245503 05/20/15 °`L4M
?' CITY OF CARMEL, INDIANA VENDOR: 357526
d r ONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: $ """*930.22"
�a CARMEL, INDIANA 46032 DEPT CH 10241 CHECK NUMBER: 245503
;,,TpN�` PALATINE IL 60055-0241 CHECK DATE: 05/20/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 4467006 19367205 749.00 EMS EQUIP
102 4239011 19367309 181.22 SPECIAL DEPT SUPPLIES
ORDER# ORDER DATE ]DUE DATE
29835780 05/04/15 06/04/15
D&B#:01-243-0880
WHSE DEA# RHO162494 Fed ID: 11-3136595
rhis order as been processed by our MIDWEST D.C.
5315 WES'" 74TH ;TREET
INDIANAP LIS,IN 46268
---------- ---==-==---------------
1 890-6868 3/PK LIFEPAK 12 PAPER EKG 17 17 10.66 181.22 1
==============================------------- ------
PLEASE REFE Z TO BACK OF PAPERWORK FOR DISCLOS JRES/TE ZMS OF SALE
---------- ------------- -------
MERCHANDI E TOTAL 181.22
Invoice Date + 30 days 181.22
Please remi: payments only to the following a dress:
Henry Scheii, Inc.
Dept CH 102 1
Palatine, IL 60055-0241
13TLL TO SHIP TO INVOICE# INVOICE AMOUNT ITEM STATUS KEY REM KEY
13 0 8571 181710 2 19 3 6 7 3 0 9 181.2 2 B
k Eff MTKEYB-liackordered:Item will follow SK-School Kit
1308571 1817102 19367309 181.22 D-Discontinued:Item no longer available NC-No Charge
ORDER# ORDER DATE IAT F-Special offer
— 4 OF BOXES M-Manufacturer will ship Item directly to you
11 Prescription Drug:Return Authorization Required
29835780 05/04/15 5/05/15 1 R Refrigerated Item:May he shipped separately
$ Special Schein pricing
CUSTOMER PO# PAGE# T-Taxable Item
U-Temporarily unavailable:please reorder
JON 050415 1 OF 1 Item has MSDS
including offers or promotions,applicable to the invoiced productslpricesto determine if your •MAIN 0ia[canllur ue n nnneu to kill nr(nurrcurier•Ally uenr ivaiKeu ncnuewrnauu:
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 otter.promotion,or discount Qpened andand 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 wtththe discount program requirements. in the original unopenedF)ackaging,unmarked and properly packaged.Speical order
equipment is not returnable.AI 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 for Prescription Drug Returns:
additional carrier charges related to special delivery services and hazardous material Plaase 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 Rom wholesalers are riot returnable.
Standard shipping methods provide direct,reduced cost,expedited air delivery These items will he identified in your invoice with the code WH.
service to all accounts in Alaska and Hawaii.Customers in the Pacific Protectorates Rx Drugs which are purchased L'y 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.
t-ow-leve]hazardous items(dangerous goods in accepted quantities and Consumer llOnly returns due to error in order kir delivery will be.allowed.
Commodity ID 8000)are now available via LIPS 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 Druid Marketing Act requires any customer returning Rx Drugs
• All orders will be subject to a handling charge.This charge includes freight through to complete and return a Prescription Drug Return Authorization form.Federal jaw
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.(5U stalest: 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 h(wnryschein.com.Unless othenn+ise 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 bv3n
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 anyway.
Customer is responsible for compliance with any applicable import requirements. CHOOSE YOUR PAYMENT METHOD
RX PRODUCTS & CONTROLLED SUBSTANCES: 2%Cash Back or Maximum Rewards on all purchases will)the Henry Schein
Regulations require us to limit the sale of fix and controlled substances only to registered, Credit Card.To apply now,call:1.866.398.9296 or online
licensed healthcare protessionals.If you are a new customer or have recently rowed, vnvw.henr schein.cmnJcrediicard Reduce the cost and administration of m
please furnish us with a copy of your updated slate DEA registration.For controlled y 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 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 pa;:ment alternatives.Orders billed to your
For information on our Controlled Substance Ordering System Owse visit account may be paid by ACH Debit,Check by Phone,or Check.If you prefer.
w�6rv�,.henryschein.r:om/e222;if you prefer to continue using Federal 222 Forms to order you(nay useynur Henry Schein Credit Card,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 :undilions.Nl 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 Avxnunts 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 1.54';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--91)rn,et. Customer Service: 1.877.344.3402 3:30ani--5:30prn,el. Customer Service: 1.800.845.3550 8:30am--5:30pm,et.
Place an Order: 1.800.772.4346 Bam-9pm,et. Place an Order: 1.877.344.3402 8:30am-5:301)m,0. Place an Order: 1.800.845.3550 8:30am-5:301)m,et
Fax an Order. 1.800.329.9109 24 Flours. Fax an Order: 1.886.885.2253 24 Flours. Fax an Order. 1.800.533.4793 24 Hours.
Internet: www.henryschein.com/medical E-Commerce Support: 1.800.711.6032 8am-8pm,et. Internet: www.henryschein.corn/erns
E-Mail: cusiserv^shenryschein.com Internet: www.henryschein.comf340B E-Mail: scott.b run er0henryschein.com
E-Mail: customer.support@henryschein.com
Please see:littp://wwty.Henrysubein.com/US-EN/MedicaIlLegalTerms.ASPX for Conditions&Exceptions.
LP300
ORDER# I ORDER DATE IDUE DATE
29835262 05/04/15 06/04/15
D&B#:01-243-0880
WHSE DEA# RHO]62494 Fed ID: 11-313695 CONTAINS MULTIPLE INVOICES
Zaar
a-R
T
rhis order has been processed by our MIDWEST 1).C.
5315 WES" 74TH TREET
INDIANAPQLIS,IN 46268
----------- --------========---------- -------
1 827-2329 EA SUCTIONUNIT W/DISP CANNNS 1 1 C 749.00 749.00 1
CASE GOOD IrEM, MAY BE SHIPPED SEPARATELY.
PLEASE REFEZ TO BACK OF PAPERWORK FOR DISCLOSURES/=MS OF SALE
MERCHANDI E TOTAL 749.00
Invoice Date + 30 days 749.00
Please remi: payments only to the following aldress:
Henry Scheii, Inc.
Dept CH 10211
Palatine, 1, 60055-0241
BILL TO SHIP TO INVOICEINVOICE AMOUNT ITEM STATUS KEY 749 .00 NC
Y
Ii-B '
ackor cred�Item%ffl follow
1)-Discontmurd:Item no longer available Charge
1308571 1308572 19367205l,
F -Special offer
OPDER# — ORDER DATE INVOICE DATE F BOXES M-Manufacturer will ship Item directly to you
11 prescription Drug:Return Authorization Required
29835262 05/04/15 5/05/15 1 R Refrigerated Item:May be shipped separately
$ Special Schein pricing
CUSTOMER PO PAGE# T Taxable Item
�
-Temporarily unavailable:please reorder
JON 050415 1 OF 1 _hem sDs
including otters or promotions,applicable to the invoiced products/prices to determine it your '1iCms roar cannuT De renrrneu mine manuiaculrer•Ally item marrtea nonreLurnanre
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,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 he returned
knowledge,your practice complies with the discount program requirements. in the original unopened��ackaging,unmarked and properly packaged.Speical order
equipment is not returna le.Aliequipment returns are subject to a restocking fee.
DELIVERYTERMS: Equipment is backed by the manulactwer's repair or repiacermentvrarranty.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 subjert to a handling charge.This charge includes freight,except for prescription Drug Returns:
additional carrier charges related fin special delivery services and hazardous mated, Please note that,in order to comply with Federal and State Pedigree requirements,
shipments.Special orders are subject to additional treight charges. Henry Schein's policy on the return of Rx Drugs is as follows:
Alaska Hawaii&Pacific Protectorates: Rx Drugs whim Henry Schein has purchased front wholesalers are riot returnable.
Standard shipping methods provide divert;reduced cost;expedited air delivery These items will be identified in vour invoice with the code WH.
service to all accounts in Alaska and Hawaii.Customers in the Pacific Protectorates Rx Drugs whicIi are purchased by 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 mel:
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 deliver r will be allowed.
Commodity ID 8000)are now available via UPS 2nd-day air. 2 Returns of Rx Drugs will only be accepted i 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&Virnin Islands. 3)The Prescription Drug Marketing Act requires any customer returning Rx Drugs
• All orders will be subject to a handling charge. This charge includes freight through to corns lete and return a Prescri M
that the hea
inn Drug Return Authorization form.Federal law
the United States Postal Service(USPS). requirelthcare 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 Hx Drugs certifies
International Terms&Conditions at henryschein.com.Unless other:vise 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
1Title 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 anyway.
Customer is responsible for compliance with any applicable import requirements. CHOOSE YOUR PAYMENT METHOD
RX PRODUCTS & CONTROLLED SUBSTANCES: 2%Cash Back or Maximum Rewards on all purchases with 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 protessionals.If you are a new customer or have recenlly moved, www.henryscliciii.coiii/creditcard Reduce the cost and administration of paying
please furnish us with a copy of your updated state.DEA registration.For controlled y p y g
substances,furnish a copy of your DEA 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 diligence review Please call Customer Service for details.
process.Schedule II controlled substances can he 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 pleasevisit account may be paid by ACH Debit,Check by Phone,or Check. If you prefer,
www.henryscheincom/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 loan 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: terns of safe.
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 3408 Program Henry Schein Medical/EMS
Customer Service: 1.800.472.4346 Sarn--9pm.et. Customer Service: 1.877.344.3402 8:30am--5:30pm.al. Customer Service: 1.800.845.3550 8:30ani--5:30Fan,PL
Place an Order: 1.800.772.43468am-9pm,et. Place an Order: 1.877.344.3402 8:30am-5:30pm,et. Place an Order: 1.800.845.3550 8:30am-5:50pm,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: tiwrw.henryschein.com/medical E-Commerce Support: 1.800.711.6032 Sam-bpm,et. Internet: www.henryschein.corn/erns
E-Mail: custservghenryschein.com Internet: www.henryschein.com/3406 E-Mail: scott.bruner@henn/schein.com
E-Mail: customer.support@henrVschein.com
Please see:littp://www.Henryschein.com/US-EN/Medical/Lega[Terms.ASPX for Conditions&Exceptions.
LP300
U HENRY SCHEIV)
EMSSHIP TO/SOLD TO:
135
INVOICE
� � Carmel Fire Dept Head Quarters MI
135 Duryea Road, Melville, NY 11747 2 civic sq
Michael Kaufmann
Carmel,IN 46032-2584
0100001,308571,19367205],1,00000000007490005051,53 BILL TO:
Carmel Fire Dept MI
2 Civic Sq
Carmel, IN 46032-7543
Carmel Fire Dept HILL To I SHIP To I INVOICE AMOUNT
2 Civic Sq
Carmel, IN 46032-7543 1308571 1308572 749.00
INVOICE# I INVOICE DATE
19367205 5/05/15
CUSTOMER PO
JON 050415
---------------------- ------- --------- --
ORDER# ORDER DATE DUE DATE
29835262 05/04/15 06/04/15
D&B#:01-243-0880
WHSEDEA# RHO162494 Fed ID: 11-3136595 CONTAINS MULTIPLE INVOICES
:.� y �# p7 a re is
' _ 4t E i 1 - N`•++:t'r•�� y'• ���*'7�i� P .P .p i.. y�1..,�X ' '' d. y
P 'i a s •s v •nt l �'ri
his order ias been processed by our MIDWEST M.C.
5315 WES 74TH 3TREET
INDIANAP LIS,IN 46268
1 827-2329 EA SUCTIONUNIT W/DISP CANNNS 1 1 C 749.00 749.00 1
ASE GOOD I EM, MAY BE SHIPPED SEPARATELY.
LEASE REFE Z TO BACK OF PAPERWORK FOR DISCLOS RES/TE ZMS OF SALE
---------- --------------------------------- ------ ----- ------------- -------
MERCHANDI E TOTAL 749.00
Invoice Date + 30 days 749.00
lease remi payments only to the following a dress:
enry Schei , Inc.
ept CH 10211
alatine, I 60055-0241
N
ILL TO SHIP TO INVOICE —INVOICE AMOUNT ITEM STATUS KEY REM KEY
B-Backordered;Item will follow SK-School Kit
1308571 1308572 19367205 749 .00 D-Discontinued;Item no longer available NC-No Charge
F-Special offer
ORDER# ORDER DATE INVOICE DATE 4 OF BOXES M-Manufacturer will ship Item directly to you
P-Prescription Drug;Return Authorization Required
29835262 05/04/15 5/05/15 1 R-Refrigerated Item;May be shipped separately
CUSTOMER PO PA E $ -Special Schein Pricing
T-Taxable Item
JON 0 5 0 415 1 OF 1 *f-Itemphas MSDS unavailable;please reorder
IM
o"' ,• �1 'M RYSCHEIN@
44 SHIP TO/SOLD TO:
EMS Carmel Fire Department MI
135 Duryea Road, Melville, NY 11747INVOICE 540 W 136th St
Station 46 Michael Kaufmann
Carmel,IN 46032-8806
07,00001308571,1,9367309110000000000187,220505],58 BILL To:
Carmel Fire Dept MI
2 Civic Sq
Carmel, IN 46032-7543
Carmel Fire Dept
2 Civic Sq BILL TO sxlP To I INVOICE AMOUNT
Carmel, IN 46032-7543 1308571 1817102 181.22
INVOICE# I INVOICE DATE
19367309 5/05/15
CUSTOMER PO#
JON 050415
ORDER# I ORDER DATE DUE DATE
29835780 05/04/15 06/04/15
D&B#:01-243-0880
WHSE DEA# RHO162494 Fed ID: 11-3136595
is ta?*:?,y.� .4 �- �:� e ��;�,. �:•.., ,a`: •-'s3 -r� t�••r, ,sr,•- - � ��^"1�
R. M.
� �`Jv �:o q y,
•.'�...I.e.- t•, �' .zzs[ o..tww�r -ii..^i3."ra6'.:+5'm L4 M . � Y.. K ¢ h•�1' ib
his order has been processed by our MIDWEST D.C.
5315 WES 74TH 3TREET
INDIANAP LIS,IN 46268
1 890-6868 3/PK LIFEPAK 12 PAPER EKG 17 17 10.66 181.22 1
-------------
LEASE REFEZ TO BACK OF PAPERWORK FOR DISCLOSTRES/TEZMS OF SALE
MERCHANDI E TOTAL 181.22
Invoice Date + 30 days 181.22
lease remi payments only to the following a dress:
enry Schei , Inc.
ept CH 102 1
alatine, I 60055-0241
BILL TO SHIP TO TNVOTCEii INVOICE AMOUNT ITEM STATUS KEY F7SK
M KEY
B-Backordered;Item will follow
1308571 181710 2 19367309 181 .2 2 D-Discontinued;Item no longer available No Charge
F-Special offer
ORDER ORDS DATE INV E DATE OF B XE M-Manufacturer will ship Item directly to you
P-Prescription Drug;Return Authorization Required
29835780 05/04/15 5/05/15 1 R-Refrigerated Item;May be shipped separately
CUSTOMER PO PA E $ -Special Schein Pricing
T-Taxable Item
U-Temporarily unavailable:please reorder
JON 050415 1 OF 1 * -Item has MSDS
prescribed 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
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))
19367205 $749.00
19367309 $151.22
1 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
VOUCHER NO. WARRANT NO.
ALLOWED 20
Henry Schein
IN SUM OF $
Dept Ch 10241
Palatine, IL 60055
$930.22
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1120 19367205 102-670.06 $749.00 1 hereby certify that the attached invoice(s), or
1120 19367309 102-390.11 $181.22 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
MAY 1 8 2015
K
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund