211829 08/14/2012 CITY OF CARMEL, INDIANA VENDOR: 361867 Page 1 of 1
0 ONE CIVIC SQUARE KEYSTONE AUTOMOTIVE INDUSTRIES CHECK AMOUNT: $84.00
CARMEL, INDIANA 46032 849MITAKER RD.#190
PLAINFIELD IN 46168 CHECK NUMBER: 211829
CHECK DATE: 8/14/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4237000 BB811688 84 . 00 REPAIR PARTS
INDIANAPOLIS, IN invoice INVOICE # BB81 1688
849 WHITAKER RD SUITE 190 LOCATION 072
PLAINFIELD, IN 46168
Phone 317-268-3466 DATE 07/30/12 12:00:34
® Fax 317-839-0540 PAGE 1 OF 1
An LKQ Company
BILL TO SHIP TO
553858 FCITY OF CARMEL FIRE DEPARTMENT
CITY OF CARMEL FIRE DEPARTMENT 2 CIVIC SQ
2 CIVIC SO CARMEL, IN 46032-2584
CARMEL, IN 46032-2584 317-571-2600
317-571-2600
ORDER NUMBER ORDER DATE SALES REP CUSTOMER P/0 NUMBER PAYMENT TERMS
BBC99415 07/30/12 A07D/J51 O JASON FC]ftCE NET;10TH PROX
SHIP DATE WRTN BY CONTACT R/O NUMBER SHIP VIA
07/30/12 1 FBD KEYSTONE TRUCK 34099
For Questions, contact JOE EVERETT, 800-525-4639, LKQ-INDIANAPOLIS
P€oOVe /bESCRIPTrON PRICE utrvi EXTEI15ION
QTY f1T OTY LIST
,.;:: OPEN SNIRPED B\4 PRrCE....:,,
GM 1320177 1 1 0 55.00 42.00 EA 42.00
MIRROR LH;MAN;BLK;88-02 CK PU
MAN FOLDING;BELOW EYELINE TYPE
GM 1321177 1 1 0 55.00 42.00 EA 42.00
MIRROR RH;MAN;BLK;88-02 CK PU
MAN FOLDING;BELOW EYELINE TYPE
THANKS JASON !
All payments are due in full in accordance with the payment terms stated herein. Balances not paid by the due date
are subject to a late payment fee of the greater of (i) 2% per month compounded monthly (2_6.8% per year) or (ii)
$5.00. In addition the customer is responsible for all costs of collection, including reasonable attorneys' fees
and other fees incurred in the collection process. If the foregoing charges exceed the rate that may be lawfully
I6)y%rfWE NEAREST DOLLAR
BUMPER INVENTORY IS BASED ON CORE AVAILABILITY, CORE RETURN IS NOW REQUIRED.
MERCHANDISE HANDLING MISC CHARGE TAX FREIGHT DEPOSIT DEPOSIT INVOICE TOTAL
TOTAL AMOUNT APPLIED
...............................................
...............................................
...............................................
84.00 0.00 0.00 0.00 0.00 0.00 0.00 8. * t1i
Received By:
30-Day Return Policy-The original sales receipt must accompany ail returns. Returns without the original sales receipt will not be accepted. A part returned undamaged within 30 days of the
original purchase date may be credited at management's discretion,but no credit will be given for any part returned more than 30 days after the original purchase date. Core charges are refundable
if the appropriate core is returned within 30 days. No returns will be accepted after 30 days.
Refund Policy- Cash Purchases returned on the same day as delivered will be refunded by your local branch. All other refunds will be processed by Keystone Automotive Industries'corporate
office and sent via U.S.mail within seven 17!%vorkine days. CUSTOMER COPY
rescribed by State Board of Accounts City Form No.201 (Rev.1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
kn invoice or bill to be properly itemized must show: kind of service,where performed, dates service rendered, by
vhom, 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))
BB811688 $84.00
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
Keystone Automotive Industries, Inc.
IN SUM OF $
849 Whitaker Road, Ste. 190
Indianapolis, IN 46168
$84.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1120 I BB811688 I 42-370.00 I $84.00 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
AUG 13 2012
1 "
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund