244258 04/15/15 4� CITY OF CARMEL, INDIANA VENDOR: 357526
> �I ONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: $*******544.00*
s ?� CARMEL, INDIANA 46032 DEPT CH 10241 CHECK NUMBER: 244258
'+iiTON�5 PALATINE IL 60055-0241 CHECK DATE: 04/15/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 4239011 18031598 505.00 SPECIAL DEPT SUPPLIES
102 4239011 18392455 39.00 SPECIAL DEPT SUPPLIES
QRDER# ORDER DATE DUE DATE
27461463 03/18/15 05/02/15
D&B#:01-243-0880
WHSE DEA# RHO162494 Fed ID:I1-3136595
51 WIN E Re�
OM SMALL 3 7 571=2600
1 499.-0857 EA INTUBATION HEAD ON BASE 1 1 505.00 505.00
TTN: TOM 3MALL
PRODUCT IS 3EING SHIPPED TO YOU DIRECTLY FROM THE FAC RER.
LEASE REFEZ TO BACK OF PAPERWORK FOR DISCLOSURES/TERMS OF SALE
MERCHANDI E TOTAL 505.00.
Invoice Date + 30 days 505.00
Please remi payments only to the following a dress:
Henry Schei ,' Inc.
—
DeptCH 10211
Palatine, I 60055-0241
a
BILL TO SHIP TO INVOICE# INVOICEINVOICEITEM STATUS KEY REM KEY
1308571 1308572 B-Backordered;Item will follow SK-School Kit
18 0 315 9 8 5.0 5.0 0 D-Discontinued;Item no longer available NC-No Charge
ORDER ORDER DATE INVOICE DATE F BOXES;. F- l offer
M-MManufacturer will ship Item directly to you
P-Prescription Drug;Return Authorization Required
27461463 03/18/15 4/02/15 R-Refrigerated Item;May be shipped separately
$ -Special Schein Pacing
CUSTOMER PO# PA
T-Taxable Item
TOM SMALL 1 OF 1 U-Temporarily unavailable;please reorder
" -IIem has MSDS
LP300
purchase(s)are subject to a bundled discount or rebate.Any such discounts must be Equipment
calculated pursuant to the terms of the applicable purchase offer,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,vie 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 withthe discount program requirements. in the original unopenedpackaging,unmarked and properly packaged.Speical order
equipment is not returnable.AI equipment returns are subject to a restocking tee.
DELIVERY TERMS: Erjuipmentis backed by the manufacturer'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 manufacturer's
Continental U.S.: warranty.
All orders will be subject to a handling charge.This charge includes freight,exceptfor Prescription Drug 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 Henri Schein has purchased from wholesalers are riot returnable.
Standard shipping methods provide direct,reduced cost,expedited air delivery These items will be identified in your invoice with the rode WH.
service to all accounts in Alaska and Hawaii.Customers in the Pacific Protectorates Rx Drugs which are purchased Gv Henry Schein directly from tie manufacturer may
are offered direct surface transport,or postal services for reliable delivery. be returned providing that tie 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 t0 error in order or delivew�will be allowed.
Commodity ID 8000)are now available via UPS 2nd-day air. 2)Returns of Rx Drugs will only be.accepted it HSI is notified within 14 calendar days
Guam.Puerto Rico.U.S.Trust Territories&Virgin Islands: of receipt of the shipment and valid return authorization is issued by HSI.
d 3)The Prescription Drug Marketing Act requires any customer returning Rx Drugs
• All orders will be subject to a handling charge. I his charge includes freight through 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 gel 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 is 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.
freight terms are FOB Shipper's Dock("Ex Works"outside North America). 5)Henry Schein will not issue credit for any returner)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.
Customer is responsible for compliance with any applicable import requirements. CHOOSE YOUR PAYMENT METHOD
__RX PR_UD.UCTS&_00 N T R 0L L EQSUBSTANCE$: _.,Cash Back-or-Maximum-Relmar-ds-on-all purchases-wiflh-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 new customer tr have recently rowed, www.henryscheiii.coin/creditcard Reduce the cost and administration of nn
please furnish us with a copy of your updated state DFA registration.For controlled y paying
substances,furnish a copy of your DEA registration verifying your shippin,I 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 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 pairs by ACH Debit,Check by Phone,or Check.If you prefer.
wwvd.henryschein nom!e222;if you prefer to 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.Irnvoices 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 comply wii 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 3408 Program Henry Schein Medical/EMS
Customer Service: 1.800.472.4346 Barn-9pm,et. Customer Service: 1.877.344.3402 8:30ani-5:30prn,al. Customer Service: 1.800.845.3550 3:30:vhh-5:30pin,eL
Place an Order: 1.800.772.4346 8anh-9pnh,et. Place an Order: 1.877.344.3402 8:313am-5:301)m,et. Place an Order 1.800.845.3550 8:30am-5:30pm,et
Fax an Order. 1.800.329.9109 24 I-lows. Fax an Order. 1.888.885.2253 24 Hours. Fax an Order. 1.800.533.4793 24 Hours.
Internet: ww►y.henryschein.com/medical E-Commerce Support: 1.800.711.6032 Sam-Spm,et. Internet: www.henryseliein.com/erns
E-Mail: custsery@henryschein.com Internet: twrw.henryschein.com/3406 E-Mail: scott.bruner@henryschein.corn
E-Mail: customer.support@hanryschein.com
Please see:Ihttp.//www.Henryschein.com/US-EN/Medical/LegalTerms.ASPX for Conditions&Exceptions.
Please detach here and mail the above with your payment
'
ORDER# ORDER DATE IDUE DATE
27792944 03/31/15 04/30/15
D&B#:01-243-0880
WHSE DEA# RHO162494 Fed ID:11-3136595
r
his order has been processed by our MIDWEST D.C.
5315 WES 74TH 3TREET
INDIANAP LIS,IN 46268
1 111-3358 100/CA RAZOR STERILE SHAVE PREP 2 SIDED 1 1 C 39.00 39.00 1
SE GOOD I EM, MAY BE SHIPPED SEPARATELY.
---------- --------------------------------- ------ ----- ------------- -------
LEASE REFEZ TO BACK OF PAPERWORK FOR DISCLOS1JRES/TEZMS OF SALE
i
MERCHANDI E TOTAL 39.00
Invoice Date + 30 days 39.00
- lease remi payments-only to the following a dress:
Henry Schei , Inc.
Dept CH 10211
Palatine, I 60055-0241
ILL TO SHIPTO INVOICE# xNV x E AMQU= ITEM STATUS KEY REM KEY
B-Backordered;Item will follow . SK-School Kit
1308571 1817102 18392455' ' 39.00 D-Discontinued;Item no longer available NC-No Charge
ORDER# ORDER DATE INVOICE DATE # OF BOXES F-Special offer
M-Manufacturer will ship Item directly to you
P-Prescription Drug;Return Authorization Required
27792944 03/31/15 3/31/15 1 R-Refrigerated Item;May be shipped separately
B E $ -Special Schein Pricing
CUSTOMER T-Taxable Item
U-Temporarily unavailable;please reorder
JON 033115 1 OF 1 11 * -Item has MSDS
lor your recorus.it is ` memserrulurlucu um; •Items that cannot be returned to the manufacturer•Any item marked nonreturnable
including offers or promotions,applicable to the invoiced products/prices to determine if your
purchase(s)are subject to a bundled discount or rebate.Any such discounts must beEauioment:
calculated pursuant to the terms of the applicable purchase offer,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;letting exactly what you ordered.Equip merit must be returned
knowledge,your practice compiles with the discount program requirements. in the original unopenedpackaging,unmarked and properly packaged.Speical order
equipment is not returnable.At equipment returns are subject to a restocking fee.
DELIVERYTERMS: Equipment is backed by the manufacturer'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 manufacturer's
Continental U.S.: warranty.
All orders will he subject to a handling charge.This charge includes freight,except far Prescription Drug_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 Wit.
service to all accounts in Alaska and Hawaii.Customers in the Pacific Protectorates Rx Drugs which are purchased Ly 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 delivery 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
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. I his,charge includes freight through to complete and return a Prescription Druo 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 or weight 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
It your order is 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.
freight terms are FOB Shipper's Dock("Ex Works"outside North America). 5)Henry Schein will not issue credit for any returnedRx 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.
Customer is responsible for compliance with any applicable import requirements.
RX PRODUCTS& CONTROLLED SUBSTANCES:'T— - CHOOSEYOUR-PAYMENT-MET!-IOD—- --- - --
Regulations require us to limit the sale of Rx and controlled substances only to registered, 2°y°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 capy of your updated state DFA registration.For controlled www.henryschein.corn/creditcard Reduce the cost and administration of paying
substances,furnish a copy of your DFA registration verifying your 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 ddigenre 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.henryschein com/e222;if you prefer to 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 741111 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 apply 10 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 344B Program Henry Schein Medical/ENCS
Customer Service: 1.800.472.4346 Bann-9pm,et. Customer Service: 1.677.344.3402 8:30am--5:30prn,el. Customer Service: 1.800.845.3550 3:30sun-5:30pin,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: wmv.henryschein.com/medical E-Commerce Support: 1.800.711.6032 8am-8pm,et. Internet: www.henryschein.com/erns
E-Mail: custseruOhenryschein.com Internet: wym.henryschein.com/3406 E-Mail: scott.brunerOhenryschein.com
E-Mail: customer.support@henryschein.com
Please see:littp://www.Henryschein.com/US-EN/Medical/LegalTerms.ASPX for Conditions&Exceptions.
LP300
VOUCHER NO. WARRANT NO.
ALLOWED 20
Henry Schein
IN SUM OF$
Dept Ch 10241
Palatine, IL 60055
I
$544.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1120 18392455 102-390.11 $39.00 1 hereby certify that the attached invoice(s), or
1120 18031598 102-390.11 $505.00 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
APR 1 X2045
NOV )6- --0~
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
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s)or bill(s))
18392455 $39.00
18031598 $505.00
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