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Home My WebLink About238117 10/15/2014 %'��"Fi CITY OF CARMEL, INDIANA VENDOR: 357526 ® 1 ONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: $********86.00* j=� CARMEL, INDIANA 46032 DEPT CH 10241 CHECK NUMBER: 238117 y��TON�. PALATINE IL 60055-0241 CHECK DATE: 10/15/14 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 102 4239011 7510103-01 86.00 SPECIAL DEPT SUPPLIES —rraceueracrlrrurc^u�umdtnn�aaavewmryauriayme511- ORDER ORDER DATE DUE DATE 22887963 09/29/14 10/30/14 D&B#:01-243-0880 WHSE DEA# RHO162494 Fed ID: 11-3136595 e 1 dI .R _�< ® 6 %�: his order has been processed by our MIDWEST D.C. 5315 WES 74TH 3TREET INDIANAP LIS,IN 46268 VERSON 1 107-0530 100/BX PURPLE NITRILE PF GLOVE LARGE 10 10 *C 8.60 86.00 1 ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. ------------- LEASE REFEZ TO BACK OF PAPERWORK FOR DISCLOSURES/TEZMS OF SALE MERCHANDI E TOTAL 86.00 Invoice Date + 30 days 86.00 Please remi payments only to the following a dress: Henry Schei , Inc. Dept CH 10211 Palatine, I 60055-0241 BILI TO SHIP TO TNVOTCE# I E AMOUNT ITEM STATUS KEY M'EMB-Backordered:Item will follow 1308571 1817102 7510103-01 86.00 D-Discontinued;Item no longer available F-Special Schein Flee Goods RD RDE DATE INV F E M-Manufacturer will Ship Item directly to you P-Prescription Drug;Return Authorization Required 22887963 09/29/14 9/30/14 1 R-Refrigerated Item;May be shipped separately ME PA E $ -Special Schein Pricing T-Taxable Item U-Temporarily unavailable;please reorder 1. ALVERSON 1 OF 1 *-Item has MSDS LP300 ll points/credits 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 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 terns are FOB Shipper's Dock k'Ex Works'outside in the original unopened packaging,unmarked and properly packaged.Speical order North America).Titre passes at the time the shipment is loaded at the shipper's dock. equipment is riot 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 subject to a handling charge.This charge includes freight,exceptfor your new 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 DRrg 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 i-lawaii.Customers in the Parific Protectorates Rx Drugs which Henrry Schein has purchased from wholesalers are not returnable. are offered direct surface transport,or postal services for reliable deliveRl. These items will be Identified in your invoice with the rode 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-d,r;air. 1)Only returns due to error in order or tlelive��f will be allowed. Guam.Puerto Rico.11 S.Trust Territories&ViLgin 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 treightthrough of receipt of the shipment and valid return authorization is issued by HSI. the United States Postal Service(USPS). 3)The Prescription Drug it4arketing 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 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 Ute 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.Uriless otherwise agreed, Rx Drugs certifies I! eight 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 any way. --RX PRODUCTS & CONTROLLED SUBSTANCES:—___ -CHOOSE_Y_QUR_PAY_MENLMEIHQD___ __ Regulations require us to limit tie sale of Rx and controlled substances only to registered, 20%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:1.006.396.9290 or online please furnish us with a copy of your updated state DEA registration.For controlled www.henryschein.cont/creditcard Reduce the cost and administration of paying substances,furnish a copy of your DEA registration verih4ng your shipping address. Henry Schein-Pay electronically(ACH Oebft)or set up AutoPay. Please note that all orders for controlled substances arc,subject to a due diligence review procAss.Schedule II controlled substances can be ordered electronically orb) 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 wvtiRv.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.o Suite 300,5315 West 74th Street • Indianapolis,IN 46268 Discover Card when placing your order.All sales are subject to o ur 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 requi rements 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 340B Program Henry Schein Medical/EMS Customer Service: 1-800.472.4346 8arn-91)m,et. Customer Service: 1.877.344.3402 8:30am-5:30pm.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 8:30am-5:30pnh,et. Place an Order: 1.800.845.3550 8:30am-5:301)m,et Fax an Order. 1.800.329.9109 24 flours. Fax an Order. 1.888.885.2253 24 Marrs. Fax an Order. 1.800-533.4793 24 Hours. Internet: tvvnv.henryschein.com/medical E-Commerce Support: 1.800.711.6032 Sam-bpm,et. Internet: www-henryschein.comlenis E-Mail: custseru@henryschein.com Internet: >,=w.henryschein.com/34013 E-Mail: scott.brener@henryschein.corn E-Mail: custom er.support@henryschein.coin Please see:http-./A""v.Henryschein.com;US-EN;Medical/LegalTerms.ASPX for Conditions&Exceptions. VOUCHER NO. WARRANT NO. ALLOWED 20 Henry Schein IN SUM OF $ Dept Ch 10241 Palatine, IL 60055 $86.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1120 7510103-01 102-390.11 $86.00 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 OCT1 3 Z014 e Fire Chief Title I Cost distribution ledger classification if i claim paid motor vehicle highway fund i 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)) 7510103-01 $86.00 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