243227 03/18/15 ;4+yr CAq�F
CITY OF CARMEL, INDIANA VENDOR: 357526
i1 ONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: S*******142.44*
CARMEL, INDIANA 46032 DEPT CH 10241 CHECK NUMBER: 243227
9M- PALATINE IL 60055-0241 CHECK DATE: 03/18/15
t rON�
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 4239011 17559914 45.24 SPECIAL DEPT SUPPLIES
102 4239011 17641239 97.20 SPECIAL DEPT SUPPLIES
ORDE11#1ORDER DATE•:•.` 113 DATE
I
27074163 03/05/15 04/04/15
D&B#:01-243-0880
WHSE DEA# RHO162494 Fed ID:11-3136595
z;,, .,.,,� .:.w<. ... -.._. . .. �.a a s ,•,.; .<.s` a €... ?:
his order has been processed by our MIDWEST B.C.
5315 WES 74TH 3TREET
INDIANAP LIS,IN 46268
ON 030515
17-571-266
---------- --------------------------------- ------ ----- ------------- -------
1 499-7780 EA TOURNIQUET COMBAT APP. ORANGE 3 3 24.04 72.12 '; 1
PRODUCT IS 3EING SHIPPED TO YOU DIRECTLY FROM THE MA4UFACTURER.
2 499-0480 EA HEAD IMMOBILIZER DISP PAIR 6 6 4.18 25.08 1
---------- --------------------------------- ------ ----- ------------- -------
---------- --------------------------------- ------ ----- ------------- -------
LEASE.REFE TO BACK OF PAPERWORK FOR DISCLOS RES/TE S OF SALE
MERCHANDI E TOTAL 97.20
nvoice Date + 30 days 97.20
lease_remi payments only to the following a dress:
enry Schei , Inc.
Dept CR 10211
Palatine, I 60055-0241
a'as TO HIP z x ITEM STATUS KEY REM KEY
B-Backordered;Item will follow SK-School Kit
1308571 1817102 17641239 97.20 D-Discontinued;Item no longer available xc-xo charge
D ti .iI A t F-Special offer
M-Manufacturer will ship Item directly to you
P-Prescription Drug;Return Authorization Required
27074163 03/05/15 3/05/15 1 R-Refrigerated Item;May be shipped separately
$ -Special Schein Pricing
:MSTOMER>PO T-Taxable Item
Item has MSDS
JON 030515 1 OF 1 U-Temporarily unavailable;please reorder
"-
purchases)are subject to a bundled discount or rebate.Any such discounts must be Equipment:
calculated pursuant to the terms of the applicable purchase atter,promotion,or discount Opened and used equipment may not be returned for credit.Before opening
program.Participation in a promotional discount program is only permissible in accordance equipment,we suggest that you check the shipping container and packing list to
with discount program rules.By participation in such program,you agree that,to your ensure that you are getting exactly what you ordered.Equipment must be returned
knowledge,your practice complies with the discount program requirements. in the original unopenedpackaging,unmarked and properly packaged.Speical order
equipment is not returnable.All equipment returns are subject to a restocking tee.
DELIVERYTERMS: Equipment is backed by the manutac:turer's repair or replacement warranty.Please
Unless otherwise agreed,freight terms are FOB Shipper's Dock('Ex Works"outside read and return all warranty information required immediately upon taking deliver} of
North America).Title passes at the time the shipment is loaded at the shipper's dock. your new equipment.Open or defective equipment is subject to the manufacturers
Continental U.S.: warranty.
All orders will be subject to a handling charge.This charge includes freight,except for Prescription Dl Returns:
additional carrier charges related to special delivery services and hazardous material Please note that,in order to comply with Federal and State Pedigree requirements,
shipments.Special orders are subject to additional freight charges. Henry Schein's policy on the return of Rx Drugs is as follows:
Alaska,Hawaii&Pacific Protectorates: Rx Drugs which Henry Schein has purchased from wholesalers are not returnable.
Standard shipping methods provide direct,reduced cost,expedited air delivery These items will be identified in your invoice with the node WH.
service to all accounts in Alaska and Hawaii.Customers in the Pacific Protectorates Rx Drugs which are purchased by Henry Schein directly from the manufacturer may
are offered direct surface transport,or postal services for reliable delivery. be returned providing thatthe following key elements are met:
No additional surcharges apply,except when special services are requested.
Low-level hazardous items(dangerous goods in accepted quantities and Consumer 1)Only returns due to error in order or delive��f will be allowed.
Commodity ID 8000)are now available via UPS 2nd-day air. 2)Returns of Rx Drugs will only be accepted if HSI is notified within 14 calendar days
Guam Puerto Rico.U.S,Trust Territories&Urn in Islands: of receipt of the shipment and valid return authorization is issued by HSI.
3}The Prescription Drug Marketing Act requires any customer returning Rx Drugs
• All orders will be subject to a handling charge.This charge includes freightthroingh to complete and return a Prescription Drug Return Authorization form.Federal law
the United States Postal Service(USPS). requires that the healthcare entity returning Rx Drugs document that the product
• Special delivery orders and hazardous material shipments can be shipped via united was kept under proper storage and handling conditions while in their possession
Parcel Services(UPS)for an additional charge.No minimum order amount orweight and during the return of the product.To get a copy of the form and proper return
applies.Speak to your International Representative for details. authorization,please contact Customer Service.
Outside U.S.(50 states); 4)In addition,Pedigree regulations require that tie healthcare entity returning
if your order is being shipped outside the U.S.(50 states),please refer to the Rx Drugs certifies
nternational Terms&Conditions at henryschein.com.Unless otherwise agreed, that the product being returned is the same exact product purchased from HSI.
freight terms are FOB Shipper's Dock("Ex Works"outside North America). 5)Henry Schein will not issue credit for any returned Rx Drugs which have been
Tite passes at the time the shipment is loaded at the shipper's dock. tampered with,are out of date or where the labeling has been altered in any way.
Customer is responsible for compliance with any applicable import requirements. CHOOSE YOUR PAYMENT METHOD
RX PRODUCTS-&-CONTROLLED-SUBSTANCES:- -- _—___2%Cash Back or-Maximum-Rowardson-all-purchaseswith-the-Henry-Schein—=- — -
Regulations require us to limit the sale of Rx and controlled substances only to registered, Credit Card.To apply now,call:1.866.398.9296 or online
licensed healthcare professionals.If you area near customer tr have recently moved, www.henryscliein.com/creditcard Reduce the cost and administration of paying
please furnish us with a copy of your updated stale DEA registration.For controlled rY PaV� 9
substances,furnish a copy of_your DEA registration verifying your shipping address. Henry Schein-Pay electronically(ACH Debrl)or set up AutoPay.
Please note that all orders for controlled substances are subject to a due diligence review Please call Customer Service for details.
process.Schedule II controlled substances can be ordered electronically or by mail. For your convenience,we provide several payment alternatives.Orders billed to your
For information on our Controlled Substance Ordering System pleasevnsnt account may be paid by ACH Debit,Check by Phone,or Check.If you prefer,
www.henryschein.com/e222;if you preferto continue using Federal 222 Forms to order you may useyour Henry Schein Credit Card,American Express,Visa,MasterCard or
Schedule II controlled substances,please mail the form to: Discover Card when placing your order.All sales are subject to our normal terms and
Henry Schein,Inc.• Suite 300,5315 West 74th Street • Indianapolis,IN 46268 conditions.All sales are subject to credit approval.Invoices are payable within agreed
REGULATORY REQUIREMENT: terms of sale.
Local regulatory requirements may ap.ly to use or installation of certain products. Open Accounts Receivable:
Be sure to understand and cornply w i any such requirements prior to purchase,use, All unpaid accounts receivable past due are subject to a 1.5%finance charge.
IE or installation ofP roducts.
To arrange fora product return,simply call Customer Service as noted below:
Henry Schein Medical 340B Program Henry Schein Medical/EMS
Customer Service: 1.800.472.4346 Barn-91)m,et. Customer Service: 1.877.344.3402 8:30am-5:30prn,el. Customer Service: 1.800.845.3550 8:30am-5:30pin,et
Place an Order: 1.800.772.4346 8am-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 Hours, Fax an Order. 1.800.533.4793 24 Hours.
Internet: wmv.henryschein.com/medical E-Commerce Support: 1.800.711.6032 Bam-bpm,et. Internet: www.henryschein.com/ems
E-Mail: custsery@henryschein.com Inlemet: %yvm.henryschein.comr340B E-Mail: scott.brun er0henryschein.com
E-Mail: customer.support@henryschein.com
Please see:ihttp://www.Henryschein.com/US-EN/Medical/LegalTerms.ASPX for Conditions&Exceptions.
LP300
i
VOUCHER NO. WARRANT NO.
' ALLOWED 20
Henry Schein
IN SUM OF$
i
Dept Ch 10241
Palatine, IL 60055
$97.20
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1120 17641239 102-390.11 $97.20 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
MAR 1 6 2015
NON)-i
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
i
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))
17641239 $97.20
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
Please detach here and mail the above with your payment
ORDER# ORDER DATE DUE DATE
26989621 03/03/15 04/02/15
D&B#:01-243-0880
WHSE DEA# RH0162494 Fed ID:11-3136595
51'® ¢ a
31 .. --..u . F. ..,h.. _-... �_ a�a„w,;, o^x®R •• •" .t '" .�. ;;s xn
This order has been processed by our MIDWEST D.C.
5315 WES 74TH 3TREET
INDIANAP LIS,IN 46268
OM SMALL 0-0315
17-571-260
1 826-5685 PU EA MURPHY TUBE ENDOTRACH CLR 7.0 20 20 1.41 28.20 1
2 857-1785 EA DISP MAC LARYNGSCOP BLADE SZ 4 4 4 4.26 17.04 2
HIS PRODUCF IS BEING SHIPPED FROM OUR NORTHEAST DIS RIBUT ON CENTER.
-------------
LEASE REFEZ TO BACK OF PAPERWORK FOR DISCLOS RES/TE S OF SALE
ortheast D stribution Center
1 WEAVER RAD
DENVER, PA 17517
MERCHANDI E TOTAL 45.24
Invoice Date + 30 days 45.24
Please remi payments only to the following a dress:
Henry Schei , Inc.
Dept CH 10211
Palatine, I 60055-0241
BILL O SHIP TO INVOICEINVOICE# INVOICE ITEM STATUS KEY REM KEY
1308571 1817102B B-Backordered:Item will follow SK-School Kit
17 5 5 9 914 4 5.2 4 D-Discontinued;Item no longer available NC-No Charge
F-Special offer
QRDER# RDER DAT INVOICE DATE it OF BOXES M-Manufacturer will ship Item directly to you
15 3/03/15 2 P-Prescription Drug;Return Authorization Required
26989621 0 3 0 3
/ R-Refrigerated Item;May be shipped separately
T MER P PAGE $ -Special Schein Pricing
CUST-Taxable Item
TOM 030315 1 OF 1 *I-Item Temporarily
MSDSavailable;please reorder
LP300
or your records.it is your response i rtytoreview any agreementsorotherdocuments,
including offers or promotions,applicable to the invoiced products/prices to determine if your °Items that Cannot be returned to the manufacturer•Any item marked nonreturnable
purchase(s)are subject to a bundled discount or rebate.Any such discounts must be E�uioment:
calculated pursuant to the terms of the applicable purchase after,promotion,or discount Opened and used equipment may not be returned for credit.Before opening
program.Participation in a promotional discount program is only permissible in accordance equipment,we suggest that you check'the shipping container and packing listto
with discount program rules.By participation in such program,you agree that,to your ensure that you are getting exactly.what you ordered.Equipment must be returned
knowledge,your practice complies with the discount program requirements. in the oriainal Unopenedpackaging,unmarked and properly packaged.Speical order
equipment is not returnable.All equipment returns are subject to a restocking tee.
DELIVERYTERMS: Equipment is backed by the manufac:turer's repair or replacement warranty.Please
Unless otherwise agreed,freight terms are FOB Shipper's Dock('Ex Works"outside read and return all warranty information required immediately upon taking delivery of
North America).Title passes at The time the shipment is loaded at the shipper's dock. your new equipment.Open or defective equipment is subject to the manufacturers
Continental U.S.: warranty.
All orders will be subject to a handling charge.This charge includes freight,except for prescription Drua Returns:
additional carrier charges related to special delivery services and hazardous material Please note that,in order to comply with Federal and State Pedigree requirements,
shipments.Special orders are subject to additional freight charges. Henry Schein's policy on the return of Rx Drugs is as follows:
Alaska,Hawaii&Pacific Protectorates: Rx Drugs which Henry Schein has purchased from wholesalers are riot returnable.
Standard shipping methods provide direct,reduced cost,expedited air delivery These items will be identified in vour invoice with the rode WH.
service to all accounts in Alaska and Hawaii.Customers in the Pacific Protectorates Rx Drugs which are purchased 61y Henry Schein directly from the manufacturer may
are offered direct surface transport,or postal services for reliable delivery. be returned providing that the following key elements are met:
No additional surcharges apply,except when special services are requested.
Low-level hazardous items(dangerous goods in accepted quantities and Consumer 1)Only returns due to error in order or delive�r will be allowed.
