking deliveFl 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 Hx Drugs which Henan Schein has purrhased from wholesalers are not returnable.
are offered direct surface transport,or postal services for reliable deliveRl. These items will be identified in vour invoice with the rode WH.
No additional surcharges apply,except when special services are requested. Rx Drugs yrhidh are purchased 61,Henry Schein directly from the manufacturer may
Low-level hazardous items(dangerous goads in accepted quantities and Consumer be returned providing that the following key elements are met:
Commodity ID 8000)are now available via LIPS 2nd-dcr;air. 1 Only returns due to error in order or delivery will be allowed.
Guam Puerto Rico tj.S.Trust Territories&Virgin Islands: 2 Returns of Rx Drugs will only be.accepted if HSI is notified within 14 calendar days
? 9 y ( l
• of receipt of the shipment and valid return authorization is issued b HSI.
All orders will be subject to a handling charge. This charge includes freight through p p y
the United States Postal Service(USPS). 3)The Prescription Drug Marketing Art requires any customer returning Fix Drugs
• Special delivery orders and hazardous material shipments ran be shipped via United to complete and return a Prescription Drug Return AiAhorization 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
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
nternational Terms&Conditions at henryschein.coIll.Unless otherwise agreed, Rx Drugs certifies
freigtleht terms arc,FOB Shipper's Dock("Ex Works"outside North America)• that the product being returned is the same exact product purchased from HSI.
Tipasses 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: CH0O19EYC1UR PAYMENT-METHOD -- — - ---
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 healthcare professionals.If you are a new rustomer 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 BEA registration.For controlled www.henryschein.com/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 substances 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
kw%w.henryschcin.com/v222;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: yotr may useyour Henry Schein Credit Card,American Express,Visa,MasterCard or
Henry Schein,Inc.• Suite 300,5315 West 74th Street • Indianapolis,IN 46268 Discover ca rd 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 comphy 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 340B Program Henry Schein Medical/EMS
Customer Service: 1.800.472.4346 8am-91)m,et. Customer Service: 1.877.344.3402 8:30ani-5:30pm,et. Customer Service: 1.800.845.3550 8:30ana-5:30prn,eL
Place an Order: 1.800.772.4346 8am-9pm,et. Place an Order: 1.877.344.3402 8:30am-5:30pnh,et. Place are Order. 1.800.845.3550 8:30am-5:30pm,eL
Fax an Order. 1.800.329.9109 24 Ilows. Fax an Order. 1.888.885.2253 24 Hours. Fax an Order 1.800.533.4793 24 Hours.
Internet: wmv.henryschein.com/medical E-Commerce Support: 1.800.711.6032 8am-8pni,et. Internet: www.lienryseliein.com/encs
E-Mail: custserv@henryschein.com Internet: wvnv.henryschein.com/340B E-Mail: scott.bruner@henryschein.com
E-Mail: customer.sripport@henryschein.cern
Please sere:littp:/Imknu.Henryschein.comJUS-EN/Medical/LegalTerms.ASPX for Conditions&Exceptions.
LP300
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ORDER# ORDER DATE IDUE DATE
20876230 07/15/14 08/14/14
D&B#:01-243-0880
WHSE DyyEA# RHO162494 Fed ID: 11-3136595
o
q
a8
@ i
r
his order has been processed by our MIDWEST D.C.
5315 WES 74TH 3TREET
INDIANAP LIS,IN 46268
1 111-7965 250/BX LAVENDER PF NITRILE GLOVE LARGE 40 40 C 14.75 590.00 4
ASE GOOD I EM, MAY BE SHIPPED SEPARATELY.
LEASE REFEZ TO BACK OF PAPERWORK FOR DISCLOSIJRES/TEZMS OF SALE
MERCHANDI E TOTAL 590.00
Invoice Date + 30 days 590.00
Please remi ' payments only to the following a dress:
enry Schei , Inc.
Dept CH 10211
alatine, 2 60055-0241
BILL TNVOTCEff INVOICE AMOUNT ITEM STATUS KEY REM KEY
1308571 181710 2 B-Backordered;Item will follow SK-School Kit
3 313 8 3 0-01 5 9 0.0 0 D-Discontinued;Item no longer available NC-No Charge
RDER RDE INVOICE DAT F XE F-Special Schein Free Goods
M-Manufacturer will ship Item directly to you
P-Prescription Drug;Return Authorization Required
20876230 07/15/14 7/15/14 4 R-Refrigerated Item;May be shipped separately
CUSTOMER PQ# PAGE#
$ -Special Schein Pricing
T-Taxable Item
TOM 071514 1 OF 1 Itemhas MDS• - pSunavailable:please reorder
(e.g.poirds,discount redemptions or other special awards),with your purchases you may earn •Items that cannot be returned to the manufacturer•Any item marked nonreturnable
points/credits redeemable for certain goods or services,in accordance with discount program Equipment:
rales.Upon discount receipt by redemption otyour earned points/credits,you are receiving or
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 and packing list to
DELIVERY TERMS' ensure that you are getting exactly what you ordered.Equipment must be returned
Unless otherwise ac reed,freight terms are FOB Shipper's Dock(Ex Works"outside in the original unopened packaging,unmarked and properly packaged.Speical order
North America).Ti e passes at the time the shipment is loaded at tie shipper's dock. equipment is not returnable.AlFequipment returns are subject to a restocking fee.
Equipment is barked by tie 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 S�Pecialdelivery services and hazardous material warranty.
shipments.Special orders are subject to additional freight charges. Prescri);tion 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 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 Henri 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 vAiich are purchased by Henn,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-dcr,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. this charge includes freight through of receipt of file 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 Drugs
• Special delivery orders and hazardous material shipments can be shipped via united to complete and return a Prescription Drug Return Authonzationform.Federarlaw
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 henn-,�sc:hein.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.
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 airy way.
RX PRODUCTS& CONTROLLED SUBSTANCES: CHQOSEYOUR PAYMENT
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 healthcare professionals.If you are a new customer or have recently moved, Credit Card.To apply now,call:1.606.398.9296 or online
please fu rnish us'with a copy of your updated state DEA registration.For controlled vnvw.henryschein.com/creditcard Reduce the cost and administration of paying
substances,furnish a copy of your DEA registration verifying your shipping address. Henry ScheirrPay electronically(ACH Debit)or set up AutoPay.
Please note that all orders for controlled substances are subject to a due diligence review
procx;ss.Schedule I I controlled 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 corrvenience,we provide several payment alternatives.Orders billed to your
ww%v.henryschein.com/e222;if you prefer to continue using Federal 2.22 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 planing your order.All sales are subject to our normal terms and
REGULATORY REQUIREMENT: c:onditions.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 3405 Program Henry Schein Medical/EMS
Customer Service: 1.800.472.4346 8am-9p m,It. Customer Service: 1.877.344.3402 8:30ani-5:30prn,It. Customer Service: 1.800.845.3550 8:30anh-5:30pin,et
Place an Order 1.800.772.4346 8am-9pm,It. Place an Order. 1.877.344.3402 8:30am-5:30pm,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 Holies. Fax an Order. 1.800.533.4793 24 liours.
Internet: www.henryschein.com/medical E-Commerce Support: 1.800.711.6032 Sam-bpm,et. Internet: www.henrysebein.com/ants
E-Mail: custserv@henryschein_com Internet: %vvnv.henryschein.comJ340B E-Mail: scott.bruner@henryschein.com
E-Mail- customer.support@henryschein.com
Please see:http-//wvnv.Henryschein.com/US-EN/Medical/Lega[Terms.ASPX for Conditions&Exceptions.
LP300
---------------------------
ease(1clach here and mail the above with your payment
ORDER# ORDER DATE IQUE DATE
20875848 07/15/14 08/14/14
D&B#:01-243-0880
WHSE DEA# RHO162494 Fed ID:11-3136595
his order has been processed by our MIDWEST D.C.
5315 WES 74TH 3TREET
INDIANAP LIS,IN 46268
OM 317-571-2600
1 827-2329 EA SUCTIONUNIT W/DISP CANNNS 2 2 *C 749.00 1498.00 2
ASE GOOD I EM, MAY BE SHIPPED SEPARATELY.
2 109-8454 EA OMNI BLS/ALS TOT SYST BAG EMPTBAG 2 2 C 177.47 354.94 4
PRODUCT IS EING SHIPPED TO YOU DIRECTLY FROM THE MANUFACTIRER.
ASE GOOD I EM, MAY BE SHIPPED SEPARATELY.
3 935-6155 50/PK BLUE SENSOR SP ELECTRODES 50 50 12.08 604.00 6
4 499-1918 EA RING CUTTER 2 2 7.00 -14.06 6-
5 499-1922 EA RING CUTTER BLADE 4 4 1.75 7.00 6
LEASE REFEZ TO BACK OF PAPERWORK FOR DISCLOS RES/TE S OF SALE
-------------
------ ----- ------------- -------
---------- --------------------------------- ------ ----- ------------- -------
MERCHANDI E TOTAL 2477.94
Invoice Date + 30 days 2477.94
Please remi payments only to the following address:
Henry Schei , Inc.
Dept CH 1021
Palatine, I 60055-0241
13TLL TO SHIPTO TNVOICE# INVOICE AMOUNT ITEM STATUS KEY REM KEY
1308571 13085723339872-01 2477.94 B-Backordered;Item will follow SK-School Kit
D-Discontinued;Item no longer available NC-No Charge
RD R ORDER AT INVOICE DATE F BOXES F-Special Schein Free Goods
M-Manufacturer will ship Item directly to you
P-Prescription Drug;Return Authorization Required
2 0 8 7 5 8 4 8 07/15/14 7/15/14 6 R-Refrigerated Item;May be shipped separately
T MER P PA E $ -Special Schein Pricing
T-Taxable Item
TOM 071514 1 OF 1 temphas MSDS unavailable:please reorder
prdQ10131101.H YOU dIV PdIJI1;JPd1IJIga PIUIIIUIIUlkdl Ukbt;UUAIL
(e.g.points,discount redemptions or other special awards),with your purchases you may earn •Items that cannot be returned to the manufacturer•Any item marked nonreturnable
points/credits redeemable for certain goods or services,in accordance with discount program Equipment:
rales.Upon discourd receipt by redemption of your earned points;credits,you are receiving or Opened and used equipment ma not be returned for credit.Before opening
will receive notice of the discount value.Accordingly,you should retain these records. equipment.vie suggest t that you check the shipping container and packing kin list to
DELIVERY TERMS: ese that you are getting exactly what you or fered.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 riot returnable.All equipment returns are subject to a restocking fee.
Equrpmentis barked by the manufacturer's repair or replacement warranty.Please
Continental U.S.: read and return all warranty inlormation required immediately upon taking delivery of
All orders will be subject to a handling charge.This charge includes freight,except for your nrnv equipment.Open or defective equipment is subject to the manufacturer's
additional carrier charges related to special delivery services and hazardous material warranty.
shipments.Special orders are subject to additions(freight charges. Prescription D&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 delivery. These items will be identified in your invoice with the rode WH.
No additional surcharges apFAy,except when special services are requested. Rx Drugs which are purchased byHenry Schein directly from the manufacturer may
Low-level hazardous nems(dangerous goods in accepted quantities and Consumer be returned providing that the foflowing key elements are met:
Commodity ID 8000)are now available via LIPS 2nd-day,air.
1 Only returns clue to error in order or delive�r will be allowed.
Guam.Puerto Rico,U.S.Trust Territories&Virgin Islands: 2)Returns of Rx Drugs will only be accepted ii 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 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
Farrel 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.
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
nternational Terms&Conditions at hennrschein.com.Unless otherwise agreed, Rx Drugs certifies
freight terms are FOB Shippers Dock("Ex Iworks"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
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:1.866.398.9296 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 shi ping address. Henry Schein-Pay electronically(ACH Debit)or set up AutoPay.
Please note that all orders for controlled substances are sublectto a due diligence review Please call Customer Service for details`
pprocess.Schedule 11 controlled substances cern be ordered electronically or by mail.
Fir information on our Controlled Substance Ordering System please visit For your convenience,we provide several payment alternatives.Orders billed to your
kvti%lv.lienpyschein.com/e222;if you preferto 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. o 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: ronditions.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 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 finance charge.
To arrange for a product return,simply call Customer Service as noted below:
Henry Schein Medical 3408 Program Henry Schein Medleal/EMS
Customer Service: 1.800.472.4346 Sam-91rm,et. Customer Service: 1.877.344.3402 8:30am-5:30prn,el. Customer Service: 1.800.845.3550 8:30am-5:30pm,eL
Place an Order: 1.800.772.4346 8am-9pm,et. Place an Order. 1.877.344.3402 8:30am-5:301)m,et. Place an Order: 1.800.845.3550 8:30am-5:30pm,eL
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.
Intemet: wvAv.henryschein.com/medical E-Commerce Support: 1.800.711.6032 Sam-bpm,et. Internet: www.henryschein.conr/encs
E-Mail: custsery@henryschein.com Internet: ivvriv.henryschein.com/3406 E-Mail: scott.bruner@henryschein.com
E-Mail: custonier.srrpport@henryschein.coin
Please see:lilt p:/Avtkw.Henryschein.comJllS-EN,Medicai/LegalTerms.ASPX for Conditions&Exceptions.
LP300
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ORDER ORDER DATE DUE DATE
20875848 07/15/14 1 08/14/14
D&B#:01-243-0880
WHSE DEA# RHO162494 Fed ID: 11-3136595
s
an
a
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NO c
his order has been processed by our MIDWEST D.C.
5315 WES 74TH 3TREET
INDIANAP LIS,IN 46268
OM 317-571-2600
---------- --------------------------------- ------ ----- ------------- -------
---------- --------------------------------- ------ ----- ------------- -------
1 499-2175 PU EA BLADE LARYN MAC#4 4 4 10.49 41.96 1
HIS PRODUCC IS BEING SHIPPED FROM OUR SOUTHWEST DIS RIBUT ON CENTER.
---------- --------------------------------- ------ ----- ------------- -------
---------- --------------------------------- ------ ----- ------------- -------
OUR ORDER 0875848 HAS BEEN SPLIT INTO MULTI LE SHI MENTS. CERTAIN ITEM WILL
E SHIPPED 3EPARATELY. YOU WILL BE BILLED FOR THESE ETEMS VHEN THEY ARE HIPPED.
LEASE REFEZ TO BACK OF PAPERWORK FOR DISCLOSURES/TEZMS OF SALE
---------- --------------------------------- ------ ----- ------------- ------ — -
Southwest D -stribution Center
001 NOLEN R. #400
RAPEVINE, PX 76051
MERCHANDI E TOTAL 41.96
invoice Date + 30 days 41.96
Please remi payments only to the following a dress:
Henry Schei , Inc.
Dept CH 10211
Palatine, I 60055-0241
BILL TO SHIP TO TNVOIC!R* E AMOUNT ITEM STATUS KEY REM KEY
1308571 1308572 B-Backordered;Item will follow SK-School Kit
3 4 3 6 7 5 7-01 41.9 6 D-Discontinued;Item no longer available NC-No Charge
RDER RDER DA NV E TE F BOXES F-Special Schein Free Goods
M-Manufacturer will ship Item directly to you
P-Prescription Drug;Return Authorization Required
20875848 07/15/14 7/15/14 1 R-Refrigerated Item;May be shipped separately
CUSTOMERP PA E $ -Special Schein Pricing
T-Taxable Item
TOM 0 71514 1 OF 1 U-Temporarily unavailable:please reorder
* -Item has MSDS
(e.g.paints,discount redemptions or other special awards),with your purchases yon may earn •Items that cannot be returned to the man ufacturer•Any item marked nonretu rnable
poirds(credits redeemable for certain goods or services,in accordance with discount program Equipment:
rules.Upon(Uscount receipt by redemption of your earned points,'credits,you are receiving or -gT
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,vie 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 k'Ex Works"outside in the original unopened packaging,unmarked and properly packaged.Speical order
North America).Title passes at the trnle the shipment is loaded at the shipper's dock. equipment is not returnable.All equipment returns are subject to a restocking fee.
Erjuipnhent 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,exceptfor 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 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 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 Henri 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 witlh the node WH.
No additional surcharges ap).?ly,except when special services are requested. Rx Drugs which are purchased by Henri Schein directly from the manufacturer may
Low-level hazardous itt ms(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 clue to error in order or delive�r will lit: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 freightthrough of receipt of the shipment and valid retum authorization is issued by HSI.
the United Stales Postal Service(USPS). 3)The Prescription Drug Marketing Act requires any customer returning Fix Druc s
• Special delivery orders and hazardous material shipments can be shipped via United to complete and return a Prescription Drug Return Authorization form.Federa 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 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 tike healthcare entity returning
International Terms&Conditions at hennischein.conh.Unless otherwise agreed, Rx Drugs certifies
I
reight terms are FOB Shipper's Dock("Ex Works"outside North America)• that the product being returned is the same exact product purchased from HSI.
lite 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:- -----CHOOSE-YOUR-PAYME-NT-ME-T—HOD—�__._--_ —
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 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 www.henrysclieiii.com/creditcard Reduce the cost and administration of paying
substances,furnish a copy of your DEA registration verihiinn your shipping address. Henry Schein-Pay electronically(ACH Debit)or set up AutoPay.
Please note that all orders for controlled substances are subjectto a due diligence review Please call Customer Service for details.
process.Schedule If controlled substances can be ordered electronically or by mail.
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 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 io our normal terms and
REGULATORY REQUIREMENT: conditions.All sales are subject to credit approval.Invoices are payable within agreed
Local regulatory requirements may agply to use or installation of certain products. terms of sale.
Be sure to understand and comply wrlh 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 340B Program Henry Schein Medlcal/EMS
Customer Service: 1.800.472.4346 Barn-9pm,et. Customer Service: 1.877.344.3402 8:30am-5:30pm,et. Customer Service: 1.800.845.3550 8:3Wnh-5:30prn,et
Place an Order: 1.800.772.4346 Gann-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 Ilours. Fax an Order. 1.888.885.2253 24 Hours. 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.henrysdhein_cem/ems
E-Mail: cusiserv@henryschein.corn Internet: urvnv.henryschein.comJ3400 E-Mail: scott.bruner@henryschein_com
E-Mail: custom ecsupport@h enryschein.coin
Please see:http:/,%ntnv.Henryschein.com/US-EN,'Medical/LegaiTerms.ASPX for Conditions&Exceptions.
LP300
VOUCHER NO. WARRANT NO.
Henry Schein 4 ALLOWED 20
II IN SUM OF$
Dept Ch 10241 �)
Palatine, IL 60055
$3,146.38
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1120 3436757-01 102-390.11 $41.96 1 hereby certify that the attached invoice(s), or
1120 3339872-01 102-390.11 $625.00 bill(s) is (are)true and correct and that the
1120 3313830-01 102-390.11 $590.00 materials or services itemized thereon for
1120 604668-02 102-390.11 $36.48 which charge is made were ordered and
1120 3339872-01 102-670.06 $1,852.94 received except
JUL 2 8 2014
Fire Chr6f
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))
3436757-01 $41.96
3339872-01 $625.00
3313830-01 $590.00
604668-02 $36.48
3339872-01 $1,852.94
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