237142 09/16/14 �.��q+, CITY OF CARMEL, INDIANA VENDOR: 357526
�r ONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: $" "
' *'906.00"
s CARMEL, INDIANA 46032 DEPT CH 10241 CHECK NUMBER: 237142
9'M,�ioN�i, PALATINE IL 60055-0241 CHECK DATE: 09/16/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 4239011 9724865-01 906.00 SPECIAL DEPT SUPPLIES
Please detach here and mailtheabove with your payment
ORDER# I ORDER DATE IDUE DATE
22164679 1 09/03/14 10/03/14
D&B#:01-243-0880
WHSEDEA# RHO162494 Fed ID: 11-3136595
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This order has been processed by our MIDWEST D.C.
5315 WES" 74TH 3TREET
INDIANAP LIS,IN 46268
1 935-6155 50/PK BLUE SENSOR SP ELECTRODES 75 75 12.08 906.00 2
=P=LEASE==R=E=F=E=Z==T=O==BACK==O=F==PAPERWORK==FOR=D==I=S=C=L=O=Sl:J=RES/TE=ZM==S==O=F==SALE
=========
MERCHANDI E TOTAL 906.00
invoice Date + 30 days 906.00
Please remi- payments only to the following aldress:
Henry Scheii, Inc.
Dept CH 10211
Palatine, 1, 60055-0241
BILL TO SHIP TO INVOICE# -INVOICE AMO= ITEM STATUS KEY REM KEY_�
B-Backordered;Item willfollow SK-School Kit
1 308571 1308572 97 24865701 906.00 D-Discontinued,Item no longer available NC-No Charge
F-Special Schein Free Goods
ORDER# ORDER DATE INVOICE DATE # OF BOXES- M-Manufacturer will ship Item directly to you
P Prescription Drug:Return Authorization Required
22164679 09/03/14 9/03/14 2 R Refrigerated Item;May be shipped separately
$ Special Schein Pricing
CUSTOMER PO PAGE# T-Taxable Item
THOMAS Item
U-Te porarilMS
DS unavaflable;please reorder
mhas
reements,
rebate.The feat ,.
transfers of value to a p.achtiener.If you are parucipaang in
(e.g.points,discount redemptions or other special awards),wine your purcriases youmay earn •r turts Matcannot u be Farc r.Inc i Ilan i ac r er•Ally item mar ea noflicLJrna le
poirdslcredits redeemable tot certain goods or services,in accordance with discount program E uipment
rales.Upon discount receipt by redemption of your earned points/credits,you are receiving or �T
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 check the shipping container and packing list to
DELIVERY TERMS: ensure that you are getting exactlywhat 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.Aliequipment returns are subject to a restocking tee.
Equipment is barked 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 manufacturer's
additional carrier charges related to special delivery services and hazardous material warrants.
shipments.Special orders are subject to additional freight charges. Prescription D yg 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 wtlich Henry Schein has purchased from wholesalers are riot returnable.
are offered direct surface transport,or postal services for reliable delivene. 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 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&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 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 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 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 farm and proper return
Outside U.S.(50 states;: authorization,please contact Customer Service.
it your order is bein shipped outside the U.S.(50 states),please refer to the 4)In addition,Pedigree regulations require that the healtheare entity returning
nternational Terms&Conditions at hennisrheiii.com.Unless otherwise agreed, Rx Drugs certifies
freight terms are FOB Shipper's Donk("Ex Works"outside North America)• that the product being returned is the sarne 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 PRODUCT-S-&-CONTROLLED-SUBSTANCES:r,- - CHOOSEYOUR_P-AYMENT 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:1.806.398.9296 or online
please furnish its with a copy of your updated stale GEA registration.For controlled wtvur.henryschein.coni/crediteard 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
v vv+nv.henrvschein.com/e222-,if you prefer to continue using Federal 222 Forms to order account may be paid by AC 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 arTy such requirements prior to purchase,use, Open Accounts Receivable:
or installation of products. All unpaid accounts receivable past due are subject to a 1.55%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 Sam-_q)m,at. Customer Service: 1.877.344.3402 8:30am-5:30prn,,at. Customer Service: 1.800.845.3550 8:Xim-5:30pin,at
Place an Order: 1.800.772.4346 8anr9pm,at. Place an Order. 1.677.344.3402 3:30am-5:30pm,at. Place an Order 1.800.845.3550 8:30am-5:301)m,at.
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: %vvnv.henryschein.com/medical E-Commerce Support: 1.800.711.6032 8am-Spm,at. Internet: www.lienryscliein.com/ems
E-Mail: cusisery@henryschein.corn Internet: twrw.henryschein.com/3406 E-Mail: scott.brurier@henryschein.com
E-Mail: customer.support@henryschein_com
Please see:littp://urtvw.Henryschein.com/US-EN/Medical/Legarrerms.ASPX for Conditions&Exceptions.
LP300
r - -
VOUCHER NO. WARRANT NO.
ALLOWED 20
Henry Schein
.I
IN SUM OF$
Dept Ch 10241 j
Palatine, IL 60055
$906.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#!TITLE AMOUNT Board Members
1120 9724865-01 102-390.11 $906.00 1 hereby certify that the attached invoice(s), or
bill(s) is (are)true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except _
14s
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
I
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s)or bill(s))
9724865-01 $906.00
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