223540 08/27/2013 CITY OF CARMEL, INDIANA VENDOR: 361867 Page 1 of 1
0 ONE CIVIC SQUARE KEYSTONE AUTOMOTIVE INDUSTRIES CHECK AMOUNT: $307.00
CARMEL, INDIANA 46032 849 WHITAKER RD.#190
PLAINFIELD IN 46168 CHECK NUMBER: 223540
CHECK DATE: 8/2712013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4237000 BB998318 307 . 00 REPAIR PARTS
INDIANAPOLIS, IN Invoice INVOICE # BB998318
849 WHITAKER RD SUITE 190 LOCATION 072
PLAINFIELD, IN 46168
Phone 317-268-3466 DATE 08/20/13 07:55:34
® Fax 317-839-0540 PAGE 1 OF 2
An LKQ Company
BILL TO SHIP TO
553858 FCITY OF CARMEL FIRE DEPARTMENT
CITY OF CARMEL FIRE DEPARTMENT 2 CIVIC SO
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/O NUMBER PAYMENT TERMS
BBG48177 08/19/13 A07D/J510 Jason NET 10TH PROX
SHIP DATE WRTN BY CONTACT R/0 NUMBER SHIP VIA
08/20/13 34136 KEYSTONE TRUCK 34036
For Questions, contact JEFFREY HARTMAN, 800-525-4639 x'3516, LKQ-INDIANAPOLIS
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2006 CHEVROLET IMPALA
GM2502261 V + 1 1 0 209.00 125.00 EA 125.00
HLAMP ASM LH;06-13 IMPALA
06-07 MONTE CARLO I, 2
GM2502187V + 1 1 0 87.00 66.00 EA 66.00
HLAMP ASM LH;99-02 SILVERADO
00-06 SUBURBAN;00-06 TAHOE
GM2503187V ) + 1 1 0 87.00 66.00 EA 66.00
HLAMP ASM RH;99-02 SILVERADO
00-06 SUBURBAN;00-06 TAHOE
GM2520173V + 1 1 0 33.00 25.00 EA 25.00
PARK LMP ASM LH;00-06 SUB/TARO
99-02 SILVERADO;UNDER HDLIGHT
GM2521173V + 1 1 0 33.00 25.00 EA 25.00
PARK LMP ASM RH;00-06 SUB/TAHO
99-02 SILVERADO;UNDER HDLIGHT
+ Lifetime warranty on value line product is limited to part replacement only.
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v, Continued
CUSTOMER COPY
INDIANAPOLIS, IN Invoice INVOICE # BB998318
849 WHITAKER RD SUITE 190 LOCATION 072
PLAINFIELD, IN 46168
Phone 317-268-3466 DATE 08/20/13 07:55:34
(Do Fax 317-839-0540 PAGE 2 OF 2
An LKQ Company
SHIP TO
BILL TO
553858 CITY OF CARMEL FIRE DEPARTMENT
CITY OF CARMEL FIRE DEPARTMENT 2 CIVIC SO
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/O NUMBER PAYMENT TERMS
BBG48177 08/19/13 A07D/J510 Jason NET 10TH PROX
SHIP DATE WRTN BY CONTACT R/0 NUMBER SHIP VIA
08/20/13 3486 KEYSTONE TRUCK 34036
For Questions, contact JEFFREY HARTMAN, 800-525-4639 x 3516, LKQ-INDIANAPOLIS
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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 (26.8% 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
charged, then such charges shall be calculated at the highest lawful rate.
BUMPER INVENTORY IS BASED ON CORE AVAILABILITY, CORE RETURN IS NOW REQUIRED.
MERCHANDISE HANDLING MISC CHARGE TAX FREIGHT DEPOSIT DEPOSIT ;: :1A1Y4ECETQTAL?';.
TOTAL AMOUNT APPLIED
307.00 0.001 0.001 0.00 0.00 0.00 0.00 307.00
Received By:
30-Day Return Policy-The original sales receipt must accompany all 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.
r local branch. All other refunds will be processed by Keystone Automotive Industries'corporate
Refund Policy- Cash Purchases returned on the same day as delivered will be refunded by you
office and sent via U.S.mail within seven(7)working days. CUSTOMER COPY
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))
BB998318 VIN 9051 &8081 $307.00
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
120
Clerk-Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
Keystone Automotive Industries, Inc.
IN SUM OF $
849 Whitaker Road, Ste. 190
Indianapolis, IN 46168
$307.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1120 I BB998318 I 42-370.00 I $307.00 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 2 6 2013
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund