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241515 01/27/15 CITY OF CARMEL, INDIANA VENDOR: 357526 CHECK AMOUNT: S***** *"560.40* ONE CIVIC SQUARE HENRY SCHEIN INC s a�' CARMEL, INDIANA 46032 DEPT CH 10241 CHECK NUMBER: 241515 9M�Gon_ ; PALATINE IL 60055-0241 CHECK DATE: 01/27115 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 102 4239011 16150350 560.40 SPECIAL DEPT SUPPLIES --------------------------------------- ..... . .... . .ORDER# ORDER R D.ER:DATE:I DUE. DATE 25617182 01/12/15 02/11/15 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 INDIANAPOLIS,IN 46268 1 905-4256 EA DISP RESUSCITATION MASK NEONATE 15 15 1.76 26.40 7 2 565-1031 100/BX NITRILE PF GLOVE BLACK LARGE 40 40 C 8.90 35.6.00 4 CASE GOOD ICEM, MAYBE SHIPPED SEPARATELY. 3 565-0811 100/BX NITRILE PF GLOVE BLACK X-LARGE 20 20 C 8.90 178.00 6 CASE GOOD ICEM, MAY BE SHIPPED SEPARATELY. PLEASE REFEZ TO BACK OF PAPERWORK FOR DISCLOS,JRES/TE ZMS OF SALE MERCHANDI! E TOTAL 560.40 nvoice Date + 30 days 560.40 lease remipayments only to the following aldress: Henry Scheii, Inc. Dept CH 10211 Palatine, I 60055-0241 M y Yt 't c' Sc '-S FIC-MN,2,e amL T6 SHIP TO NV ICE INVOTCE AMOUNT ITEM STATUS KEY B-Backordered;Item will follow 1308571 1817102 16150350 S60.40 D-Discontinued;Item no longer available F-Special offer ORT)ER# ORDER DATE INVOICF DATE # OF 13OXES M-Manufacturer will ship Item directly to you P Prescription Drug;Return Authorization Required 25617182 01/12/1S 1/12/15 7 R Refrigerated Item;May be shipped separately $ Special Schein Pricing CUSTOMER•-PO# PA # T-Taxable Item Temporarily unavailable;please reorder F011215 1 OF 1 Item has MSDS LP300 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 equip merit may not be returned for credit.Before opening equipment,we suggest that you check the shipping container and packing list to DELIVERYTERMS: ensure that you are getting exactly what you ordered.Equipment must be returned Unless otherwise agreed,freight terms are FOR Shipper's Dock(Ex Works"outside in the original unopenedpackaging,unmarked and property packaged.Speical order North America).TilFe passes at the time the shipment is loaded at the shipper's dock. equipment is not returnable.Alrequiprnent returns are subject to a restocking tee. Equipment is barked by the manuffacturer'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 subje ct to the manufacturers additional carrier charges related to special delive services and hazardous material warranty. shipments.Special orders are subject to additional freight charges. Prescription D1r.ig 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 Heng Schein has purchased from wholesalers are not returnable. are offered direct surface transport,or postal services for reliable delivery. 9 . r ,• P p 1 These items a ill be identified in your invoice with the rode WH. No additional surcharges apply,except when special services are requested. Rx Drugs which are purchased be Henry Schein directly from the manufacturer may Low-level hazardous items(dangerous goods in accepted quantities and Consumer be returned providing thatthe fgflowing key elements are met: 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 Territndes&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. 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 Act requires any customer returning Rx Druys • 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 the U.S.(50 states),please refer to the 4)In addition,Pedigree regulations require that the healthcare entity returning Internatonal Terms&Conditions athenryschein.com.Unless otherwise agreed, Rx Drugs certifies freight terms are FOB Shipper's Dock("Ex Works"outside North America)• that the product being returned is the same exact product purchased from HSI. riive 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—RID DUCT_S&_GONT_RQLLE®SUBSTA NOES____ ____CHOQSEY(_UR PAYMENT-METHOD— 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.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.henrysclrein.coitt/creditcard Reduce the cost and administration of paying substances,furnish a copy of your DEA registration verifying your shipping address. Please note that all orders for controlled substances are subject to a due:diligence review Henry Schein-Pay electronically,(ACH Debit)or set up AutoPay. 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 convenience,we provide several payment alternatives.Orders billed to your www.henryschein.com/e222;if you 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 Schein,Inc.• Suite 300,5315 West 74th Street • Indianapolis,IN 46268 Discover Card when placing 1/our order.All sales are subjert 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 amply 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 1.5%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 Sarn-:)pm,et. Customer Service: 1.877.344.3402 8:30am-5:30pin,et. Customer Service: 1.800.845.3550 8:30ani-5:30pin,et. Place an Order: 1.800.772.4346 8anr9pnh,et. Place an Order: 1.877.344.3402 3:30am-5:301)nh,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. Internet: %vvnv.henryschein.com/medical E-Commerce Support: 1.800.711.6032 Sam-8pnh,et. Internet: www.henryschein.com/ems E-Mail: custserv@henryschein.com Internet: www.11renryschein.com/3400 E-Mail: scott.bruner@hearyschein.com E-Mail: custonher.support@henryschein.coiu Please see:littp.//wvnv.Henryschein.com/US-EN/Medical/LegalTerms.ASPX for Conditions&Exceptions. M� Ht.--NIRY S CHEIM C SHIP TO/SOLD TO: EMS Carmel Fire Department MI 135 Duryea Road, Melville, NY 11747INVOICE n I\,®I 540 W 136th St 1 V V Station 46 Michael Kaufmann Carmel,IN 46032-8806 01000013085711615035011,0000000000560400112151 BILL TO: Carmel Fire Dept MI 2 Civic Sq Carmel, IN 46032-7543 Carmel Fire Dept HILL TO SHIP TO INVOICE AMOUNT --J 2 Civic Sq Carmel, IN 46032-7543 1308571 1817102 560.40 INVO ICE# INVOICE DATE 16150350 1/12/15 CUSTOMER PO 011215 Please detach here and mail the above with your payment "ORDER �ORDER DATE. DUE"DATE 25617182 01/12/15 02/11/15 D&B#:01-243-0880 WHSE DEA# RHO162494 Fed ID: 11-3136595 ,sY u P s 5. `;ra 1 �3ei�" r y...,,11e & '� ...; - b a b.-. e Vit)-,.�: F � •�u.kl zk'x' -- �fe�,, ' .;mat y ``t--' -z z � � s a awa`�.�:� :t.. �...�, Y:��x.� ��`� � .:�, °`, ..��,.w'`Y �3.,� re•e s•r<.s�q '°�p A •' � :�� ..,� �.'�r 4'i ...zo. ° ;,. "'� e�: � : '� his order has been processed by our MIDWEST• .C. 5315 WES 74TH 3TREET INDIANAP LIS,IN 46268 1 905-4256 EA DISP RESUSCITATION MASK NEONATE 15 15 1.76 26.40 7 2 565-1031 100/BX NITRILE PF GLOVE BLACK LARGE 40 40 C 8.90 356.00 4 SE GOOD I EM, MAY BE SHIPPED SEPARATELY. 3 565-0811 100/13X NITRILE PF GLOVE BLACK X-LARGE 20 20 C 8.90 178.00 6 SE GOOD 2 EM, MAY BE SHIPPED SEPARATELY. ---------- --------------------------------- ------ ----- ------------- ------- ---------- --------------------------------- ------ ----- ------------- ------- LEASE REFEZ TO BACK OF PAPERWORK FOR DISCLOS ES/TE S OF SALE MERCHANDI E TOTAL 560.40 nvoice Date t 30 days 560.40 Please remi payments only to the following a dress: Henry Schei , Inc. Dept CH i0211 Palatine, 2 60055-0241 BILL-`To ' SHIP TO �>INVOICE# INVOICEAMOUNT � ITEM STATUS KEY REM KEY B-Backordered;Item will follow SK-School Kit 1308571 181710 2 1615 0 3 5 0 5 6 0 4 0 D-Discontinued;I em no longer available IN -No Charge .. 0P ii0xES. '. pact al offer " RDER � ORDER DATE, INVOICE A E M-Manufacturer Will ship Item directly[0 you P-Prescription Drug;Return Authorization Required 25617182 01/12/15 1/12/15 7 R-Refrigerated Item;May be shipped separately Pricing is .. .. CUSTOMER PO _ ... PAGE Schein mg T-Taxable Item U-Temporarily unavailable;please reorder 011215 1 OF 1 -Item has MSDS P300 VOUCHER NO. WARRANT NO. ALLOWED 20 Henry Schein IN SUM OF $ Dept Ch 10241 Palatine, IL 60055 $560.40 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1120 16150350 102-390.11 $560.40 I 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 JAN 6 2015 i Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund I 11 i Prescribed by State Board of Accounts City Form No.201(Rev.1995) ACCOUNTS PAYABLE VOUCHER �I 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. I Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 16150350 $560.40 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