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248369 08/12/15 0�'��p" CITY OF CARMEL, INDIANA VENDOR: 357526 �i ONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: S""""1,643.06" r.. ,i°; CARMEL, INDIANA 46032 DEPT CH 10241 CHECK NUMBER: 248369 ,M[TUN�� PALATINE IL 60055-0241 CHECK DATE: 08/12/15 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 102 4239011 21763203 1,643.06 SPECIAL DEPT SUPPLIES MDER4 I ORDER DATE IDUE DATE 32255048 07/23/15 08/22/15 D&B#:01-243-0880 WHSE DEA# RHO162494 Fed ID:11-3136595 .-\\\ .r. `.� .^\� ��. �� \�\� "Qa ��\ �\\� �\ �„a .\��.: ® .,•:�\� , his order has beenY rocessed b our MIDWESTM.C. P 5315 WES 74TH 3TREET INDIANAP LIS,IN 46268 ---------- --------------------------------- ------ ----- ------------- ------- ---------- --------------------------------- ------ ----- ------------- ------- 1 360-1359 EA SAM SPLINT ORANGE/BLUE 36X4.25 40 40 6.54 261.60 4 2 499-2923 10/CA GRAHAM MEGA MOVER 1500 2 2 C 177.33 354.66 2 SE GOOD =M, MAY BE SHIPPED SEPARATELY. 3 935-6155 50/PK BLUE SENSOR SP ELECTRODES 30 30 12.08 362.40 3 4 857-3190 EA NASAL AIRWAY LF 28FR 10 10 2.54 25.40 3 5 220-1398 3/ST BODY STRAP SET DISP YELLOW 100 100 5.75 575.00 3 6 890-4524 EA KERLIX GAUZE RL STER 6PLY 4.5X4.1 50 50 1.28 64.00 3 LEASE REFEZ TO BACK OF PAPERWORK FOR DISCLOSJRES/TEZMS OF SALE MERCHANDI E TOTAL 1643.06 Invoice Date + 30 days 1643.06 lease remi payments only to the following a dress: Henry Schei , Inc. Dept CH 10211 Palatine, I 60055-0241 BILL TO SH I IP T - NV i- E z E AMOUNT ITEM STATUS KEY REM KEY B-Backordered;Itemwill follow SK-School Kit 1308571 1817102 21763203 1643 .06 D-Discontinued;Item no longer available NC-No Charge F-Special offer QRDER# ORDER DATE INVOICE DATE # OF BOXES M-Manufacturer will ship Item directly to you P-Prescription Drug;Return Authorization Required 32255048 07/23/15 7/23/15 4 R-Refrigerated Item;May be shipped separately _ - - - $ -Special Schein Pricing CUSTOMER I?0# PAGE T-Taxable Item 0 7 2115 1 OF 1 U-Temporarily unavailable;please reorder • -Item has MSDS purchase(s)are subject to a bundled discount or rebate:Any such discounts must be Eauip hent: calculated pursuant to the terms or the applicable purchase offer,promotion,or discount Cdpenedandand 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 original unopenedpackaging,unmarked and properly packaged.Speical order equipment is not returnable.Alf 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 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,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 Henry Schein has purchased from wholesalers are riot returnable. Standard shipping methods provide direct,reduced cost,expedited air delivers These items will be identified inour invoice with the rode WH. service to all accounts in Alaska and Hawaii.Customers in the Pacific Protectorates Rx Drugs which are purchased btu 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 delivew�will be allowed. Commodity ID 8000)are now available via UPS'l_nd-dxs 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. g 3)The Prescription Drug Marketing Act requires any customer returning Rx Drur s • All orders will be subject to a handling charge. This charge includes freight through to complete and return a Prescription Drug Return Authorizationform.Feder2law the United States Postal Service(USE'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 slates); 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.coin.Unless otherwise as reed, 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 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 _RKLROD-U.C_T_S.&_C_ONTRO.LLEDSUBSTANCES: _ -2%Gash sack or Maximum-Rewardson-all-purchasss-witlz-the-Henry-Schein Regulations require us to limit the sale of Poi and controlled substances only to registered, Credit Card.To apply now,call:1.866.398.9296 or online licensed healthcare professionals.If you are a new customer or have recently moved, please furnish us with a copy of your updated slate DEA registration.For controlled www.henryscliein.coin/crediteard 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 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 11 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 Systein 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 74th Street • Indianapolis,IN 46268 c:onditions.All sales are subject to credit approval.Invoices are payable within agreed. REGULATORY REQUIREMENT: terms of sale. Local regulatory requirements may aptrly to rise 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 a arran9 fora P Pproduct return,simply call Customer Service as noted below: Henry Schein Medical 340B Program Henry Schein Medical/EMS Customer Service: 1.800.472.4346 Barn-9pm,et. Customer Service: 1.877.344.3402 8:30ani-5:30pm,el. Customer Service: 1.800.845.3550&M-mi-5:0 et Place an Order: 1.800.772.4346 8ani-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 flours. Fax an Order. 1.888.885.2253 24 Hours. Fax an Order 1.800.533.4793 24 Hours. Internet: www.henryschein.com/medical E-Commerce Support: 1.800.711.6032 Sam-8pin,et. Internet: www.henryschein.com/erns E-Mail: cusiservghenryschein.com Internet: twnv.henryschein.com/3406 E-Mail: scoff.braner@+henryschein.com E-Mail: customer.support@henrVschein.com Please see:Idtp://wvnv.Henryschein.com/US-EN/Medical/LegalTerms.ASPX for Conditions&Exceptions. LP300 VOUCHER NO. WARRANT NO. ALLOWED 20 Henry Schein IN SUM OF $ ,I Dept Ch 10241 Palatine, IL 60055 $1,643.06 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1120 21763203 102-390.11 $1,643.06 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 AN 10 2015 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)) 21763203 $1,643.06 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 , 20 Clerk-Treasurer