241995 2 /10/2015 a°-`-'�`�pb
�/ *, CITY OF CARMEL, INDIANA VENDOR: 357526
® \;• ONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: $*******386.87*
s. i° CARMEL, INDIANA 46032 DEPT CH 10241 CHECK NUMBER: 241995
9,�`t0N LA` PALATINE IL 60055-0241 CHECK DATE: 02/10/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 4239011 16516547 386.87 SPECIAL DEPT SUPPLIES
--
ORDER# ORDER DATE DUE DATE
25979761 01/23/15 02/22/15
D&B#:01-243-0880
WHSE DEA# RHO162494 Fed ID:11-3136595
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his order has been processed by our MIDWEST D.C.
5315 WES 74TH 3TREET
INDIANAP LIS,IN 46268
---------- --------------------------------- ------ -=--- ------------- -------
---------- --------------------------------- ------ ----- ------------- -------
1 153-2007 20/RL BIOHAZARD BAG 14.5X19 RED 3GAL 20 20 C 1.99 39.80 2
SE GOOD IMM, MAY BE SHIPPED SEPARATELY.
2 826-8384 EA ET SLICK STYLETTE 6FR 10 10 3.07 30.70 4
3 932-7431 10/PK E-T INTRODUCER W/COUDE 2 2. 47.23 94.46 4
4 110-6384 10/BX INTRODUCER PEDI COUDE/ STR TIP 2 2 47.23 94.46 4
5 890-4792 EA SHARPSTAR SHARPS CONTAINE 5-QT 25 25 4.17 104.25 4
6 499-2557 6/PK PENLITE DISP W/PUPILGAUGE 4 4 * 4.55 18.20 4
7 499-8403 EA TRIANGULAR BANDAGE 40X4OX5 25 25 0.20 5.00 4
LEASE REFEZ TO BACK OF PAPERWORK FOR DISCLOS1JRES/TEZMS OF SALE
MERCHANDI E TOTAL 386.87
Invoice Date + 30 days 386.87
BILL T SHIP INvoI E ITEM STATUS KEY REM KEY
B-Backordered;Item will follow FIK-School Kit1308571 1817102 16516547 386.87 D-Discontinued;Item no longer available -No Chazge
F-Special offer
ERORDER DATE INVOICE DATE # OF BOXES M-Manufacturer will Ship Item directly to you
25979761 01/23/15 1/23/15 P-Refrigerated
Drug;Rehm shipped
4 R-Refricrated Item;May be shi ed se azatel
$ -Special Schein Pricing
CUSTOMERPO# PAGE T-Taxable Item
*-Item has M1SD5 unavailable;please reorder Continued on Next Page..........
012315 1 OF 2 g
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Please detach here and mail the above with your payment
ORDER# ORDER DATE IDUE DATE
25979761 01/23/15 1 02/22/15
D&B#:01-243-0880
WHSE DEA# RHO162494 Fed ID:11-3136595
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Please remi payments only to the following a dress:
Henry Schein, Inc.
ept CH 102 1
Palatine, I 60055-0241
D
H LL TO SHIP TO INVOICE# TNVOICE ITEM STATUS KEY REM KEY
B-Backordered;Item will follow SK-School Kit
13085711817102 16 516 5 4 7 3 8 6.8 7 D-Discontinued;Item no longer available NC-No Charge
F-Special offer
DER RDE 6 I E BOXES M-Manufacturer will ship Item directly to you
P-Prescription Drug;Return Authorization Required
2 5 9 7 9 7 61 01/2 3/15 1123,15 4 R-Refrigerated Item;May be shipped separately
$ -Special Schein Pricing
CUMMER PO# PAGE T-Taxable Item
U-Temporarily unavailable;please reorder
012 315 2 OF 2 *-Item has MSDS
LP3
JG.9.Pullub.Y 1 bJ,-W TUUFFL11GWdbE.SYuuntdrCdfll uGufnUldtWAtOfIULUt:IlaellIt'ULl7ItIt;IIIUIILIdbLLAG1 YHIyIl[%111IIlalft aUhlhewnI—Ju
pofrds/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 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 returned
Unless otherwise aggreed,freight terms are FOB Shipper's Dock('Ex Works"outside in tie 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 warranty.Please
Continental U.S.: read and return all warranty information required immediately upontaking delivery of
All orders will be subject to a handling charge.This charge includes freight,eyceptfor 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 additions(freight charges. Prescription Dnrg Returns:
Alaska.Hawaii&Pacific Protectorates: Please note teat.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 tie Pacific Protectorates Rx Drugs which Henri 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 invoke with the code WH.
No additional surcharges apply,except when special services are requested. Rx Drugs which are purchased by Henn;Schein directly from the manufacturer may
Low-level hazardous items(dangerous goods in accepted quantities and Consumer be returned providing that tie following key elements are met:
Commodity ID 8000)are now available via LIPS 2nd-day air.
1 Only returns clue to error in order of de livery 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.This 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 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 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
International Terms&Conditions at henryschein.com.Unless otherwise agreed, Rx Drugs certifies
freht terms are FOB Shipper's Dock("Ex Works"outside North America). that the product being returned is the same exact product purchased from HSI.
lineigpasses 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-ROOUCTS-&-CONTROLLED-SUBSTANCES.:__ CHOOSEYO.UR-P_AY_MENT_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 rustorner 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.henrysclhein.com/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 sol up AutoPay.
Please notch that all orders for controlled substances are subject to a duck diligence review Please call Customer Service for details.
process.Schedule II controlled substances can be ordered electronically or by inail.
For information on our Controlled Substance Ordering System pleasevhsit For your corrvenience,we provide several payment alternatives.Orders billed to your
wwtv.henrvschein.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 your order.All sales are subject to our normal terms and
REGULATORY REQUIREMENT: c:onditions.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 vdh 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.
P P P 1
To arrange for a product return,simply call Customer Service as noted below:
Henry Schein Medical 3406 Program Henry Schein Medlcal/EMS
Customer Service: 1.800.472.4346 Barn-;ynm,et. Customer Service: 1.877.344.3402 8:30anh-5:300m,ol. Customer Service: 1.800.845.3550 8:30arn-5:30pm,et
Place an Order 1.800.772.4346 8anh-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 Hows. Fax an Order. 1.800.533.4793 24 Hours.
Internet: wmv.henryschein.com/medical E-Commerce Support: 1.800.711.6032 Sam—bpm,et. Internet: www.lienrysdnein.com/encs
E-Mail: eustsertiftenryschein_cem Intemet: wvnv.henryschein.comr3406 E-Mail: scott.brunerOhenryschein.com
E-Mail: customer.snpport@henryschein.com
Please see:http://vnuw.Henryschein.com,US-EN,fMedical/LegaiTerms.ASPX for Conditions&Exceptions.
HENRY SCI-MEIN
� SHIP TO/SOLD TO:
EMS Carmel Fire Department MI
135 Duryea Road, Melville, NY 11747540 W 136th St
INVOICE Station 46 Michael Kaufmann
Carmel,IN 46032-8806
010000130857116516547110000000000386870123155 BILL TO:
Carmel Fire Dept MI
2 Civic Sq
Carmel, IN 46032-7543
Carmel Fire Dept BILL TO I SHIP TO INVOICE AMOUNT
2 Civic Sq
Carmel, IN 46032-7543 1308571 1 1817102 1 386.87
INVOICE4 INVOICE DATE
16516547 1/23/15
CUSTOMER PO
012315
Medical Terms & Conditions
THE HENRY SCHEIN PRICE POLICY: RETURNS:
WE CANNOT ACCEPT ANY RETURNS WITHOUT PRIOR
We endeavor to maintain prices for the duration of a catalog,but we AUTHORIZATION.
reserve the right to make price adjustments in response to manufacturers' To arrange for a retum,simply call our Customer Service department or contact
price increases or extraordinary circumstances.Prices are subject to your Sales Consultant.The following conditions must be complied with:
change without notice. •All returns must be.accompanied by a copy of your invoice and a reason for
Henry Schein,Inc.("Henry Schein")and customer agree that the terms and conditions the return.
hereinafter set forth shall Jovern the relationship between Henry Schein and the •Merchandise must be returned in its original unopened container,unmarked,and
customer to the extentihat the parties do not have a written agreement in effect that properly packaged.
conflicts wilh such temis and conditions.Customer acknowledges and accepts all •Returned products must have been purchased within the previous thirty(30)days.
such terms and conditions by planing an order for goods with Henry Schein,and upon Any returns past thirtj(30)days are subject to a restocking fee.
Henry Schein's dP,livery of the orderto the customer. •Shortages or errors in shipments must be reported within seven(7)days of invoice
DISCOUNTS •Shipping charges will apply on all
REBATES AND DISCLOSURES: date to issue credit(if applicablell
returns.
The prices stated in the invoice or statement may reflect a discount or be subject to a rebate.
You must fully and accurately report this stated discount price,or if applicable,any net pricing, Exceptions:
after giving effect to any rebates,to Medicare.Medicaid,Tricare and any other federal or The following special,customized,or government-regulated items are not returnable::
State program upon request by any such program.It is your responsibility to review any •Immune globulin products•Special order items(products that we do not ordinarily
agreements or other documents applicable to these prices to determine it they are subjeetto a stock)•Personalized and imprinted items•Opened computer hardware and
rebate.The federal government imposes certain restrictions on,and requires public reporting of.,
transfers of value to a practitioner.If you are participating in a promotional discount program software•Controlled substances•Hazardous materials•Expired products
VOUCHER NO. WARRANT NO.
ALLOWED 20
Henry Schein
IN SUM OF$
Dept Ch 10241
Palatine, IL 60055
$386.87
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1120 16516547 102-390.11 $386.87 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 1
received except
FEB 9 2915
I
l
Fire Chief
Title
Cost distribution ledger classification if 1
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts City Form No.201 (Rev.1995)
i
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
Fwhom, 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))
16516547 $386.87
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