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Home My WebLink About238622 10/28/14 (9, CITY OF CARMEL, INDIANA VENDOR: 357526 ONE CIVIC SQUARE HENRY SCHEIN INC CHECKAMOUNT: $*******163.62* CARMEL, INDIANA 46032 DEPT CH 10241 CHECK NUMBER: 238622 PALATINE IL 60055-0241 CHECK DATE: 10/28/14 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 102 4239011 3925405-01 163.62 SPECIAL DEPT SUPPLIES ease detaen here and mail the above with your payment ORDER# I ORDER DATE IQUE DATE 23239086 10/10/14 11/12/14 D&B#:01-243-0880 WHSE DEA# RHO 162494 Fed ID: 11-3136595 o :.��...:.-. _,: a��_ ansa _ _ � ,.� ., n --.�__. . .., `�' e•tt � '� .."q�, .�� .�.a.�g�. ..°tm . ,�?,�, 5., a�, his order has been processed by our MIDWEST D.C. 5315 WES 74TH 3TREET INDIANAP LIS,IN 46268 OM 317-571-2600 ---------- --------------------------------- ------ ----- ------------- ------- ---------- --------------------------------- ------ ----- ------------- ------- 1 170-8733 20/BX MOLDED N95 MASK W/FLANGE SMALL 3 3 18.18 54.54 2 HIS ITEM 13 NON-RETURNABLE HIS PRODUCC IS BEING SHIPPED FROM OUR NORTHEAST DIS RIBUT ON CENTER. 2 499-2281 20/BX MED MOLDED N95 MASK W/ 3 3 18.18 54.54 1 3 683-5379 20/BX MOLDEX N95 MASK RESPIRATR LARGE 3 3 18.18 54.54 1 ---------- --------------------------------- ------ ----- ------------- ------- ---------- --------------------------------- ------ ----- ------------- ------- LEASE REFEZ TO BACK OF PAPERWORK FOR DISCLOS RES/TE S OF SALE ortheast D stribution Center 1 WEAVER R AD ENVER, PA 17517 MERCHANDI E TOTAL 163.62 Invoice Date + 30 days 163.62 Please remi payments only to the following a dress: Henry Schei , Inc. Dept CH 10211 alatine, I 60055-0241 BILL T!O SHIP TO TNVOTCEO INVOICE AMOUNT ITEM STATUS KEY REM KEY B-Backordered:Item will follow SK-School Kit 1308571 1817102 3925405-01 163 .62 D-Discontinued;Item no longer available NC-No Charge RD ORDER DATE INVOICE DATE BOXESF-Special Schein Free Goods M-Manufacturer will ship Item directly to you P-Prescription Drug;Return Authorization Required 23239086 10/10/14 10/13/14 2 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 -Item has MSDS :.. (e.g.points,discount redemptions or other speciai awards),with your purchases you may earn •Items that cannot be returned to the manufacturer•Any item marked nonreturnable poirdslcredils 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 relamthese records. Opened and used equipment may not be returned for credit.Before opening equipment;we suggest that you check the shipping container anti packing list to DELIVERY TERMS: ensure that you are getting exactly what you ordered.Equipment must be returned Unless otherwise a 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.AIF quipment returns are subject to a restocking fee. Equipmentis backed by the manufac:turer's repair or replacementwarranty.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 via rranty. 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 requesfed. Rx Drugs which are purchased h,,Flenry 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 6000)are now available via LIPS 2nd-dav air. 1 Only returns due to error in order or delive�r will be allowed. Guam.Puerto Rico U.S.Trust Territories&Virgjn 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 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 Fix Drugs • SFyecial 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 form and proper return Outside U.S.(50 states): authorization,please contact Customer Serdice. If your order is being shipped outside the U.S.(50 states),please refer to the 4)In addition,Pedigree regulations require that tie healthcare entity returning International Terms&Conditions at henr;rschein.com.Unless otherwise 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 NIETHOI _ 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.It y nu are a new customer or have recently moved, Credit Card.To apply now,call:1.860.398.9296 or online please furnish us with a copy of your updated state DEA registration.For controlled www.henryschein.coni/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 11 controlled substances can be ordered electronically or by mail. Please call Customer Service for details. For information on our Controlled Substance Ordering System please visit For your corrvenience,we provide several payment alternatives.Orders billed to your w�+M1v.henrvsrhein f•om/e22.2;ifyou 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 Qisrover 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 rompli with anysuch requirements prior to I. Open Accounts Receivable:purchase,use, -n r installation of products. All unpaid accounts receivable past due are subject to a 1.5%finance charge. o p p p J 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 8am-:Jim,ot. Customer Service: 1.877.344.3402 8:30am-5:30pm.et. Customer Service: 1.800.845.3550 3:30arn-5:30pm,et Place an Order: 1.800.772.4346 8am-9pm,et. 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 Hours. Fax an Order. 1.800.533.4793 24 liours. Internet: ivwiv.henryschein.com/medical E-Commerce Support: 1.800.711.6032 Sam-Spm,et. Internet: www.henryschein.com/ems E-Mail: cusisery@henryschein_com Internet: wvnv.henryschein.com/340B E-Mail: scott.bruner@henryschein.com E-Mail: custoniecsripporti�henryschein.coin Please see:http:/Mvw.Henryschein.comJUS-EN,'Medical/LegalTerms.ASPX for Conditions&Exceptions. LP300 VOUCHER NO. WARRANT NO. ALLOWED 20 Henry Schein IN SUM OF $ Dept Ch 10241 Palatine, IL 60055 $163.62 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1120 3925405-01 102-390.11 $163.62 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 OCT 2 7 2014 Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No.201 (Rev.1995) 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)) 3925405-01 $163.62 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