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Home My WebLink About241739 02/03/15 CITY OF CARMEL, INDIANA VENDOR: 357526 ONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: $*******183.30* ,r CARMEL, INDIANA 46032 DEPT CH 10241 CHECK NUMBER: 241739 PALATINE IL 60055-0241 CHECK DATE: 02/03/15 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 102 4239011 16387391 183.30 SPECIAL DEPT SUPPLIES QRDER# I ORDER DATE DUE DATE 25861392 01/20/15 02/19/15 D&B#:01-243-0880 WHSE DEA# RHO162494 Fed ID:11-3136595 " r46268 e 2 his order as been processed by our MIDWEST .C. 5315 WES 74TH INDIANAP LIS,IN 1 499-2923 10/CA GRAHAM MEGA MOVER 1500 1 1 C 175.34 175.34 1 SE GOOD I EM, MAY BE SHIPPED SEPARATELY. 2 153-2007 20/RL BIOHAZARD BAG 14.5X19 RED 3GAL 4 4 1.99 7.96 2 LEASE REFEZ TO BACK OF PAPERWORK FOR DISCLOSJRES/TEZMS OF SALE MERCHANDI E TOTAL 183.30 nvoice Date + 30 days -183.30- Please remi payments only to the following a dress: Henry Schei , Inc. Dept CH 10211 Palatine, I 60055-0241 LL TO SHIP TO INVOICE# INV - ITEM STATUS KEY REM KEY B-Backordered;Item will follow• SK-School Kit 1308571 1817102 16387391 183 .3 0 D-Discontinued;Item no longer available NC-No Charge F-Special offer ORDER# ORDERDATE INVOICE DATTE # OF BOXES M-Manufacturer will ship Item directly to you 25861392 01/2 0/15 1/20/15 P Prescription Drug;RetuMay b shipped separately Required 2 R-Refrigerated Item;May be shi ed se azatel $ -Special Schein Pricing CUSTOMER PrIii PAQE - T-Taxable Item U-Temporarily unavailable;please reorder TOM 012 015 1 OF 1. *-Item has MSDS LP300 pointsicredils redeematile 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 DELIVERYTERMS: 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.Alrequiprnent returns are subject to a restocking fee. Edurpmentis 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 charge.This charge 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 Dnrg Returns: Alaska.Hawaii&Pacific Protectorates:_ Please note that,in order to comply with Federal and Stott:Pedigree requirements, Standard shipping methods provide direct,reduced cost,expedited air delivery Henry Schein's policy ori the return of fix Drugs is as follows: service to all accounts in Alaska and Hawaii.Customers tie e 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 rode WH. No additional surcharges apF)ly,except when special services are requested. Rx Drugs which are purchased 6y Henry Schein directly from the manufacturer may Low-level hazardous items(dangerous goods in accepted quantities and Consumer fie returned providing thatthe followinq key elements are met: Commodity IR 8000)are now available via LIPS 2nd-day air. 1 Only returns clue to error in order or deliver)v will be allowed. Guam,Puerto Rico U.S.Trust Territories&Virgin Islands: 2)Returns of Rx Drugs will only be.accepted ii HSI is notified within 14 calendar days • All orders will be subject to a handling charge. this charge includes freightthrough of receipt of[tie shiprnent 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 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 enfi�f 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 arid 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 hens;schein.com.Unless otherwise agreed, Rx Drugs certifies fret ghtterms 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 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 ..PRODU-C-TS_i&_C-ONT_ROLLED$UBSTANCES:_____ CHOOSEYOUR PAYMENT METHOD Regulations require us to limit Hie sale of Rx and controlled substances only to registededd 2�/,Cash Back or Maximum Rdwards on all purchases wi11i the Henry Schein licensed healthcare professionals.If you are a new customer or have recently moved, Credit Card.To apply now,-call:1.666.398.9296 or online please furnish us with a copy of your updated state DEA registration.For controlled www.henrVsclieiii.coili/creditcard Reduce the cost and administration of paying substances,furnish a copy ofyour DEA registration verifying year 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 prop ss.Schedule II controlled substances can be ordered electronically or by mail. Please call Customer Service for details. Fgr information on our Controlled Substance Ordering System please visit For your convenience,we provide several payment alternatives.Orders billed to your wv%%v.henrysrhein.com/0222;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 46266 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.Imvoices are payable within agreed Local 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 1.5%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 Sam-91)m,et. Customer Service: 1.877.344.3402 8:30am-5:30prn,et. Customer Service: 1.800.845.3550 8:30am-5:30prn,et Place an Order: 1.800.772.4346 Elam-9pm,et. Place an Order. 1.677.344.3402 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 Hour's. Fax an Order. 1.888.885.2253 24 Hours. Fax an Order. 1.800.533.4793 24 Hours. Internet: www.henryrschein.com/medical E-Commerce Support: 1.800.711.6032 8am-8pm,et. Internet: www.lienrVschein.com/eiiis E-Mail: custserv@henryschein.com Internet: wvnv.henryschein.comr3400 E-Mail: scott.bruner@henryschein.com E-Mail: etistonrer.support@henryschein.coin Please see:http:/,§uww.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 $183.30 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1120 16387391 102-390.11 $183.30 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 FEB - 2 2015 - Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund rescribed by State Board of Accounts City Form No.201(Rev.1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL n invoice or bill to be properly itemized must show: kind of service,where performed,dates service rendered, by hom, 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)) 16387391 $183.30 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