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Home My WebLink About252660 12/15/15 �;�' ;� CITY OF CARMEL, INDIANA VENDOR: 357526 ;, ® 1 ONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: $****....39.00* r CARMEL, INDIANA 46032 DEPT CH 10241 CHECK NUMBER: 252660 �M'��oN`�°` PALATINE IL 60055-0241 CHECK DATE: 12/15/15 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 102 4239011 25563789 39.00 SPECIAL DEPT SUPPLIES ORDER# ORDER DATE DUE DATE 35987499 11/25/15 12/25/15 D&B#:01-243-0880 WHSE DEA# RHO162494 Fed ID: 11-3136595 his order has been processed by our MIDWEST D.C. 5315 WES 74TH 3TREET INDIANAP LIS,IN 46268 1 900-4970 6/BG PENLIGHT DISPSBLE W/PUPIL GA WHTE 2 2 4.00 8.00 1 2 116-9264 EA SEP-T-VAC SYSTEM II 120OCC 10 10 3.10 31.00 1 LEASE REFEZ TO BACK OF PAPERWORK FOR DISCLOSJRES/TEZMS OF SALE MERCHANDI E TOTAL 39.00 nvoice Date + 30 days 39.00 Please remi payments only to the following a dress: enry Schei , Inc. Dept CH 10211 Palatine, I 60055-0241 RILL TO SHIPTO INVOICE4INVOICE AMOUNT ITEM STATUS KEY REMKEY 1308571 1817102 25563789 39 .00 8-Backordered:Item wmonger N -SchoolKit rg D-Discontinued.Item no longer available NC-No Charge F-Special offer ORDER4 ORDER DATE INVOICE DATE # OF BOXES M-Manufacturer will ship Item directly to you P-Prescription Drug:Return Authorization Required 35987499 11/25/15 11/25/15 1 R-Refrigerated Item:May be shipped separately CUSTOMER PO# PAGE# $ -Special Schein Pricing T-Taxable Item U-Temporarily unavailable:please reorder 112515 1 OF 1 Item has MSDS LP300 1ONum119u—NotoPtumuuuua,appnwmatome111vulutmpruuucrsrPneesWuerermneifyour purchase(s)are subject to a bundled discount or rebate.Any such discounts must be EaUiDment: calculated pursuant to the terms of the applicable purchase otter.promotion,or discount Opened and used equipment may not he returned for cretlrt.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.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 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,except for 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 additionaf 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 your invoice Leith the code WH. service to all accounts in Alaska and Hawaii.Customers in the Pacitic Protectorates Rx Drugs whim are purchased by Henry Schein directly from the 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. L-ow-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 LIPS 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. • All orders will be subject Trust a handling charge.1 his charge includes freight through 3)The Prescription Drug Marketing Act requires any customer-returning Rx Drugs United Stto complete and return a Piesciiption Drug Return Authorization form.Federal jaw the UnitStates Postal Service(USPS . • Special ed t orders and hazardous material shipments can he shipped via United requires that the healthcare entity returning Rx Drugs document that the product Parra(Services(UPS)for an additional charge.No minimum order amount orweight was leapt under proper storage and handling conditions while in(heir possession applies.Speak to your International Representative for details. and during the return of the product. get a copy of the toren and proper return authorization,please contact Customer Sereice. Outside U.S.(50 states), 4)In addition.Pedigree regulations iequiie 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 hen ryschein.coill.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. Pampered 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 ail purchases with the Henry Schein Regulations require us to limit the sale of Rx and controlled substances only to registered, Credit Card.Toapply now,call:1.866.398.9296 or online licensed healthcare pvotessionals.If you are a nee,customer or have recently moved, pp y please furnish us with a copy of your updated slate.DFA registration.For controlled wtvw.henryschein.com/cre.diteard 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 System pleasevisit account may be paid by ACH Debit,Check by Phone,or Check.If you prefer, wt�rw.henryschein.rom!e222;if you prefer to continue using Federal 222 Forms to order you(nay useirour 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 46266 c:onditions.All 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 finance charge. or installation of products. To arrange for a product retum,simply call Customer Service as noted below: Henry Schein Medical 34OB Program Henry Schein Medical/EMS Customer Service: 1.800.472.4346 Un-9prn,et. Customer Service: 1.877.344.3402 8:30ani--5:30pm,el. Customer Service: 1.800.845.3550 8:30yn 5:30pm,e.1. Place an Order: 1.800.772.4346 Sam-Spm,et. Place an Order: 1.877.344.3402 8:30am-5:30pm,et. Place an Order: 1.800.845.3550 8:30am-5:301)m,et. Fax an Order. 1.800.329.9109 24 f lours. Fax an Order. 1.868.1185.2253 24 Flours. Fax an Order: 1.800.533.4793 24 Houis. Internet: www.henrVschein.com/medical E-Commerce Support: 1.800.711.6032 8am-8pm,et. Internet: www.henryschein.corn ems E-Mail: custseryshenryschein.com Internet: wwm.henryschein.com/3408 E-Mail: scott.b run er(Ohenryschein.com E-Mail: custom er.support9henryschein.com Please see.littp://www.Henryschein.com/US-EN/Modical/Lega[Terms.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)) 25563789 $39.00 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 VOUCHER NO. WARRANT NO. ALLOWED 20 Henry Schein IN SUM OF $ Dept Ch 10241 Palatine, IL 60055 $39.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO#/Dept. INVOICE NO. ACCT#!TITLE AMOUNT Board Members 1120 25563789 102-390.11 $39.00 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 DEC 1 4 2015 Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund