K-3 - Dump Truck Price Adjustment - Henderson Products

Invoice Sold To: Henderson Products 1085 South Third St Manchester IA 52057 United States Ship To: Henderson Truck Equipment 916 S 10th Street Manchester IA 52057 United States Remit To: Grote Industries, LLC P.O. Box 734425 Chicago, IL 60673-4425 DUNS 00-638-2840 BACKORDERS DISPLAYED ON PACKING LIST ONLY. ALL CLAIMS MUST BE FILED WITH THE CARRIER WITHIN 15 DAYS AFTER RECEIPT OF GOODS. NO GOODS MAY BE RETURNED WITHOUT OUR WRITTEN PERMISSION. WE HEREBY CERTIFY THAT THESE GOODS WERE PRODUCED IN COMPLIANCE WITH ALL APPLICABLE REQUIREMENTS OF SECTION 6, 7, AND 12 OF THE FAIR LABOR STANDARDS ACT OF 1938, AS AMENDED, AND OF REGULATIONS AND ORDERS OF THE ADMINISTRATOR OF THE WAGE AND HOUR DIVISION ISSUED UNDER SECTION 14 THEREOF. PLEASE REFER TO GROTE INVOICE NUMBER IN ALL CORRESPONDENCE ABOUT THIS INVOICE <table> <tr> <th>Line #</th> <th>Item Number</th> <th>Description</th> <th>City of Origin</th> <th>UM</th> <th>Qty. Shipped</th> <th>Unit Price</th> <th>Amount</th> </tr> <tr> <td>1.000</td> <td>01625M2<br>01-625-M2</td> <td>JUMPER HARNESS<br>CAB SHIELD HARNESS</td> <td>MX</td> <td>EA</td> <td>10</td> <td>29.2600</td> <td>292.60</td> </tr> </table> Send Orders To: Grote Industries, LLC 2600 Lanier Dr. Madison, IN 47250 *Fax 812/265-8440 812/273-1296 Invoice Sold To: Henderson Products 1085 South Third St Manchester IA 52057 United States Ship To: Henderson Truck Equipment 22000 Fisher Road Waterloo IA 50701 United States Remit To: Grote Industries, LLC P.O. Box 734425 Chicago, IL 60673-4425 DUNS 00-638-2840 BACKORDERS DISPLAYED ON PACKING LIST ONLY. ALL CLAIMS MUST BE FILED WITH THE CARRIER WITHIN 15 DAYS AFTER RECEIPT OF GOODS. NO GOODS MAY BE RETURNED WITHOUT OUR WRITTEN PERMISSION. WE HEREBY CERTIFY THAT THESE GOODS WERE PRODUCED IN COMPLIANCE WITH ALL APPLICABLE REQUIREMENTS OF SECTION 6, 7, AND 12 OF THE FAIR LABOR STANDARDS ACT OF 1938, AS AMENDED, AND OF REGULATIONS AND ORDERS OF THE ADMINISTRATOR OF THE WAGE AND HOUR DIVISION ISSUED UNDER SECTION 14 THEREOF. PLEASE REFER TO GROTE INVOICE NUMBER IN ALL CORRESPONDENCE ABOUT THIS INVOICE <table> <tr> <th>F.O.B. Point Factory</th> <th>Customer Order Number</th> <th>Freight Terms</th> <th>Invoice Date</th> <th>Invoice Number</th> <th>Delivery Number</th> </tr> <tr> <td>241362-00</td> <td>254891-00</td> <td>Collect</td> <td>03/03/2021</td> <td>7572055 RI</td> <td>6515433</td> </tr> <tr> <td></td> <td>119356</td> <td>Grote Order Number</td> <td></td> <td>9373732</td> <td>SW</td> </tr> </table> <table> <tr> <th>Line #</th> <th>Item Number</th> <th>Description</th> <th>City of Origin</th> <th>UM</th> <th>Qty. Shipped</th> <th>Unit Price</th> <th>Amount</th> </tr> <tr> <td>1.000</td> <td>01625M2<br>01-625-M2</td> <td>JUMPER HARNESS<br>CAB SHIELD HARNESS</td> <td>MX</td> <td>EA</td> <td>20</td> <td>36.8700</td> <td>737.40</td> </tr> <tr> <td>3.000</td> <td>SHIPPING CHARGE<br>SHIPPING CHARGE</td> <td>SHIPPING CHARGE</td> <td>EA</td> <td>1</td> <td>41.2200</td> <td>41.22</td> </tr> </table> 26% Increase <table> <tr> <th>Terms</th> <th>Due Date</th> <th>Currency</th> <th>Tax ID:</th> <th>Total - Taxes</th> <th>Total Invoice Amount</th> </tr> <tr> <td>Net 30 Days</td> <td>2021-11-12</td> <td>USD</td> <td></td> <td>0.00</td> <td>778.62</td> </tr> </table>