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Home My WebLink About248857 08/26/1 5 a.•C.IgMF( >� � CITY OF CARMEL, INDIANA VENDOR: 357526 d :; ONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: $"�""""464.56" } ?� CARMEL, INDIANA 46032 DEPT CH 10241 CHECK NUMBER: 248857 ,,,,TON Lo, PALATINE IL 60055-0241 CHECK DATE: 08/26/15 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4239011 22045885 464.56 SPECIAL DEPT SUPPLIES ORDER# ORDER DATE IDUE DATE 32520503 08/03/15 09/02/151 D&B#:01-243-0880 WHSE DEA# RHO 162494 Fed ID: H-3136595 D.N i 1 N NMI -9 wl.all N 1*94 mm I This order has been processed by our MIDWEST B.C. 5315 WES" 74TH 3TREET INDIANAP LIS,IN 46268 1 565-7365 100/BX NITRILE PF GLOVE BLACK MEDIUM 30 30 C 8.90 267.00 3 CASE GOOD IPEM, MAY BE SHIPPED SEPARATELY. 2 647-4174 10/TRAY CURITY GAUZE 12PLY STER 411X4" 128 128 C 0.65 83.20 4 CASE GOOD IPEM, MAY BE SHIPPED SEPARATELY. 3 499-3940 EA SPUR RESUSC W/MASK RESV ADULT 12 12 9.53 114.36 5 PLEASE REFEZ TO BACK OF PAPERWORK FOR DISCLOS RES/TEZMS OF SALE MERCHANDI E TOTAL 464.56 Invoice Date + 30 days 464.56 lease remipayments only to the following aldress: Henry Scheii, Inc. Dept CH 10211 Palatine, 1, 60055-0241 REM BILL TO SHIP TO INVOICE# INVOICE AMOUNT ITEM STATUS KEY KEY Y Sch B-Backordered:Item will follo,, "'o Kit � 1308571 1817102 22045885 464 .56 1)-Discontinued:Item no longer available a", F -Special offer ORDER# ORDER DATE INVOICE DATE # OF BOXES M-Manufacturer will ship Item directly to you 11 prescription Drug:Return Authorization Required 32520503 08/03/15 8/03/15 5 R Refrigerated Item:May be shipped separately $ Special Schein pricing CUSTOMER PO# PAGE# T-Taxable Item T mporanly unavailable:please reorder 080315 1 OF 1 Item has MSDS purchase(s)are subject to a bundled discount or rebate.Any such discounts must be Etc uipment: 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 with the discount program requirements. in the original unopened packaging,unmarked and properly packaged.Speical order equipment is not returnable.Alf equipment returns are subject to a restocking tee. DELIVERY TERMS: Equipment is backed by the manufacturer's repair or replacement warranty.Please Unless otherwise agreed,freight terms are FOB Shipper's Dock(Ex'VVorks"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.: vrarranty. All orders will be subject to a handling charge.This charge includes freight,excoptfor 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 treight charges. Henry Schein's policy on the return of Fix 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 your invoicewith the rode WH. service to all accounts in Alaska and Hawaii.Customers in the Pacific Protectorates Rx Drugs which are purchased Ly Henry Schein directly from Ute manufacturer may are offered direct surface transport,or postal services for reliable deliver/. be returned providing that the following key elements are met: No additional surcharges apply,except when special services are requested. Low-bevel hazardous items(dangerous goods in accepted quantities and Consumer 1)Only returns due to error in order or deliver i 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&Vi+yin 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 treight through to complete and return a Prescription Or 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 or 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 slates)-)- 4)In addition.Pedigree regulations require that the healthcare entity returning It your order is being shipped outside the LI.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 returned Rx Drugs which have been tie 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:1.666.396.9296 or online licensed healthcare professionals.I r up area newstat customer tr have recFor coy moved, www.henrysclieiii.coin/creditcard Reduce the cost and administration of in please furnish us with a copy of your updated state GEA registration.For controlled Y Pay 9 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 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 please visit account may be paid by ACH Debit,Check by Phone,or Check.If you prefer, wOAw.fienryschein.(:om/e222;if you prefer to f:ontinue using Federal 222 Forms to older you may useyoui 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 c:ondilions.All sales are subject to credit approval.Invoices are payable within agreed REGULATORY REQUIREMENT: terinsof sale. Local regulatory requirements may apply to use or installation of certain products. Open Arxounts Receivable: Be sure to understand and comply with arty 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--9prn,et. Customer Service: 1.877.344.3402 8:30am--5:30pm.al. Customer Service: 1.800.845.3550 8:30arn-5:30pm,et. Place an Order: 1.800.772.43468am-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,r.t. Fax an Order. 11.800.329.9109 24 1louis. Fax an Order: 1.a88.885.2253 24 Hovis. Fax an Order: 1.800.533.4793 24 Hours. Internet: www.henryschein.com/medical E-Commerce Support: 1.800.711.6032 8am-1pm,el. Internet: www.henrysctrein.corn/ems E-Mail: custsery@henryschein.com Internet: %=w.henryschein.com/340B E-Mail: scott.brunernahenryschein.com E-Mail: custom er.support@henryschein.com Please see:littp://www.Henryschein.com/US-EN/Medical/LegalTerms.ASPX for Conditions&Exceptions. 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)) 22045885 $464.56 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 5-11-10-1.6 120 Clerk-Treasurer VOUCHER NO. WARRANT NO. ALLOWED 20 Henry Schein IN SUM OF $ Dept Ch 10241 Palatine, IL 60055 $464.56 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO#/Dept. INVOICE NO. ACCT#!TITLE AMOUNT Board Members 1120 22045885 102-390.11 $464.56 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 —AUG-2 4 2015- j Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund