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Home My WebLink About239998 12/09/14 �� ,A,,f• CITY OF CARMEL, INDIANA VENDOR: 357526 ( ONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: $******%782.91' 9: ?a CARMEL, INDIANA 46032 DEPT CH 10241 CHECK NUMBER: 239998 M�troN�, PALATINE IL 60055-0241 CHECK DATE: 12/09/14 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 102 4239011 14949644 782.91 SPECIAL DEPT SUPPLIES ------------ ORDER# ORDER DATE IDUE DATE 24488933 11/25/14 12/25/14 D&B#:01-243-0880 WHSE DEA# RH01 62494 Fed ID:11-3136595 rhis order has been processed by our MIDWEST D.C. 5315 WES" 74TH 3TREET INDIANAP LIS,IN 46268 rOM SMALL 317-571-260) 1 360-1359 EA SAM SPLINT ORANGE/BLUE 36X4.25 20 20 6.54 130.80 2 2 111-3107 25/PK BLUE SENSOR ELECTRODE ADULT 50 50 8.44 422.00 2 3 890-6868 3/PK LIFEPAK 12 PAPER EKG 20 20 10.66 213.20 2 4 101-8612 50/PK PREP RAZORS DISPOSABLE 1 1 16.91 16.91 2 PLEASE REFEZ TO BACK OF PAPERWORK FOR DISCLOS ES/TEZMS OF SALE MERCHANDI E TOTAL 782.91 oice Date + 30 days 782.91 Please remi payments only to the following aldress: Henry Scheii, Inc- ept CH 10211 Palatine, I 60055-0241 BILL,LL TO » SHIP .TO INVOICE#. INVO.ICE,AMO.UNT ITEM STATUS KEY REM KEY B-Backordered;Item will follow SK-School Kit 1308571 1817102 14949644 782 .91 D-Discontinued;Item no longer available NC-No Charge F-Special offer :6kDFR#' ORDER DATE INVOICE DATE.. #:OF BOXES M-Manufacturer will ship Item directly to you P-Prescription Drug;Return Authorization Required 24488933 11/2S/14 11/25/14 2 R-Refrigerated Item;May be shipped separately $ -Special Schein Pricing CUSTOMER POU PAGE# T-Taxable Item Temporarily unavailable;please reorder TOM 11/25/14 1 OF 1 Item has MSDS LP300 poiidsJeredits redeemable for certain goods or services,in accordance with discount program Equipment: rules.Upon discourd receipt by redemption of your earned poin%fcreddts,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 parking 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 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.All equipment returns are subject to a restocking fee. 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 urge.This rharcge 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 DnLg 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 Henrr 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 whicdh are purchased by Henry Schein directly from the manufacturer may Low-level hazardous ttems(dangerous goods in accepted quantities and Consumer be returned providing thatthe following key elements are mei: Commodity ID 8000)are now available via UPS 2nd-day air. 1 Only returns clue 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. l 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 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 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 the healthcare entity returning International Terms&Conditions at lien Rischein.coiii.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-P_RODU-CT-S_& CQNTROLLED_SUBS-TANCES:- __ CHOOSE_Y-YOUR-P-AYMEN-T-MET-HOD— — - Regulations require us to limit the sale of Rx and controlled substances only to registered, 20/6 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 Lis with a copy of your updated state DEA registration.For controlled www.henryscheiii.com/creditcard Reduce the cost and administration of paying substances,furnish a copy of your DFA registration verifying your shipping address. Henry Schein-Pay electronically(ACH Debit)or set up AutoPay. Please note that all orders for controllefJ substances are subjectto a due diligence review promss.Schedule II controlled substances can be ordered electronically or by mail. Please call Customer Service for details. For information an our Controlled Substance Ordering System please visit For your convenience,we provide several payment alternatives.Orders billed to your ww%v.henrysrhein.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 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 any such requirements prior to purchase,use, Open Accounts Receivable: or installation of products. All unpaid accounts receivable past due are subject to a 1.6%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 8arrr9pm,et. Customer Service: 1.877.344.3402 8:30am-5:30pm,el. Customer Service: 1.800.845.3550 8:30anh-5:30pin,et Place an Order 1.800.772.4346 8anr9pm,et. Place an Order. 1.877.344.3402 8:30am-5:30pm,et. Place are 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. Internet: %vww.henryschein.com/medical E-Commerce Support: 1.800.711.6032 8am-8pnh,et. Internet: www.lienrVscliein.com/jenis E-Mail: cusesenr@henryschein.com Internet: wvnv.henryschein.com/3400 E-Mail: scott.bruner@heuryschein.com E-Mail: custonier.support@henryschein.cem Please see:I7ttp:/,Wt"v.Henryschein.com/US-EN/Medical/LegaiTerms.ASPX for Conditions&Exceptions. VOUCHER NO. WARRANT NO. ALLOWED 20 Henry Schein IN SUM OF$ Dept Ch 10241 Palatine, IL 60055 $782.91 i I i ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1120 14949644 102-390.11 $782.91 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 Fire Chief i 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)) 14949644 $782.91 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