Commodity ID 8000 are now available via UPS 2nd-day air. 2)Returns of Rx Drugs will only be.accepted if HSI is notified within 14 calendar days
Co iy ) y
of receipt of the shipment and valid return authorization is issued by HSI.
Guam,Puerto Rico,U.S.Trust Territories&Virgin Islands: 3 The Prescription Drug Marketing Act requires any customer returning Rx Drugs
• All orders will be subject to a handling charge.l his charge includes freight through to complete and return a Prescription Drug Return Authorization form.Federal law
the United States Postal Service(US[S). requires that the healthcare entity returning Rx Drugs document that the product
• Special delivery orders and hazardous material shipments can be.shipped via United was kept under proper storage and handling conditions while in their possession
Parcel Services(UPS)for an additional charge.No minimum order amount orweight and during the return of the product.To get a copy of the form and proper return
applies.Speak to your International Representative for details. authorization,please contact Customer Service.
Outside U.S.(50 states 4)In addition,Pedigree regulations require that the healthcare entity returning
If your order rs being shipped outside the U.S.(50 states),please refer to the Rx Drugs certifies
International Terms&Conditions at henryschein.com.Unless otherwise agreed, that the product being returned is the same exact product purchased from HSI.
freightterms are FOB Shipper's Dock("Ex Works"outside North America). 5)Henry Schein will not issue credit for any returned Rx Drugs which have been
Title passes at the time the shipment is loaded at the shipper's dock. tampered with,are out of date or where the labeling has been altered in any way.
_—Customeris_responsible tor_conip liance_with an�Lappli:ableJmport requirements.
RX PRODUCTS& CONTROLLED SUBSTANCES: —���oSE orMaxi B�t�YewardsanallTI=1aD—
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 witii a copy of your updated state DEA registration.For controlled veww.henrysclieiii.coin/creditcard Reduce the cost and administration of paying
substances,furnish a copy of your DEA registration verifying your shipping address. Henry Scheitr-Pay electronically(ACH Debit)or set up AutoPay.
Please note that all orders for controlled substances are subject to a due diligence review Please call Customer Service for details.
process.Schedule II controlled substances can be ordered electronically or by mail. For your convenience,we provide several payment alternatives.Orders billed to your
For information on our Controlled Substance Ordering System please visit account may be paid by ACH Debit,Check by Phone,or Check.if you prefer.
www.henryscheln.com!e222;ifyou prefer to continue using Federal 222 Forms to order you may useyour Henry Schein Credit(,aid,American Express,Visa,MasterCard or
Schedule 11 controlled substances,please mail the form to: Discover Card when placing your order.All sales are subject to Our normal terms and
Henry Schein,Inc.• Suite 300.5315 West 74th Street ° Indianapolis,IN 46268 conditions.101 sales are subject to credit approval.Invoices are payable within agreed
REGULATORY REQUIREMENT: terms of sale.
Local regulatory requirements may apply to use or installation of certain products. Open Accounts Receivable:
Be sure to understand and comply with any such requirements prior to purchase,use, All unpaid accounts receivable past due are subject to a 1.5%finance charge.
or installation of products.
To arrange for a product return,simply call Customer Service as noted below:
Henry Schein Medical 340B Program Henry Schein MedicallEMS
Customer Service: 1.800.472.4346 Barn--9prn,et. Customer Service: 1.877.344.3402 8:30aill-5:30pin.el. Customer Service: 1.800.845.3550 8:30ani-5:30pm,et
Place an Order: 1.800.772.4346 Sam-9pm,et. Place an Order: 1.877.344.3402 8:30am-5:301)m,et. Place an Order: 1.800.845.3550 8:30am-5:301)m,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: www.honrVschein.com/me(lical E-Commerce Support: 1.800.711.6032 Sam-Spin,et. Internet: www.henryschein_comi'erns
E-Mail: custserv@?henryschein.com Internet: www.henryschein.com/3406 E-Mail: scott.bruner@henryschein.com
E-Mail: custom er.supp ort@h enryschein_corn
Please see:littp.//www.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
$45.24
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1120 17559914 102-390.11 $45.24 1 hereby certify that the attached invoice(s), or
bill(s) is(are)true and correct and that the
I
materials or services itemized thereon for
which charge is made were ordered and
received except -AR 1 6 2015
hAA
Fire Chief
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
i
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s)or bill(s))
17559914 $45.24
I '
I
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 i
, 20
Clerk-Treasurer