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Home My WebLink About239738 12/03/14 r C_�q'- ,,'.. ''° CITY OF CARMEL, INDIANA VENDOR: 357526 G ` .4 ® �• ONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: $****""""66.30* :. ,� CARMEL, INDIANA 46032 DEPT CH 10241 CHECK NUMBER: 239738 99j,�T.�N.�p.• PALATINE IL 60055-0241 CHECK DATE: 12/03/14 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 102 4239011 14840755 66.30 SPECIAL DEPT SUPPLIES ORDER ORDER DATE DUE DATE 24393909 11/20/14 12/20/14 D&B#:01-243-0880 WHSE DEA# RH0162494 Fed ID:11-3136595 Ok 3INNER his order has been processed by our MIDWEST D.C. 5315 WES 74TH STREET INDIANAP LIS,IN 46268 OHN 112014 17-571-266 ---------- --------------------------------- ------ ----- ------------- ------- 1 116-9264 EA SEP-T-VAC SYSTEM II 120OCC 10 10 3.07 30.70 1 2 565-7365 100/BX NITRILE PF GLOVE BLACK MEDIUM 4 4 8.90 35.60 1 LEASE REFEZ TO BACK OF PAPERWORK FOR DISCLOS ES/TE S OF SALE MERCHANDI E TOTAL 66.30 Invoice Date + 30 days 66.30 Please remi payments only to the following a dress: Henry Schei i, Inc Dept CH 10211 Palatine, I 60055-0241 B„LL To SHir TD icvo>cE irivo cE hMotINT ITEM STATUS KEY REM KEY B-Backordered;Item will follow SK-School Kit 1308571 1817102 14840755 66.30 D-Discontinued;Item no longer available NC-No Charge PDER RDE -DATE ATE BOXES, F- l Offer M-MManufacturer will ship Item directly to you P-Prescription Drug;Return Authorization Required 24393909 11/20/14 11/20/14 1 R-Refrigerated Item;May be shipped separately $ -Special Schein Pricing <CUSTOMER PO PAGE ” T-Taxable Item U-Temporarily unavailable;please reorder 112 014 JON 1 OF 1 *-Item has MSDS LP300 e.g.points, iscount re emp rens oro ter speciin awards),W11n your purchases you may earn Items tnai cannot a returnecl to tine manu acturer•Any item mar ec nonreturnable poird*redits 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 DELIVERYTERMS: ensure that you are getting exactly what you ordered.Equipment must be resumed Unless otherwise areed,freight terms are FOB Shipper's Dock('Ex Works'outside in the original unopened packaging,unmarked and properly packaged.Spejcal order North America).Tire passes at the time the shipment is loaded at the shipper's dock. equipment is riot returnable.Airequipinent returns are subject to a restocking tee. Equipment is barked by the manufacturer's repair or replacement warranty.Please Continental U.S.: read and return all warfanty information required immediately upon taking delivery of All orders will he subject to a handling charge.This charge includes fright,except for your newequipment.O en or defective equipment is subject to e manufacturer's additional carrier charges related to special delivery services and hazardous material warranty. shipments.Special orders are subject to additional 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 liens,Schein's policy on the return of Rx Drugs is as follows: serice 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 apF�ly,except when special services are requested. Rx Drugs which are purchased by Henry Schein directly from the manufacturer ma r Low-level hazardous items(dangerous goods in accepted quantities and Consumer be returned providing that the foflowinq 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. 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 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.Federarlaw 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 tie healthcare entity returning nternational Terms&Conditions at henr,rschehoont.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 front 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. R-PRODUCT S &-£:(3NTROL—LED-SUBSTANCES: ----- -- GHOOSEYOUR--PAYMENT—Mu c.THrOD---.-- Requlations require us to limit the 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:1.866.398.9296 or online please furnish us with a copy of your updated state DEA registration.For controlled www.henrysclieiii.coiii/credftcard Reduce the cost and administration of m substances,furnish a copy of your DEA registration verifying your shipping address. paying Please note that all orders for controlled substances are subject to a due:diligence reviak, Henry Schein-Pay electronically(ACH Debre)or set up AutoPay. process.Schedule II controlled substances can be ordered electronically or by snail. Please call Customer Service for details, Fnr information on our Controlled Substance Ordering System please visit For your convenience,we provide several payment alternatives.Orders billed to your wv%,w.henryschein Gom/e222;ifyou preferto 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 Scheln,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 appply to use or installation of certain products. terms of sake. Be sure to understand and comply wrth 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 3448 Program Henry Schein Medical/EMS Customer Service: 1.800.472.4346 8arrr-9pm,et. Customer Service: 1.877.344.3402 8:30am-5:30prn,el. Customer Service: 1.800.845.3550 8:30am-5:30pm,et Place an Order: 1.800.772.4346 8anr9pni,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,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 Hours. Intemet: wvaw.henryschein.com/medical E-Commerce Support: 1.800.711.6032 8arrr-8pm,et. Internet: www.lieuryschein.coniferris E-Mail: custserv@henryschein.com Internet: wym.henryschein.com/340B E-Mail: scott.bran er@h enryschein.cum E-Mail: customersupport@henryschein.com Please see:http.//www.Henryschein.com,US-EN/Medical/LegaiTerms.ASPX for Conditions&Exceptions. i VOUCHER NO. WARRANT NO. j ALLOWED 20 Henry Schein IN SUM OF$ Dept Ch 10241 Palatine, IL 60055 $66.30 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1120 14840755 102-390.11 $66.30 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 DEC 1 2014 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)) 14840755 $66.30 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