242292 02/17/15 o
CITY OF CARMEL, INDIANA VENDOR: 357526
ONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: $ ...""294.33'CARMEL, INDIANA 46032 DEPT CH 10241 CHECK NUMBER: 242292
PALATINE IL 60055-0241 CHECK DATE: 02/17/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 4239011 16670066 294.33 SPECIAL DEPT SUPPLIES
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points/credits redeemable for certain goods or services,in accordance with discount program
rales.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[hat you check the shipping container and packing list to
DELIVERY TERMS: ensure that you are getting exartly what you ordered.Equipment must be.returned
Unless otherwise agreed,Ireight terms are FOB Shipper's Dock("Ex Works"outside. in the original unopened packaging,unmarked and property packaged.Speical order
North America).Title passes M the time the shipment is loaded at the shipper's clock. equipment is riot returnable.Alrequiprnen[returns are subject to a restocking lee.
Equipment is barked by the manufacturer's repair or replacement warrants`.Please
Continental U.S.: read and return all warrant.;information required immediately upon taking delivery of
All orders will he subject to a handling charge.This charg0 includes freight,except for your nerl equipment.;-pen or defective equipment is subject to the manufacturer's
additional carrier charges related to special delivery services and hazardous material warranty.
shipments.Special orders are subject to additional freight charges. Prescription Dqw Returns
Alaska.Hawaii&Pacilic Protectorates: Please note that,in ride r to comply with Federal and State Pedigree requirements,
:itandal'd SI11(.�ping nlethOdS provide direct.reduced cost,expedited air delivery 1-lenry Schein's policy on the return of Rx Drugs is as follows:
service to all accounts In Alaska and Hawaii.Cnstrmers In the Pacific Protertc rates Rx Drugs which Henry Schein has purchased lrom wholesalers are riot 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 which are purchased liv Henry Schein directly from the manufacturer may
Low-level hazardous items(dangerous goods in accepted quantities and Consumer be returned providing that the tollowing key elements are mel:
Commodity ID 9000)are.now available via LIPS 2nd day air.
1 Only returns due to error in order or delivery will be.allowed.
Guam.Puerto Rico.[I,S.Trust Territories&Virctin lslands: 2)Returns of Rx Drugs will only be accepted it HSI is notified within 14 calendar days
•
NI orders`frill be subject to a handling charge. this charge includes freight through of receiptrriptiof the shipment and valid return authorization is issued by HSI.
the United States Postal Service(USPS). 3)The Preson Drug Marketing Act requires any customer returning Fix Drugs
• Special delivery riders and hazardous material shipments can be shipped aria United to complete and return a Prescription Drug Return Authorization form.Federal teat
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 Representalive 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 beingshipped Outside the U.S.(50 states),please refer to the 4)In addition,Pedigree regulations require that the healthcare entiVy returning
International Terms&Conditions at henryschein.com.Unless otherwise agreed, Rx Drugs certllies
freight terms are FOR Shipper's P.nrk("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 anyway.
Rat PRODUCTS & CONTROLLED SUBSTANCES: CHOOSEYOUR PAYMENT METHOD
Regulations require us to limit the sale of Fix and controlled substances only to regislereil, 2%Cash Back or Maximum Rewards on all purchases with the Henry Schein
licensri healthcare piofessionals.It you are a new customer or have recently moved, Credit Card.To apply now,cal[:1.866.398.9296 or online
please lumish us with a copy of your updated slate DEA registration.For controlled
www.henrysclieiii.coili/creditcard Reduce the cost and administration of m
substances,furnish a copy of your DFA registration vrrii�finq your shipping addrrss. Henry Schein Pay electronically{ACH DebO)or set up AutoPay. paU g
Please nota that all orders for controlled substances are subject to a due diligence review Please call Customer Service for details.
pra�;ss.Schedule II controlled substances can be ordered electronicallym
or by all.
For information on our Controlled Substance Ordering System please visit For your convenience,we.provide several payment alternatives.Orders billed to your
wy+lv.henrvschrin.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 ill 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 cur normal terms and
REGULATORY REQUIREMENT: conditiions.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 romply 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 retum,simply call Customer Service as noted below:
Henry Schein Medical 3408 Program Henry Schein Medical/EMS
Customer Service: 1.800.472.4346 Barn-9pin,ct. Customer Service: 1.877.344.3402 8:30am-5:30pm.et. Customer Service: 1.600.845.3550 8:30om-15:30pm,e9.
Place an Order: 1.800.772.4346 8anF-9pm,et. Place an Order. 1.877.344.3402 8:30am-5:30pm,et. Place an Order: 1.800.945.3550 3:30am-5:30prn,et.
Fax an Order. 1.800.329.9109 24 Hours. Fax an Order. 1.888.685.2253 24 Hours. Fax an Order 1.800.533.4793 24 Hours.
Internet: www.heiiryschein.com/medical E-Commerce Support: 1.800.711.6032 8am-8pm,et. Internet: www-henryschein.coni/ems
E-Mail: custserufhenryschein-com Internet: www.henryschein.comr3406 E-Mail: scott.bruner@henryschein.com
E-Mail: customecsupport@henryschein.com
Please see:littp:Uwww.Henryschein.com,US-EN;Medical/LegalTerms.ASPX for Conditions&Exceptions.
rrescribed by State Board of Accounts City Form No.201 (Rev.1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
4n invoice or bill to be properly itemized must show: kind of service,where performed, dates service rendered, by
,vhom, 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))
16670066 $294.93
I
I hereby certify that the attached invoice(s), or bill(s), is(are)true and correct and 1 have audited same in accordance
with IC 5-11-10-1.6
20
Clerk-Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
Henry Schein
IN SUM OF $
Dept Ch 10241
Palatine, IL 60055
$294.93
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1120 16670066 102-390.11 $294.93 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 i o ..u1
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund