HomeMy WebLinkAboutAU-12/06/2011 Fishers IslandFISHERS ISLAND FERRY DISTRICT
VENDOR 001395 ADVANTECH CONSULTING CORP 12/06/2011 CHECK 178
FUND & ACCOUNT P.O.# INVOICE DESCRIPTION AMOUNT
SM ,5710.4.000.500 965635 (3)DELL MINI TOWER PC'S 2,641.75
TOTAL 2,641.75
Town of Southold, New York - Payment Voucher
Vendor Tax ID Number or Social Security Number Vendor Address
Advantech Consulting Corp.
Vendor Telephone Number
VendorContact
Invoice Invoice
P.O. Box 951
Suffleld, CT 06078
Net Purchase Order
Vendor No.
965636
Date
11/21/2011
Total
2,641.75
Discount Amount Claime~
2,641.75
2,641.761 ~ 2,64t.75
Payee Certification
The undersigned (Claimant) (Acting on behalf of thc above named claimant)
does hereby certify that thc forcgnMg claim is true and correct, that no part has
been paid, except as therein stated, that the balance therein stated is actua)ly
due and owing, and that taxes from which the Town ' mpt are eluded,
- / (
'"~ ~/' ~ '/ I
/
Number
Descrtption of Goods or Services
Dell Optiplex 390
Mini Tower PC's (3)
FI Bus Office and Res
Check No.
Entered by ~
AUdit Date
DEC 0 6 2011
town Clerk ~, ,~.,-x · mt
Genial Ledger Fund and Account Nmb~'
8M6710.4.000.500
Department Certification
I hereby certif~ that the materials above specified have been received by me
in good condition without substitution, thc services properly
performed and that the quantities thereof have been verified with thc exceptions
Title ~/~,q .~, ~ Date ,If~/[,
Advan Tech Consulting
P.O. Box 951
Suffield, CT 06078
BILL TO I
Fishers Island Ferry
P.O. Box H
Fishers Island, NY 06390
Invoice
I
DATE I INVOICE #
11/21/20111 965635
TERMS DUE DATE PROJECT
Due on receipt 11121/2011
QTY DESCRIPTION RATE AMOUNT
Dell Optiplex 390 mini tower PC's (qty 3) 2,641.75 2,641.75
lhank you for your business. Contact u~ ,t {860)
Total $2,641.75
Unpaid invoices over 68 days past due date subject to late fee and interest charges.
FISHERS ISLAND FERRY DISTRICT
VENDOR 001327 AIRGAS EAST, INC 12/06/2011 CHECK 179
FUND & ACCOUNT P.O. # INVOICE DESCRIPTION AMOUNT
SM .5710.4.000.000
SM .5710.4.000.000
116805014
116983046
TANK RENTALS 42.14
(2)PROPANE-FORKLIFT FUEL 65.10
TOTAL 107.24
Town of Southold, New York - Payment Voucher
Vendor Tax ID Number or Socia~ Security Number Vendor Address
P.O. Box 827049
Vendor Name
Air,las East
V~ndor Telephone Number
Vendor Contact
:Vendor No.
Philadelphia, PA 19182-7049
1327
1168~05014
11698304
Date
10/3112011
1t/17/20tl
Invoice Net
Total Discount Amount Claime~
$~2 14 ! $42.14
$65.10 i $65.10
107.24
Payee Certification
The undersigned (Claimant) (Acting on bebalf of the above named claimant)
does hereby certify that the foregoing claim is true and con.ct, that no part has
been paid. except ~s therein stated, that the balance therein stated is actually
Company Name
t07.24
Number
Check No.
Audit Date i
DEC 0 6 2011
Description of Goods or Services
Tank Rentals
SM5710.4.000.000
Department Certification
I hereby certify that the materials above specified have been received by me
in good condition without substitution, the services properly
performed and that the quantities thereof have been verified with the exceptions
or discrepancies noted, and payment is approved.
Signature .~ ~'x
TO ENSURE PROPER CREDIT, PLEASE RETURN THE UPPER PORTION WITH YOUR REMITTANCE. FOR QUESTIONS ON YOUR ACCOUNT P~.EASE CALL: 80U-56Z-3t115}:~. ;~UU-
.! 16 o5o!L j / 10/31/11 I ,L NE SAYS L J,
~ ALS ..... TO~ %LS ..... > 5 4 4 5 3 62 .227 14.07
?P 25 BALANCt FORWAR[ 3
FUEL GAS ~MALL
~ FGS ..... TO~ %LS ..... > 3 0 0 3 0 93 .219 20.37
HAZARDOU~ MATERIt C
~ HAZ ..... TO~ %LS ..... > 0 0 0 0 0 0 7.70 7.70
DX 200 BALANCE FORWAR[ 3
OXYGEN Lt kGE
9 OXL ..... TO~ %LS ..... > 3 0 0 3 3 0 .541 .00
.......................... SUMMAR~ OF fLIN ER B LANCE S ...........................
9 ALS ALUMINUM 9MALL 5 4 4 5 3 62 .227 14.07
B FGS FUEL GAS ~MALL 3 0 0 3 0 93 .219 20.37
~ HAZ HAZARDOU~ MATERI~ C 0 0 0 0 0 0 7.70 7.70
9 OXL OXYGEN L~ ~GE 3 0 0 3~ 3 0 .541 .00
TAX: .00
Airgas
www.airgas.com FISHERS ISLAND ACT. NAME AIRGAS EAST
Airgas East FERRY DISTRICT ACT. NO. 8606074799
17 Northwestern Drive FISHERS ISLAND NY 06390 PNC SANK- ABA NO. 031000053
Salem, NH 03079 REF. 116805014/02081
s~- ~®o RENTAL INVOICE
IE UPPER PORTION WITH Y [ REMITTANCE. FOR C
384250-00 116983046 02081 11/17/11 FISHERS ISLAND
465 841 810 CUST PICKUP NET30 DAYS 1
' ** LOCATION: B6 **
38425( [lil7PR 33A 2 Q PROPANE 32LBS ALUMINUM 2I 28.5.~ 57.10 N
2 2 VOL: 64
38425( [i:17~AZHAZMAT HAZARDOUS MATERIAL CHARG ~ 8.0( 8.00 N
S ~k total 68.10
TO~ ~L fLI~DERS SHIPPED: 2 RETURi~E[
TAX CD,: ]00000006 TAX ESCRt C( qNE~TI~U EXMPT CD: 0 EXMPT/CERI ~UNICIPt ~ITY
:
:
:
:
:
:
$.00 ~ I~ $65.10
Air, as. www.airgas.com FISHERS ISLAND ACT. NAME AIRGAS EAST
Airgas Easl FERRY DISTRICT ACT. NO. 8606074799
17Northwestern Drive FISHERS ISLAND NY 06390 PNC BANK -ABA NO. 031000053
Salem. NH 03079 REF. 116983046102081
ORIGINAL INVOICE
heAcrou~tApplicatio ( a ehasbee conpeed) a d heTensofSae o a htsL: ww.aa qascot.c some s._!;rv_~ce/tcrms as )* collectivey he Semi,of Sale
FISHERS ISLAND FERRY DISTRICT
VENDOR 019500 AT&T 12/06/2011 CHECK 180
FUND & ACCOUNT P.O.~ INVOICE DESCRIPTION AMOUNT
SM .5710.4.000.100 86044201651211 TEL/NL TERM-II/15-12/14 360.03
TOTAL 360.03
Town of Southold, New York - Payment Voucher
Vendor Tax iD Number or Social Security Number
Vendor Name
AT&T
Vendor Telephone Number
VendorContuct
Number
8604420166.
Date
11/15/2011
Invoice
Total
360.03
Discount
Vendor No.
I 19500
Vendor Address
AT&T ~ _
RO:'~zx-el't~ ?0
~01 54r eax~,rz. &olct~
Net
Amount Claim¢
360.03
I
Payee Certification
The undersigned (Claimant) (Acting on behalf of the above named claimant)
does hereby certify that the foregoing claim is true and correct, that no pan has
been paid, except as therein stated, that the balance therein stated is actually
due and owing, a~llthat taxes fi~om which the ToVgNs exempt are excluded.
Company Name~> ' Date/7?
Purchase Order
Number
Description of Goods or Services
NL Terminal Tel
11116/11-12/14/11
Check No.
Entered by ~)
Audit Date
DEC 0 6 2011
town Clerk
Genial L~d~ex Fund and Account Number
8M6710.4.000.100
Department Certification
I hereby certify that the materials above specified have been received by me
in good condition without substitution, the services properly
performed and that the quantities thereof have been verified with thc exceptions
Z iscrepancies noted, and payment is approved
Signa
at&t
FISHERS ISLAND FERRY DISTRICT Page
PO BOX H Account Nnmber
FISHERSlSLE NY 06390-0607 Billing Date
Web Site
I of 7
860 442-0165 078
Nov 15, 2011
att.com
Monthly Statement
Previous Bill 371.93
Payment .00
Adjustments 5.49
Pant Due - Please Pay Immediately 377.42
Current Charges
Total Amount Due
Current Charges Due in Full by
$737.45 *
Dec 14, 2011
· Thank you for being an ALL DISTANCE® customer,
Your ALL DISTANCE® savings includes:
Promotions and Discounts
Item
No. Date Description Adiusbnents
1. 11-15 Late Payment Charge 1.5% 5.49
27.00
Payments
Questions? Call:
Plans and Services
1 800 321-2000
Repair:
1 800 246-8464
Internet Services:
1 877 722-3755
Total Current Charges
Page
1
· PREVENT DISCONNECT · CARRIER INFO
· KEEP YOUR DISCOUNT · CENTRALINK 1100
· BRI PRICE INCREASE · PRICE INCREASE
· MANAGING FEATURES · E-REPAIR
See 'News You Can Use' for additional information,
360.O3
360.03
Promotions and Discounts
2. Save Elite-S Conn-$27 off -12mo term 27.00CR
Monthk/Service - Nov 1S thru Dec 14
Charges for ~8 442-0165
3. Monthly Charges 144.60
50.35
50,35
50.35
Charges for 860 ~A3~851
4. Monthly Charges
Charges for ~O MA-0320
5. Monthly Charges
Charges Ior ~O 447-9371
6. Monthly Charges
Total Monthly Service
CMl Charges
Bus Block st Time 700 II ZY Summaq' 834 Minutes Used
700 Minutes Allowed
instate Long Distance
Out of State Long Distance 4.92
Call Plan Summary Total 5.74
7. Bus Block of Time 700 Ii 2Y
Charges for ~68 44Z-0165
Item
No. Date Time P!R~? Nqmber Code
Itemized Calls
8. 10 16 314P FISHERS IS NY 631 788 7394 2 0:30+
*BASIC $495.40 NON BASIC $242.05
at&t
FISHERS ISLAND FERRY DISTRICT Page
PO BOX H Account Nmnbar
FISHERS ISLE NY 06390-0607 Billing Dnte
Web Site
2of7
860 442-0165 07~J
Nov 15, 2011
att.com
Call Charges - Continued
Item
No. Date Time Place
1.10-17 815A FISHERS iS
2.10-17 823A FISHERSIS
3.10-17 850A FISHERSIS
4.10-17 928A FISHERSIS
5.10-17 959A FISHERSIS
6. 10-17 1086A WILUMNTIC
7.10-17 1109A FISHERSIS
Number
NY 631 788-7326
NY 631 786-7463
NY 631 788-7326
NY 631 788-7141
NY 631 786-7444
CT 860 234-2059
NY 631 786-7345
8.10-17 1112A NEWHAVEN CT 203494-7251
9.10-17 1129A NARRAGNSTT RI 4Ot786-6626
10.10-17 1133A RIVERHEAD NY 631 852-4561
11.10-17 115OA PROVIDENCE RI 401550-4150
12.10-17 1214P OLDSAYBRK CT 860227-1660
13.10-17 1234P OLDSAYBRK CT 860227-1660
14.10-17 1251P FISHERSIS
15.10-17 1254P PERRINE
16.10-17 1255P PERRINE
17.10-17 118P FISREBSlS
18.10-17 147P RSHEBSlS
19.10-17 2eDP WALPOLE
20,10-18 851A FISHERSIS
21.10-18 It05A HARTFORD
22.10-18 1247P FISHERSIS
23.10-18 104P FISHERS IS
NY 631 786-7345
FL 305 255-0861
FL 305 255-01 I1
NY 631 786-7193
NY 631 786-7573
MA 508641-8611
NY 631 786-7345
CT 860 729-9844
NY 631 786-7919
NY 631 786-7919
24.10-18 320P NEWBRNSWCKNJ 50~227-1515
25.10-19 716A GUILFORD
26.10-19 832A FISHERSIS
27.10-19 839A NEWPORT
28.10-19 910A FISHERS IS
29.10-19 937A FISHERS IS
30.10-19 939A FISHERS IS
31.10-19 943A FISHERS IS
32. 10-19 1009A FISHERS IS
33.10-19 1058A HARTFORD
34.10-19 1225P COVINGTON
35.10-19 1247P BRANFORO
36.10-20 500A COVINGTON
37.10-20 930A FISHERSIS
38.10-20 1049A FISHERS IS
39. 10-20 1142A GUILFORD
40. 10-201146A FISHERS IS
41.10-20 1222P FISHERS IS
42.10-20 228P FISHERS IS
CT 203458-7286
NY 631 786-7463
RI 4OI 847-2260
NY 631 786-7345
NY 631 786-7463
NY 631 786-7345
NY 631 786-7345
NY 631 786-7345
CT 860 729-8644
KY 859 240-3176
CT 203481-2321
KY 859 240-3176
NY 631 786-7463
NY 631 786-7345
CT 203458-3411
NY 631 786-7444
NY 631 786-7463
NY 631 786-7444
43.10-20 338P NEWHAVEN CT 203468-4547
44.10-21 931A COVINGTON KY 859 240-3176
45.10-21 934A NEWYORK NY 917363-4~27
46.10-21 I038A FISHERS IS NY 631 786-7345
47.10-21 1150A FISHERSIS NY 631786-7463
48. 10-211247P HARTFORD CT 860 986-7634
49.10-21 328P FISHERS IS NY 631 786-7345
Call CharDes - Continued
Item
No. Date Time Place Number
50.10-22 158P FISHERSIS NY 631788-5SO2
51.10-24 954A BALTIMORE MD 410 347-8724
Code Mi.__~n 52.10-24 1861A WALPOLE MA ,508641-8611
I 0:32+ .00 53. 10-24 1021A WALPOLE MA 508641-8611
I 16:36+ .00 54. 10-24 1086A DULLES VA 703996-8144
I 0:36+ .00 55.10-24 1148A NEWHAVEN CT 203468-4503
1 1:58+ .00 50.10-24 1149A NEWHAVEN CT 203468-4509
I 4:07+ .00 57. 10-24 1150A NEW HAVEN CT 203 468-4426
O 0:30+ ,00 58.10-24 II1P READING PA 4842506-4169
1 1:02+ .00 59.10-24 120P FISHERS IS NY 631 786-7345
O 0:30+ .(X) 60. 10-24 150P FISHERS IS NY 631 786-7919
1 0:30+ .86 81.10-24 216P ROANOKE VA 540 397-5731
1 16:14+ .00 62, 10-24 234P FISHERS IS NY 631 788-5515
1 1:31+ .86 63. 10-24 237P FISHERS IS NY 861 786-7463
§ 2:28+ .00 64. 10-24 338P FISHERS IS NY 631 788-~673
D 0:40+ .~0 65. 10-24 34OP FISHERS IS NY 861 788-7345
0:37+ .86 86,10-25 825A WATERBURY CT 203 754-5334
0:38+ .00 67.10-25 958A RIVERHEAD NY 631 852-4861
1:20+ .00 86. 10-25 1122A NEW YORK NY 212 841-2626
0:40+ .00 69. 10-25 127P FISHERS IS NY 631 788-7857
0:30+ .00 70. 10-25 386P FISHERS IS NY 631 786-7463
1:01+ .50 71.10-25 329P FISHERS IS NY 631 786-7463
0:30+ .00 72. 10-26 862A FISHERS IS NY 631 786-7867
D 2:59+ .00 73. 10-26 832A FISHERS 19 NY 631 788-7857
1 5:46+ .00 74.10-26 84OA OLDSAYBRK CT 860227-1660
1 0:30+ .00 75. 10-26 950A FISHERS IS NY 631 786-7463
1 0:40+ .00 76. 10-26 1147A FISHERS IS NY 631 788-7463
N 2:13+ .00 77. 10-26 1224P HARTFORD CT 860986-7634
2:25+ .00 78. 10-26 158P FISHERS IS NY 631 786-7345
2:01+ .00 79. 10-26 202P FISHERS IS NY 631 786-7345
0:49+ .00 86. 10-26 620P WILLIMNTIC CT 860 942-1472
0:30+ .86 81.10-27 832A FISHERS IS NY 631 788-7463
o:3o+ .00 82. 10-27 924A PROVIDENCE RI 401 301-7466
0:30+ .00 83. 10-27 1053A FISHERS IS NY 631 786-7225
0:30+ .00 84. 10-27 1055A GREENWICH RI 401 884-7800
D 1:22+ .00 85, 10-27 1101A SOUTHOLD NY 631 765-4333
I 0:47+ .00 86.10-27 1186A HARTFORD CT 860916-6867
O 3:37+ .00 87. 10-27 1231P DARIEN CT 203655-0786
1 1:28+ .00 86.10-27 1232P FISHERS IS NY 631 786-5545
1 2:37+ .00 86. 10-27 1251P FISHERS IS NY 631 786-5545
1 0:86+ .00 90.10-27 I30P DARIEN CT 203655-0786
O 0:86+ .00 91.10-27 148P FISHERSIS NY 631786-7343
1 4:13+ .00 92. 10-27 157P DARIEN CT 203 655-0786
1 0:30* .00 86, 10-27 223P FISHERS IS NY 631 786-7857
1 1:01+ .00 94, 10-27 386P FISHERS IS NY 631 786-7463
B 1:54. 00 95. 10-27 486P FISHERS IS NY 631 786-7345
I 1:48+ .00 86. 10-28 715A FISHERS IS NY 631 786-~7
1 1:46+ .86 97.10-28 818A SOUTHINGTN CT 860628-5~87
I 0:54+ .00 86. 10-28 823A FISHERS IS NY 631 786-7345
1 7:23+ .00 86. 10-28 986A FISHERS IS NY 631 786-5667
D 11:49+ .00 186. 10-28 914A FISHERS IS NY 631 786-7345
I 0:30+ .00 101, 10-28 915A WARWICK RI 401 773-9943
102.10-28 917A PROVIDENCE RI 401 369-3559
Code
0:30+ .00
1:02+ .00
2:49+ ,86
9:29+
0:53+ .86
0:30+ .86
0:39+ .00
0:30+ .00
1:34+ .86
0:33+ ,00
1:13+ .00
0:33+ .00
1:07+ .86
3:40+ .00
0:31+ .00
0:30+ .86
0:35+ .86
2:27+ .86
1:04+
0:30+ .86
0:30+ .00
0:37+ .00
4:37+
0:45+
0:58+ .50
0:42+ .80
4:19+ .00
1:12+ ,00
0:30+ ,00
0:33+ .86
0:48+ .86
0:30+ .00
0:53+ .OD
0:30+ .00
5:39+ .00
5:45+ .00
6:32+ .86
0:32+ .00
0:57+ .50
0:31+ .86
0:86+ .00
2:21+
0:49+ .00
1:86+ .00
6:14+ .00
0:30+ .86
1:50+ .00
1:44+ .50
0:58+ .00
0:34+ .86
0:44+
0:30+ .50
0:41+ .86
3080.503.035577.01.04.0860800 NYNNNNNY 71193.71193
at&t
FISHERS IS[AND FERRY DISTRICT Page
PO BOX H Account Nmaber
FISHERStSLE NY 06390-0607 Billing Date
3 of 7
860442-0165 078
Nov 15,2011
Call Charges - Continued
Item
~L~ ~ Tim~ Place
I.lO-20 936A SOUTHOLD
2.10-28 151P BRISTOL
3.10-28 158P BRISTOL
4.10-28 216P BRISTOL
5.10-28 219P FISHERSIS
6.10-20 244P HARTFORD
7.10-28 429P FISHERS ~S
0.10-31 909A FISHERS IS
9.10-31 912A FISHERS IS
10.10-31 917A WARWICK
11,10-31 932A FISHERS IS
Number
NY 631 765-4333
VT 802453-5049
VT 802403-5549
VT 802 453-5549
NY 631 788-7919
CT 860290-4100
NY 631 788-7463
NY 631 788-7463
NY 631 788-7251
RI 401 773-9943
NY 631 78e-7311
12,10-31 945A WINDSORLKS CT 860668-0044
13.1031 956A FISHERSIS NY 631788-7463
14.1031 1003A OLDSAYBRK CT 860388-1224
15.10-31 1033A FISHERSIS NY 631788-7463
16.10-31 1043A FISHERS IS NY 631788-7029
17.10-31 1059A FISHERS IS NY 631 788-7345
18. 10-311217P FISHERS IS NY 631 788-/405
19.10-31 1218P FISHERSIS NY 631788-7463
20.10-31 1257P PITTSBURGH PA 412432-0304
21.10-31 23OP FISHERSIS NY 631788-7857
22.10-31 236P FISHERSIS NY 631788-7632
23.11-01 855A FISRERSIS NY 631788-7463
24.11-01 1014A BRIDGEPORT CT 203650-0327
25.11-01 1015A FISHERSIS NY 631788-5673
26.11-01 1016A FISHERSIS NY 631763-7463
27.11-01 1046A FISRERSIS NY 63178~-7463
28.11-01 1051A FISRERSIS NY 631788-7632
29.11-01 1116A BRIDGEPORT CT 203650-0327
30.11-01 1124A NEWYORK NY 917363-4627
31.11-01 202P SOUTHINGTN CT 860637-1844
32. tl-01353P FISHERStS NY 631788-7463
33.1t-02 1051A FISHERSIS NY 631788-7463
34.11-02 1151A NEWBEDEORO MA 508 996-8591
35.11-02 1202P NEWBEDFORD UA 508996-8591
36.11-02 1216P ANSONIDRBY CT 203732-3532
37.11-02 312P READING
38.11-02 331P FISHERSIS
39.11-02 429P FISHERS IS
40. 11-03 75OA OYSTER BAY
41,11-03 926A OYSTERBA¥
42.11-03 928A NEW YORK
43.11-03 1023A FISHERS IS
44.11-03 1210P NEWHAVEN
45.11-03 1219P CLINTON
46.11 03 1250P FISHERSIS
47.11-03 343P FISHERS IS
48.11-04 908A FISRERSIS
49. 11-04 1049A ESSEX
PA 484256-4169
NY 631 788-7724
NY 631 788-7463
NY 516 922-4056
NY 516922-4056
NY 212 680-8814
NY 631 783-7463
CT 203 468-4429
CT 860 669-9272
NY 631 788-7463
NY 631 788-5685
NY 631 788-7463
CT 860662-3013
Mien
11:46+ .00
0:54+ .00
4:15+ ,00
0:56+ .00
0:32+ .00
2:49+ .(JO
0:30+ .00
3:23+ .O0
2:05+
8:01+ .00
0:30+ .00
1:51+ .00
4:47+ .00
4:57+ .00
0:38+ ,00
1:08+ .00
0:30+
0:47+
2:50+
1:04+
0:30+ .00
0:50+ .00
1:33+ .00
0:30+ .OB
0:30+ .00
2:50+ .00
1:46+
0:30+ .OB
0:51+ .IX)
1:07+
0:40+ .{30
0:30+
1:3t+
8:18+ .00
1:34+ .00
3:22+ .(30
0:45+ .00
28:13+ .00
0:43+ .(30
1:38+ .00
0:31+ .00
3:37+ .00
2:44+ .00
0:49+ .00
0:53+ .00
0:30+ .00
0:30+ .00
0:31+
2:40+
Call Charges - Continued
Item
~L~ [Z~ Tim~ Place Number
50.11-04 207P FISHERSIS NY 631788-7463
51.11 04 226P PLAINVILLE CT 860747-9911
52. 11-04 232P FISHERS IS NY 631 788-7919
53.11-04 246P FISHERS IS NY 631 788-7099
5¢ 11-04 333P FISHERS IS NY 631 788-7463
55.11-07 800A NEWYORK NY 212855-7777
56.11-07 910A PROVIDENCE RI 401441-0334
57. 11-07 1113A FISHERS IS NY 631 788-7345
58. 11-07 1132A FISHERS IS NY 631 788-7716
59.11-07 1138A OLDSAYBRK CT 860388-9895
60.11-07 1212P ATLANTANE GA 678533-1900
61.11-07 1255P FISHERS IS NY 631 788-7716
62.11-01 206P OLBSAYBRK CT 860399-9754
63.11-07 231P FISRERSIS NY 631788-5655
64. 11-08 906A FISHERS IS NY 631 788-7200
65.11-08 921A FISHERSIS NY 6317887318
66.11-08 932A NEWYORK NY 2126808814
67. 11-08 94§A SOUTROLD NY 631 765-4333
68. 11-08 1019A FISHERS IS NY 631 788-5673
69.11-08 11.56A NEWRAVEN CT 203488-4503
70.11-08 1157A NEWHAVEN CT 2034684441
71.11-08 1252P FISHERSlS NY 631788-7463
72.11-08 1255P FISHERSlS NY 63178&7463
73.11-08 103P FISHERSlS NY 631788-7323
74.11-09 748A FISHERS IS NY 631 788-7323
75. 11-09 902A FISHERS IS NY 631 788-5545
76. 11-09 110HA FISHERS IS NY 631 788-7463
77. 11-09 1127A SOUTHOLD NY 631 765-4333
78.11-09 1259P FARMINGDL NY 631 414-5808
79.11-09 117P FISHERSIS NY 631788-7463
80.11-09 302P PROVIDENCE RI 401459-1225
81.11-10 804A FISHERSIS NY 631788-5673
82.11-10 846A FISHERSIS NY 631783-7463
83. 11-10 1052A WARWICK RI 401 773-9943
84.11-10 1057A PROVIDENCE RI 401785-3781
85.11-10 1150A FISHERSIS NY 631788-7463
86.11-t0 136P ANSONIDRBY CT 203735-5933
87.11-10 348P FISHERS IS NY 631 788-7463
88.11-10 625P QUEENS NY 917834-2255
89.11-11 739A FISHERSIS NY 631788-7835
90.11-11 800A QUEENS NY 718247-2069
91,11-11 80lA QUEENS NY 718247-2069
92.11-11 838A FISHERS IS NY 631 788-7311
93.11-11 847A PROVIDENCE RI 401 353-6500
94.11-11 958A WINDSORLKS CT 860668-0044
95.11 11 959A WINDSORLKS CT 860668-0044
96.11-11 1008A COLUMBIA CT 860228-2296
97.11-11 1009A COLUMBIA CT 860228-2296
90.11-11 306P FISHERS IS NY 631 78&7919
99.11-14 756A WALLINGFO CT 203679-0100
100.11-14 804A NEWYORK NY 212855-7777
101.11-14 901A FISHERSIS NY 631788-7919
102.11 14 915A FISHERS IS NY 631 788-7345
Code
0:30+ .00
0:30+ .00
4:39+ .00
0:31+ .00
5:14+ .00
11:12+ .00
5:03+ .00
0:30+ .00
0:30+ .00
0:36+ .00
2:24+ .00
1:04+ .00
2:03+ .00
0:52+ .00
0:50+
10:48+ .00
1:08+ ,00
1:27+ .00
0:58+ .00
0:30+ .00
0:30+
1:17+ .00
0:47+ .00
0:30+
0:30+ .00
9:48+ .00
0:30+ .00
4:27+ .00
0:34+
18:08+ .0O
0:42+
l:0l+ .BO
22:22+ .00
0:50+ .00
2:00+
0:30+ .00
2:32+ ,00
6:0~+ .00
0:30+ .00
0:30+ .00
1:06+ .00
0:30+ .00
0:37+ .00
0:38+ .00
0:49+ .00
1:31+ .00
0:30+ .00
0:30+ .00
0:45+ .00
1:09+ .00
6:43+
0:47+
0:30+ .00
at&t
FISHERS ISLAND FERRY DISTRICT
PO BOX H
FISHERS ISLE NY
Page
Acco#or Number
Billing Dale
4of7
8~0 442-0165 07'8
Nov 15, 2011
Call Charges- Coednlmd
Item
No. ~ Time Plot{:
1.11-14 927A FISHERSIS
2.11-14 1882A FISHERS IS
3.11-14 1026A GLASTON BY
4.11-14 1030A FISHERSIS
§.11-14 1107A ESSEX
6. 11-14 1136A FISHERS IS
7.11-14 1202P FISHERS IS
8.11-14 1216P FISRERSIS
9.11-14 1230P QUEENS
10.11-14 128P FISHERSIS
11.11-14 144P HARTFORH
12.11-14 330P FISHERSIS
13.11 14 401P HARTFORD
Total Itamize0 Calls
Total Charges for 860 442-0165
Charges for 868 443-6E1
Itemized Calls
14. 10-17 1084A FISHERS IS
16.10-17 1128A FISHERSIS
16.10 17 887P FISHERSIS
17.]0-18 913A FISHERS IS
18. 10-18 1083A FISHERS IS
19.10 18 1181A FISHERSIS
20. 10 18 248P FISHERS IS
21.10-19 1026A FISHERS IS
22.10-10 311P FISItEBSIS
23.10-20 188SA FISHERSIS
24.10-21 950A FISHERS IS
25. 10-21 329P FISHERS IS
26.10-22 251P FISHERS IS
27, 10-24 1052A FISHERS IS
28.10-24 311P FISHERSIS
29.10-28 101§A FISHERS IS
30. 10-26 247P FISHERS IS
31.10-26 714A FISHERSIS
32.10-26 IO]7A FISHERS IS
33.10-26 230P FISHERSIS
34.10-27 IOIOA FISHERS IS
35.10-27 1154A FISHERS IS
36.10-27 11§9A FISHERS IS
37.10-27 1203P FISHERS IS
38.10-27 288P FISHERS IS
39. 10-28 942A FISHERS IS
40.10-28 312P FISRERSIS
41.10-31 1035A FISHERS IS
42.10 31 251P FISHERS IS
43.11-01 ~2A FISHERS IS
44.11-01 9r~A FISHERSIS
45.11-01 101gA FISHERS IS
Number Cod{: Min
NY 631 788-7463 1 0:30+ .08
NY 631 788-7463 1 2:09+ .(JO
CT 880 633-8770 D 1:19+ .OO
NY 631 788-7630 1 0:30+ .30
CT 808 882-3013 0 0:30-:- .30
NY 631 788-7488 1 0:30+ .00
NY 631 788-7632 I 0:88+ .08
NY 631 788-7345 I 0:31+ .88
NY 718706-7999 I 6:05+ .08
NY 631 788-7463 1 1:06+ .30
CT 880 306-7634 O 11:32+ .30
NV 631 788-7463 1 1:01+ .30
CT 860883-8925 D 0:48+ .(JO
.00
.08
NY 631 788-3022
NY 631 788 5522
NY 631 788-5522
NY 631 788-5522
NY 631 788-5522
NY 631 788-5522
NY 631 788-5522
NY 631 788-5522
NY 631 788-5522
NY 631 788-5522
NY 631 788-5522
NY 631 788-5522
NY 631 788-5522
NY 631 783-5522
NY 631 788-5522
NY 631 788-3022
NY 631 788-5522
NY 631 788-5022
NY 631 788-5522
NY 631 788-6522
NY 631 788-5522
NY 631 788-5522
NY 631 788-5622
NY 631 788-5622
NY 631 788-5522
NY 631 788-5522
NY 631 788 5522
NY 631 788-5522
NY 631 788-5522
NY 631 788-5522
NY 631 788-5622
NY 631 788-5522
0:41+ .88
0:44~- .08
0:31+ .88
0:30+ .30
0:88+ .30
0:46+ .00
0:30+ .08
0:39+ .08
0:31+ .30
0:36+ .30
0:35+ .30
0:~+ 90
0:38+ .08
0:37+ .08
0:32+ 30
0:35+ .00
0:32+ .30
0:30+ .00
0:39~ .08
0:33+ .08
0:37',- .88
2:23+ .88
1:31~. .80
1:23+ .00
0:30+ .00
0:34+ .08
0:31+ .08
0:35+ .88
0:33~ .30
0:56+ .30
0:54+ .00
0:33+ .88
Call Charges - Condnued
Item
No. gale Till7{: Place
46.11-01 229P FISHERSIS
47.11 01 351P FISHERSIS
48. ll-02 1887A FISHERS IS
49.11-02 230P FISHERS IS
30.11-03 1088A EiSHERSIS
51.11-04 IOI1A FISHERS tS
52.11-04 230P FISHERSIS
53. 11-05 148P FISHERS IS
54. 11-07 1308A FISHERS IS
55.11 07 302P FISRERSIS
30.11 08 659A FISHERSIS
57.11-88 10IIA FISHERS IS
58. 11-08 251P FISHERS IS
59.11-09 955A FISHERS IS
88.11-88 887P FISREFlSIS
61.11-10 1010A FISHERS IS
62.11-11 94OA FISHERSIS
63. 11-11 946A FISHERS IS
Number
NY 631 788 5522
NY 031 788-3023
NY 631 788-0522
NY 631 788-5522
NY 631 788-5522
NY 631 788-5522
NY 631 788 5522
NY 631 788-5522
NY 631 788-5522
NY 631 788-5522
NY 631 788-3023
NY 631 788-5522
NY 631 788-5522
NY 631 788-5522
NY 631 788-5522
NY 631 788-5522
NY 631 788-5522
NY 631 788 5622
64.11-14 718A AILANTANW GA 770966-9115
65.11-14 988A FISHERS IS
66. 11-14 1083A FISHERS IS
67.11-14 307P FISHERSIS
Total Ilemized Calls
Total Charges for 860 443-6851
Charges for 866 444-0320
Itemized Calls
68.10-17 II03A FISHERSIS
09.10 18 135P LINDENHST
70. 10-10 1238P FISHERS IS
71.10-20 938A FISHERS IS
72.10-20 928A FISHERS IS
73.11-02 887A FISHERS IS
74.11 04 903A FtSHERSIS
75.11 04 988A FISHEFlSIS
76.11-07 1210P FARMINGDL
77.11 07 1219P FARMINGDL
78.11-07 1222P FARMINGOL
79.11-08 1100A FISHERS IS
80. 11-11 524A FISHERSIS
81.11-11 546A FISHERSIS
82.11-14 1042A FISHERS IS
83.11-14 1237P FARMINGDL
Total Jlemized Calls
Total Charges for 860 444-0320
Charges for 860 447-8871
Itemized Calls
84.10-17 1037A FISHERSIS
85.10-17 1128A OLD SA¥aRK
NY 631 788 5522
NY 631 788-5522
NY 631 7888 5522
NY 631 788-5523
NY 631 225-7911
NY 631 788-5523
NY 631 788-5523
NY 631 788-5523
NY 631 788 5523
NY 631 788-5523
NY 631 788-5523
NY 631 293-6061
NY 631 293-6127
NY 631 293-6061
NY 631 788-5523
NY 631 788-5523
NY 631 788-0523
NY 631 788-5523
NY 631 293 6127
Cod~e
0:33+ .00
0:30+ .88
0:42+ .00
0:30+ ,00
0:36+ .30
0:33+ .DO
0:31+ .88
0:30+ .08
0:50+ .88
0:33+ .88
0:30+ .(30
0:44~. .88
0:34+ 30
0:38+ 90
0:32+ .08
0:40+ .88
0:88~ .88
0:33+ .08
0:~4+ .88
0:30+ .30
0:42+ .30
0:35+ .88
.08
.08
0:57+ .(JO
0:53+ .30
0:36+ .30
0:34+ .08
0:32+ .08
0:30+ .00
0:34+ .30
0:43+ .30
0:30+ .00
1:47+ .08
0:30+ .08
0:36+ .08
0:33+ .08
0:34+ .00
0:40+ .30
2:09+ .08
.08
.88
NY 631 788-7444 1 2:09+ .88
CT 860 399-9754 R 0:48+ .08
88.10-17 1151A OLOSAYBRK CT 860227-1660 D 0:30+ .08
87. 10-17 1225P OLD SAYBRK CT 860 227-1660 D 1:15+ .0O
88. 10 17 243P FISHERS IS NY 631 788-7345 I 0:30+ .00
3880.003.035577.02.04.0088808 NYNNNNNY 70165.70165
at&t
FISHERS ISLAND FERRY DISTRICT
PO BOX H
FISHERSISLE NY 06390 0607
Page
Account Number
Billing Date
5of7
860 442 0165 078
Nov 15, 2011
Call Charges - Continued
item
No. Date Time Place
1.10-17 318P FISHERSIS NY
2.10-17 332P NEWRAVEN CT
3.10-17 340P ALBANY NY
4.10-18 857A FISHERSIS NY
5.10-18 506A FISHERSIS NY
6.10-18 210P OLDSAYBRK CT
7.10-19 819A NEWYORK NY
8.10-19 937A FISHERSIS NY
9.10-19 1223P NEWYORK NY
10.10-20 341P NEWHAVEN CT
11.10-20 342P NEWHAVEN CT
12.10-21 1109A HARTFORD CT
13.10-21 1206R FISHERS iS NY
14.10-24 920A BRIDGEPORT CT
15.10-24 920A NORWALK CT
16.10-24 922A NEW RAVEN CT
17.10-24 927A NFWHAVEN CT
18.10-24 927A NEWRAVEN CT
19.10-24 958A FISRERSIS NY
20.10-24 1156A NEWHAVEN CT
21.10-24 214P FISRERSIS NY
22.10-24 253P FISHER31S NY
23.10-24 333P FISHERS IS NY
24.10-24 336P OLD SAYRRK CT
25.10-25 683A FISRFRSIS NY
26.10-25 1032A FISHERSIS NY
27.10-25 246P GUILFORD CT
28.10-25 309P FISHERSI9 NY
29.10-26 802A FISHERSIS NY
30.10-26 823A FISHERSIS NY
31.10-26 912A GUILFORD CT
32.10-26 917A WALLINGFD CT
33.10-26 1200P FISHERSIS NY
34.10-26 1222P PLAINVILLE CT
35.10-26 1239P RIVERHEAB NY
36.10-26 219P SOUTHOLO NY
37.10-26 226P NEWYORK NY
38.10-26 257P SOUTHOLD NY
39.10-26 350P SOUTHOLD NY
40.10-26 329P FISHERS IS NY
41.10-26 342P FISHERS IS NY
42.1027 757A FISRERSIS NY
43.10-27 759A FISHERS IS NY
44.10-27 923A FISHERS IS NY
45.10-27 1507A FISHERS IS NY
46.10-27 1033A COVENTRY RI
47.10-27 1034A COVEN~IRY RI
48.10-27 1036A PROVIDENCE RI
49.10-27 1037A PROVIDENCE RI
Number Code
631 788-5673 I
203868-2251 D
518402-2696 I
631 788-7345 I 0:42+
631 788-7463 I 0:30+
860227-1660 D 0:51+
917363-4627 1 1:00+
631 788-7345 1 0:37+
917363-4627 1 0:48+
203 468-4547 D 0:30+
2034684592 D 1:21+
860 986-7634 D 30:02+
631 78~-7463 1 1:42+
203336-0108 D 0:30+
203 829-/468 D 0:31+
203868-2251 D 3:59+
203 868-2251 D 0:30+
203868-2251 D 0:43+
331 788-7528 1 0:31+
203468-4444 D 1:45+
631 788-5515 1 3:04+
631 788-1444 1 2:40+
631 188-5518 1 1:08+
860227-1660 D 5:41+
631 788 7144 2 0:30+
631 788-7345 1 0:48+
203 458-7200 D 6:46+
631 788-7345 0:34+
631 788-7632 0:30+
631 788-7857 3:47+
203 458-7200 D 0:53+
203 284-0402 B 7:05+
631 788-7463 0:30+
960747-9911 D 11:59+
631 852-4561 0:59+
631 765-1938 6:22+
917 453-5040 30:15+
631 765-1938 2:41+
631 765 4333 16:01+
631 788-7463 4:00+
631 788-7463 18:43+
631 788-7345 0:39+
631 788-5673 2M 1:02+
631 788-7345 0:30+
631 788-7345 1:10+
401 392-0749 0:30+
401 392-0749 0:55+
401 556-4196 0:30+
401 556-4196 0:30+
Mi,]
2:50+ .50
1:06+ .00
0:30+ .00
.00
.00
.50
.00
.50
.50
.50
.50
.50
.50
.50
.50
.50
.50
.50
.50
.50
.50
.50
.50
.50
.50
.50
.50
.50
.00
.50
.50
.50
.50
.00
.50
.00
.31
.17
.80
.03
.04
.02
.05
.02
.04
.02
.02
Cai Charges- Cont hued
HeR1
No. Date Time Place
50. 10-27 1053A FISRERS IS
51.10-27 1154A FISHERS IS
52.10-27 1231P DARIEN
53.10-28 713A FISHERS IS
54.10-31 502A HARTFORD
55.10-31 948A SOUTBOLB
NY 631 788-7123
NY 631 788-7345
CT 203 655-0266
NY 631 788-7345
CT 860 986-7634
NY 631 765-4333
56.10-31 1152A WASHINGTON DC 202475-3406
57.10-31 1153A WASHINGTON DC 202475-3450
58. 10 31 1153A WASHINGTON DC 202475-3401
59.1031 148P DEEPRIVER CT 860526-9836
60.1031 301P FISHERSIS NY 631788-7345
61.11-02 929A FISHERSlS NY 631788-7463
62.11-02 10~A OLD SAYBRK CT 850227-2934
63.11-02 1016A PROVIDENCE RI 401467-3730
64.11-02 III2A NOKINGSTN RI 4012950373
65.11-02 1114A NOKINGSTN RI 401667-0526
66.11-02 1233P BRIDGEPORT CT 203610-4193
67.11-02 1239P DANBURY
68.11-02 340P FISHERSIS
69.11 02 358P FISHERSIS
70. TF04 1034A FISHERS IS
71.11-07 827A FISHERS IS
72.11-07 945A FISHERS IS
73.11-07 953A HICKSVILLE
74,11-07 1136A FISHERS IS
75.11-07 254P FISHERSIS
76.11-07 317P FISHERSIS
77.11-07 450P FARMINGDL
78.11-08 907A FISHERS IS
79.11-08 952A FISHERS iS
80.11-08 1037A FISHERS IS
61.11-08 1037A FISHERS IS
82.11-08 1042A FISHERS IS
CT 203 243-6455
NY 631 788-7463
NY 631 788-7463
NY 631 788-7345
NY 631 788-7716
NY 631 788-7463
NY 516 728-6771
NY 631 788-7463
NY 631 788-7463
NY 631 788-7463
NY 631 293-5061
NY 631 788q463
NY 631 788*7835
NY 631 788-7463
NY 631 788 5673
NY 631 788-5673
63. 11-00 1051A NEWBEDFORD MA 508 525-9593
84.11-11 916A FISHERSIS NY 631788-7311
05.11-11 100~A NWYRCYZN01 NY 646593-7363
86.11-14 1003A FISHERS IS NY 631 788-7835
87.11-14 1039A FISHERS IS NY 631 788-7463
88.11 14 220P POUGHKEPSI NY 914475-7500
Total Itemized Calls
Total Charges for 860 447-9371
+ - Optional Calling Plan
Key to Calling Codes
1 Peak 2 Off Peak
E Evening M Multiple Rate Periods
Total Call Charges
Code Min
I 0:30+ .02
I 0:43+ .03
0 1:13+ .05
2 1:45+ .08
D 9:03+ 39
I 7:09+ .31
1 0:34+ .02
1 0:30+ .02
1 6:52+ .30
D 0:46+ .03
I 0:30+ .02
1 3:58+ .17
O 0:42+ .03
1 1:27+ .50
1 1:30+ .06
1 6:50+ .26
O 3:49+ .16
O 3:47+ .16
3:41+ .16
0:30+ .02
1:58+
0:30+ .02
6:51+ .29
0:48+ .03
2:25+ .10
7:20+ .32
0:30+ .02
0:59+ .04
1:02+ .04
1:50+ .05
0:30+ .02
0:30+ .02
0:50+ .04
0:53+ .04
1:20+ .50
4:40+ .20
0:34+ .02
2:03+ .09
7:47+ .33
5.14
524
D Day
N Night/Weekend
35.74
at&t
Surcharges and Other Fees
AT&T Connecticut
I. Cennecbcut E 9-1 - I Surcharge - 4 Lines
2. Connec0cut Service Fund - 4 Unes
3. Universal Service Fund - Local(4 @ S1.17)
4. Federal Subscriber Line Charge - 4 Utes
Futal AF&T Connecticut
AT&T LD East
5. Federal Regulatory Fee
6. Universal Service Fund Interstate
Total AT&F Long Distance East
Toutl Smcharges and O@er Fees
Taxes
1.20
20
4,68
23.08
29.16
25
2.67
2.92
3Z.08
7. Federal
8. State SalesTax
Totol Taxes
Total Plans and Services
6.0~
17A8
Z3.56
PREVENT DISCONNECT
If your bill shows a past due amounh BOTH the Past Due amount and
Current Charges are due IMMEDIATELY, All of your bill charges must be
paid each ioonth to keep your account current and avoid collection
activities (See Terms and Conditions for further information). However,
to avoid disconnection of local service, Basic Charges MUST be paid. For
this account, that amount is:
$~44.U for Curreut Basic Charges
S250.5Z for Past Due Basic Charges
CARRIER INFO
Our records indicate that AT&T Connecticut is your carrier for instate
calls. AT&T Long Distance East is your carrier for interstate and
intemabonal calls.
KEEP YOOR DISCOUNT
You receive any discounts, reduced rates, or promotional credits de-
scribed in the AF&T Benefits section of the bill because you subscribe
to certain required services, for example, because you ar6 an
ALL DISTANCE® customer. If you remove any of the services required for a
particular discount, reduced rate, or promotional credit, your
effective rate for the associated remaiehlg service will change. Please
call your AT&T service representative if you have any questions.
CENTRAUNK 1100
EUecbve 113/2012, the monthly prices for Cenb'aUnk 1100
Month-to-Month services will iecrease by S3.00 per line. CentraLiek 1100
customers under term plans are net impacted. If you have any questions
or wish to consider other price plans for your business, please contact
your AT&T account executive or call AT&T at the toll-free number on your
bill.
BRI PRICE INCREASE
Effective 1/3/2012, the monthly price for Digital Enhancer service will
chauge, [}igital Enhancer service wiil increase from S81.30 to S102,
Please contact an AT&T Service Representative at tthe number listed on
this statement for details.
PRICE INCREASE
Effective January 3, 2012, the monthly price for Business Privacy
Manager will increase from S7.50 to Sg.00. If you have any questions or
wish to learn more about our money saving packages or other products and
services, please call ae AT&T Service Representa0ve atthe toll-free
number on you bill or visit us online at wu~v.attcom. Thank you for
choosing AT&T ConnectJcuL
MANAGING FEATURES
Our Phone Features capabdiP/allows you to change the seeings of your
local calling features online. For example, you can change your
voicemail password, acbvato or deacbvate your call forwarding, or
establisb or update your speed calling list_ Once you are registered to
use the AT&T Account Management tool, these services will be available
to you online. Go to attcom/mybusiness, to manage your custom calling
features online.
E REPAIR
The eRepair tool at attcom/repair provides answers to common repair
quesbons online. The tool also helps you t~oubleshont problems,
submit a repair request, foltow die request through resolution, or even
cancel the reguest if necessary. You'll also find easy 24/7 ontine
access to AT&T user guides, which reduces the need to store bard copies.
Instead, you'll have ready access to the most up-to-dato versions
online.
BASIC CHARGES
Basic Charges are charges for Basic Services. Basic Services include
local service and in-state toll if you are on AT&T Connecticut local
service customer. Basic Charges include: Monthly Charges for your local
line and other services, such as Totalphone and Smardink; in*stole
Calling Charges; in-state Directory Assistance Charges; the Connecticut
E 91 f Surcbmge; die Connecticut Service Fund fee; die Federal
Subscriber Line Charge; and the Universal Service Fund - Local fee.
NON-BASIC CHARGES
Non-Basic Charges are charges for Non-Basic Smvices. These charges
include: Call Charges for out of state calls, 9(]O calls and calls placed
througll alternative services providers; Call Charges for in state long
distance provided by a company other than AT&T Connecticut, out of state
Directory Assistance Charges; charges for telephone equipment and inside
wire maintenance, AT&T Voice Mail, AT&T Unified Messaging, AT&T High
Speed Intoraet,-Wireless, AT&T I DISH Network, AT&I' I DIRECTV.
Advertising in the white page directories or other media; and the
Universal Service Fund - Interstate tee,
CHARGES THAT MAY BE BASIC OR NUN-BASIC
Certain charges may be either Basic or Non-Basic, depending off the
associated service. Tbese include taxes, Late Payment Charges,
Collection Cbarges, and Additions and Cbanges to your service.
3080.003.035577.03.04.0(Xxx)go NYNNNNNY 70167.70167
at&t
FISHERS ISLAND FERRY DISTRICT
PO BOX H
FISHERS ISLE NY 0~390 0607
Page
Account Number
Billing Bale
7 of 7
860442-0165 078
Nov 15,2011
BILL PAYMENT, LATE PAYMENT CHARGES AND OTHER EEES
Failure to pay any portion of your bill may result in additional
collection action. Any partial payment made will first be applied to
Basic Charges, then to Non-Basic Charges. Failure to pay your Basic
Charges will result in interruption of your local service. If you fail
to pay your Non-Basic Charges, your AT&T Connecticut local service wdl
not be interrupted, but all of your Non-Basic services will be
terrninated. AT&T Connecticut may apply a late payment charge per month
on any unpaid balance, excluding the previously assessed late payme~lt
charges. To avoid a late charge, we must receive payment for the total
amount due no later than the date specified on your bill statement. AT&T
Connecticut will apply a $20.00 Collection Charge on an account where a
termination notice has been sent, An explanation of these charges may be
obtained by calling AT&T Connecticut at the number shown on your bill or
accessing our wetislte: http~/www, att. com/ctbillglossary
AT&T SERVICES
Local and in state long distance services, inside wire, rental sets, and
voice mail services (except where shown as provided tiy AT&T Messaging)
are provided by AT&T Connecticut Out of state long distance is provided
by AT&T Long Distance EasL Internet services are provided tiy AT&T
Internet Services. Wireless services are provided by AT&T Mobility.
3(]~.003.035577.04.04.(~(](](]0 NYNNNNNY 70169,70169
FISHERS ISLAND FERRY DISTRICT
VENDOR 001019 AT&T TELECONFERENCE SERVICES 12/06/2011 CHECK 181
FUND & ACCOUNT P.O.# INVOICE DESCRIPTION AMOUNT
SM .5710.4.000.200 04630710-1011 CONF.CALLS 10/7,10/18 107.45
TOTAL 107.45
Town of Southold, New York - Payment Voucher
Vendor Tax ID Number or Social Security Number Vendor Address
P.O. Box 2840
Omaha, NE 68103-2840
AT&T Teleconference Service
Vendor Telephone Number
Vendor Contact
Check No.
Entered by
AUdit Date
DEC 0 6 2011
Invoice
Number
Invoice Invoice
Data Total
Payee Certification
046307104141~
Net
Discount Amotmt Claimed
107.45
Pur ~ht~neb ¢ rO~e r [ Dascription of G~s or Services
Conference Calls
The undersigned (Claimant) (Acting on behalf of the above named claimant)
does hereby certify that the foregoing claim is true and correct, that no pert has
been paid, ex as therein stated, that the balance therein stated is actually
dued~(.~and owl d that taxes from which the. Title ~v~/el~Town is exempt are excl ded.
Company Name ~ Dal~ fl /, 6'~ 7~
8M6710.4.000.200
Department Certification
I hereby certify that the matarials above specified have been received by me
m goo~ condition without substitution, the services properly
performed and that the quantities thereof have been verified with the exceptions
Signatur~ iff~° discrepancies note~ payment~is approved,l !
AT&T TeleConference Services
ACCOUNT ID:
BILL DATE:
PAYHENT DUE DATE:
CUSTOHER:
04650710-00001
NOV O1 2011
PAYABLE UPON RECEIPT
ATTN: TOH DONERTY
FISHERS ISLAND FERRY DISTRICT
/at&t
BILLING INQUIRIES:
FOR OTHER QUESTIONS:
Page 3 of 10
(800) 722-3481
(412) 222-1409
Please con~act
your AT&T sales
representative.
BALANCE BROUGHT FORWARD:
PRIOR BALANCE
PAYHENTS
50.39
50.39CR
BALANCE FORWARD
NEW CHARGES - CREDIT CARD:
CONFERENCE CHARGES
OTHER CHARGES & CREDITS
TAXES
SURCHARGES
0.00
0.00
0.00
0.00
TOTAL
$0.00
NEW CHARGES - NON CREDIT CARD:
CONFERENCE CHARGES
OTHER CHARGES & CREDITS
TAXES
SURCHARGES
104.16
0.00
0.00
3.29
TOTAL
~107.45
AT&T TeleConference Services
ACCOUNT ID:
BILL DATE:
PAYHENT DUE DATE:
CUSTOHER:
04650710-00001
NOV 01 2011
PAYABLE UPON RECEIPT
ATTN= TON OOHERTY
FISHERS ISLAND FERRY DISTRICT
at&t
BILLING INQUIRIES:
FOR OTHER QUESTIONS:
Page q of 10'
(800) 722-$fi81
(~12) 222-1q09
Please con~ac~
your AT&T sales
representative.
AT&T TeleConference Services
at&t
ACCOUNT ID=
CUSTOMER:
0q630710-00001
ATTN: TOM DOHERTY
FISHERS ISLAND FERRY DISTRICT
Page 5 of 10
BILL DATE: NOV O1 2011
CONFERENCE CHARGES:
SETUP
BRIDGE CONNECTIONS
TRANSPORT
FEATURES
TOTAL PRE-DISCOUNT CHARGES
0.00
59.52
qq.6~
0.00
CHARGE DISCOUNT DISCOUNT
CATEGORY AMOUNT PERCENTAGE AMOUNT
SETUP N/A N/A N/A
BRIDGE CONNECTIONS N/A N/A N/A
TRANSPORT N/A N/A N/A
FEATURES N/A N/A N/A
TOTAL DISCOUNT
CLASSIFICATION
SUBTOTAL
AMOUNT
TOTAL
AMOUNT
FEDERAL
STATE
COUNTY
CITY
LOCAL
SURCHARGES
TOTAL
0.00
0.00
0.00
0.00
0.00
3.29
PLAN ID: WEB PROMO
PERIOD COMMITMENT
03/01/2011 THROUGH 02/29/2012
PERIOD-TO-DATE APPLICABLE CHARGES
$0.00
~q2q.90
PERIOD SURPLUS
AT&T TeleConference Services
at&t
ACCOUNT ID:
CUSTOHER=
0q65071§-00001
ATTN: TOM DOHERTY
FISHERS ISLAND FERRY DISTRICT
Page 6 of [0 '
BILL DATE: NOV 01 2011
7867.002.010758.04.06.0000000 NNNNNNNY 126441.126441
AT&T TeleConference Services
ACCOUNT ID:
CUSTOMER:
04650710-00001
ATTN: TOM DOHERTY
FISHERS ISLAND FERRY DISTRICT
Page 7 of 10
BILL DATE: NOV 01 2011
PAYMENT DETAIL
SUBTOTAL TOTAL
1. 10/51/2011 PAYMENT RECEIVED
TOTAL PAYMENTS
50. :59CR
AT&T TeleConference Services
at&t
ACCOUNT
CUSTOHER:
0fi630710-00001
ATTN: TOM DOHERTY
FISHERS ISLAND FERRY DISTRICT
Page 8 of 10-
BILL DATE: NOV 01 2011
7867.002.010758.05.06~0Q~00 NNNNNNNY 126443.126443
AT&T TeleConference Services
ACCOUNT ID:
CUSTOHER=
0fi650710-00001
ATTN: TOM DOHERTY
FISHERS ISLAND FERRY DISTRICT
Page 9 of 10
BZLL DATE: NOV 01 2011
ITEM
_QTY_ ~TYPE_
__DATE TIME__ _MINUTES_ ..__TOTAL__
AUDIO DIAL-IN TELECONFERENCES
CONFERENCE: MTD6779
HOST NAME: TOM DOHERTY
HOST NUMBER: 651-788-7465
RESERVED MINUTES:
RESERVED CONNECTIONS=
1. CONFEREE 917-857-7570 RSVLDIUSA 10/07/2011 12:01pm
Z. CONFEREE RSVLDIUSA 10/07/2011 1Z:01pm
5. CONFEREE 860-886-1750 RSVLDIUSA 10/07/2011 12:02pm
4. CONFEREE 860-916-6867 RSVLDIUSA 10/07/2011 12:02pm
5. CONFEREE 651-694-2500 RSVLDIUSA 10/07/2011 12:05pm
6. CONFEREE 860-916-6867 RSVLDIUSA 10/07/2011 12=06pm
7, CONFEREE 917-857-7570 RSVLDIUSA 10/07/2011 12:20pm
8. CONFEREE 917-857-7570 RSVLDIUSA 10/07/Z011 12:57pm
SUBTOTAL
TAXES
TOTAL FOR CONFERENCE ID: MTD6779
90
10 DIAL-IN
18 2.52
88 12.52
79 11.06
2 0.28
74 10.56
73 10.22
17 2.38
51 7,14
56.28
1,78
402 $58.06
CONFERENCE:
HOST NAME:
HOST NUMBER:
HTD1850
TOM DOHERTY
631-788-7465
1. CONFEREE
Z. CONFEREE
3. CONFEREE
4. CONFEREE
212-410-~301
212-410-4301
SUBTOTAL
TAXES
TOTAL FOR CONFERENCE ID: MTDZ850
RESERVED MINUTES:
RESERVED CONNECTIONS:
90
10 DIAL-IN
RSVLDIUSA 10/18/2011 O~=SOpm 15 2.10
RSVLDIUSA 10/18/2011 O~:50pm 114 15.96
RSVLDIUSA 10/18/2011 04:50pm 11~ 15.96
RSVLDIUSA 10/18/2011 05:05pm 99 13.86
47.88
1.51
$49.39
CALL TYPE
CONFERENCES CONNECTIONS
MINUTES
CHARGES
RESERVATIONLESS:
-800 Auto 2
12
107.45
Z 12 74~ $107.45
AT&T TeleConference Services
ACCOUNT ID=
CUSTOHER=
0q650710-00001
ATTN: TOM DOHERTY
FISHERS ISLAND FERRY DISTRICT
at&t
Page lO of 10 ·
BILL DATE: NOV 01 2011
7867.002.010758.06.06.00(](]000 NNNNNNNY 126445.126445
FISHERS ISLAND FERRY DISTRICT
VENDOR 002433 WILLIAM BLOETHE 12/06/2011 CHECK 182
FUND & ACCOUNT P.O.# INVOICE DESCRIPTION AMOUNT
SM .5713.4.000.000 113011 MAIL TRANSPORT-ii/il 750.00
TOTAL 750.00
~ Vendor No.
Town of Southold, New York - Payment Voucher
Vendor Tax ID Number or Social Security Number Vendor Address
P.O. Box 446
Fishers Island, NY 06390
William Bloethe
Vendor Telephone Number
Vendor Contact
2433
Invoice
Number
Date
11130/2011
Invoice Net
Total Discount Amount Claimed
750.00 ! 750.00
Payee Certification
The undersigned (Claimant) (Acting on behalf of the above named claimant)
does hereby certify that the foregoing claim is true and correct, that no pm has
been paid, pt as therein stated, that the balance therein stated is actually
Purchase Order
Number
Description of Goods or Services
Mail Transport Novll 1
Check No.
Audit Date
0E¢ 0 $ 2011
Town Clerk
General Ledger Fund and A~t
SM5713.4.000.000
Department Certification
I hereby certify that the materials above specified have been received by me
in good condition without substitution, the services properly
performed and at the quantities thereofbeve been verified with the exceptions
Signatu.re. _ ]~ ~discrepa les no and payment is approved.
Title ~Q~,,/~I~ Date
FISHERS ISLAND FERRY DISTRICT
VENDOR 014225 BUSINESS CARD 12/06/2011 CHECK 183
FUND & ACCOUNT P.O. ~ INVOICE DESCRIPTION AMOUNT
SM .5710.4.000.000
SM .5710.4.000.800
SM .5709.2.000.200
SM .5710.2.000.100
SM .5710.4.000.950
SM .1930.4.000.000
SM .5710.4.000.000
48026100-10/11 SPRY PRT,VEST,FEES,CAL, 383.01
48026100-10/11 NAME TAG/INT.FEE 21.79
48026100-10/11 STEEL-GAS CYL PLATFORM 352.02
48026100-10/11 MU PA PLYR,DRYDOCK L/N 563.33
48026100-10/11 PVA REG CONF REG 390.00
48026100-10/11 HEATH-VEH.DAMAGE REPAIR 790.06
48026100-10/11 PRE-PAYMENT 104.59-
TOTAL
2,395.62
--ri
Town of Southold, New York - Payment Voucher
Vendor Name ~ ~
Bank of America
[~ndor No.
14225
Vendor Addr~s
Business Card
P.O. Box ~
IWilmin_gton, DE 19886-5710
10127/2011 383.01 383.01
Check No.
Entered by ~
Audit Date
DEC 0 6 2011
Town Clerk
21.79
21.79
352.02; 352.02 v/
563.33 563.33
390.00 390.00
790.06!
'"t 790.06 v/
(/~ 04,59
Description of Goods or Sermees
/
r Part,lnd Live Vat
Fee~,Mldw Remr, Caindr
SteeI-Ges Cyl
SM5710.4,000.000
8M5710.4,000.800
SMSm5709.2.000.200
SMI~
§'ILO.
2,500.21 2,395.62
Payee Certification
Thc undersigned (CIeimant) (Acting on behalf of the above named claimant)
does hereby certify that the foregoing claim is true and correct, that no par~ has
been laid except as therein stated, that the balance therein stated is aciually
~~ ~ Titli~duc and g, and that taxes from which thc To is cxem ~ are~%~excluded. /
Title
Department Certification
the materials above specified have been received by me
properly
c been verified with the exceptions
payment is approved.
BankofAmerica
Business Card
Account Information:
www.bankofamerica.com
Mail Billing Inquiries to;
BANK OF AMERICA
PO BOX 982238
EL PASO, TX 79998-2238
Mail Payments to:
BUSINESS CARD
PO BOX 15796
WILMINGTON, DE 19886-5796
Customer Service:
1.800.673.1044, 24 Hours
TTY Hearing Impaired:
1.888.500.6267, 24 Hours
Outside the U.S.:
1.509.353.6656, 24 Hours
For Lost or Stolen Card:
1 ~800.673.1044, 24 Hours
FISHERS ISLAND FERRY DST
......... ]]] )316
Septem..?r~ 28, 201_1- O~o~r~7! ~11 ..
Company Statement
New Balance Total .................................... $4,352,12
Past Due Amount
Minimum Payment Due
Payment Due Date
Minimum Payment Warning: if you make onll
minimum payment each period, you will pay more
interest and it will take you longer to pay off your
balance.
Previous Balance ..................................... $1,851.91
Payments and Other Credits ........................... $0.00
Balance Transfer Activity ................................ $0.00
.................................... $0.00
Purchases and Other Charges ................ $2,403.28
Fees Charged .............................................. $74.64
Finance Charge ........................................... $22.29
New Balance Total ................................... $4,352.12
Credit Limit ................................................. $10,000
Credit Available ........................................ $5,647.88
Statement Closing Date ............................. 10127/11
Days in Billing Cycle ............................................ 30
Business Offers:
www,bankofsmerica.conVmybusinesscenter
Account Number
Credit Umit Total Activtty
DOHERTY, THOMAS
:----Z - ]~] --~: 7732
1,000 35.00
EASTER, MARK
- I I ~ 9726
Payments and Other Balance Transfer Cash Advance Purchases and Other
Credits Activity Activin~ Char(les Fees Char~ed
0.00 0.00 0.00 __0.00 35,00
10,000 973.52 0.00 0.00 0,00 972,88
0.64 ~
I CUSTOMER STATEMENT OF DISPUTED ITEM (Y0" must use e sepa~aie form for each dispute, Please print.)
If you believe a transact on on your sta ement is an error, complete end sign a ccpy of this form using blue or black ink, or write a detailed leffer on a separate
sheet of paper. Then return it to: PO BOX 53,10'1. PHOENIX, AZ 85072-3'1~'~ no later than 60 days after we sent you the first bill on which the transactidn or
error appeared. If you prefer to speak with a representative about your dispute, please cell '1.866.60'1.44,10, 8am-8pm Est. You do not have to pay any amount
in question while we are investigating, but you are obligated to pay the parts of your bill that are not in question.
PLEASE DO NOT ALTER WORDING ON THIS FORM OR MAIL YOUR LETTER WITH YOUR PAYMENT. Provide copies of all documentation that will
help us investigate your dispute (e.g. contracts, invoices, detailed letter, sales slips, return receipts, or second opinions).
Your Name: Account Number:
Posting Date: Transaction Date: Reference Number:
Amount: Disputed Amount: Merchant Name:
Below tell us why you think the item noted above ia in error, Check one box only.
[, 1. I certify that I do not recognize the transaction, r have attempted to e-Il
contact the merchant to verify this transaction,
L~ 2. I certify that the charge listed above was not made by me or a carson
authorized b~me to use m~' card, nor were the goods or services
represented by tlqe transaction received by me or authorized by me,
L_; 3. Although I did engage in a transaction with this merchant, I was billed
for__~ transaction(s) totaling $, that i
did not engage in, I have my card in my possession. If available, enclose
a copy of the cales s~ip for the valid charge.
[] 4. I have not received the merchandise that was to be shipped to me on
__1 I__ (MMIDD/YY). I have asked the merchant to credit my i J
account.
L7 5. Merchandise shipped to me w~s not ae described. Please explain in
detail and if applicable provide proof of return.
?~ A![hou~h I did engage in the above transaction, I dispute the entire
charge or a portion in the amount of $ . I have
contacted the merchant, returned the merchandise on__/~ /
(MM/DD/YY) and requested a credit adiustment. I am disputing this
charge because
Please supply proof of return or if unable to return merchandise please
explain.
8. I notified the merchant on ___./__/.~ (MM/DD/YY) to cancel the
preauthorized order or reservation. Please note cancellation # and if
available, enclose a copy of your telephone bill showing date and time
of cancellation. Reason for cancellatidn:
9. Although I did engage in the above transaction, I have contacted the
merchant for credit. The services to be provided on _~/~/.~
(MM/DD/YY) were not received. Please describe the services to be
received and explain the merchants failure to provide the services.
I~J 10. I was issued a credit slip that was not shown on my statement.
A copy of my credit slip is enclosed. If the merchant hae agreed to
~ 6. Merchandise shipped to me arrived damaged and/or defective, issue a credit, be advised the merchant has up to 30 days to supply this
I returned it on .~_/~1 (MM/DD/YY) and asked the merchant to credit to your account.
credit my account. Please provide oroof of return and describe how tiqe I J 11, The amount of the charge was increased from $. to
merchandise was dama¢;ed and/or defective. $ or my sales slip was added incorrectly.
Enclosed is a copy of the sales slip that shows the correct amount.
[] 12. Other: Please explain
Merchants often provide telephone numbers with their names on your billing statament~ If you do not recognize a transaction, attempt first to contact the
merchant for transaction information.
Cardholder Signature (required): Date:
Home Telephone: ( ) Business Telephone: (__~)
PLEASE KEEP A COPY OF BOTH SIDES OF THIS STATEMENT FOR YOUR RECORDS
PA YMENTS
We credit a payment es of the date we receive it if the payment is: f) received by 5:00 p.m. (Eastam Time) Monday through Friday (except legal holidays).
2) received at the payment address indicated on the front of this statement, 3) paid with a check drawn in U.S. dollars on a U.S. financier rnstitution or a U.S.
dollar money orcier~ and 4) sent in the return envelope with only the bottom portion of your statement accompanying it. Payments received after 5:00 p.m.
(Eastern Time) Friday, but that otherwise meet the above requiremects, will be processed on the next business day, which is usually the following Monday.
Saturdays, Sundays, and holidays are not business days. Credit for payments received in any other manner may be delayed up to five business days, during
which time finance charges, if applicable will continue to accrue. We will reject any payments that are not drawn in U.S. dollars and those drawn on a
financial institution located outside of the United States, Please do not send cash, credit cards, correspondence, staples or paper clips with your payment.
Mail your payment at least 7 days in advance of the payment due date to ensure timely delivery.
SERVICE FOR THE HEARING IMPAIRED: 1.888,500,6267, 24 Hours ~ .
CUSTOMER CORRESPONDENCE
If you prefer to senti a written Inqui~y regarding your account, please send the request to: BANK OF AMERICA, PO BOX 982238, EL PASO, TX. 79998-2238,
USA. This address should not be utilized to dispute merchant transactions appearing on your billing statement. Please see the paragraph above for instructions
BankofAmerica
Account Number
Crac~t Li_'ctit___~ Total Activity
SCHMID, NINA
10,000 1,430.40
FISHERS ISLAND FERRY DST
September 28, 2011 - October 27, 2011
Page 3 of 4
Payments and Other Balance Transfer Cash Advance
Credits A~#vity Activity
PurChases and Other
Cha~es Fees Char~led
0.00 0.00 0.00 1,430.40 0.00
Pos#ng Transaction
Date Date Desc#p~on
FISHER8 ISLAND FERRY DST
Account Number: 0310
10/24 10/24 LATE PAYMENT FEE
Reference Number
Amount
10/27 10/27 PURCHASE *FINANCE CHARGE*
DO~:~[~ ¥, THOMAS
Account Number: 7732
10/03 10/01 ANNUAL MEMBERSHIP FEE
35.(Y~ f
EASTER, MARK
Account Number: 9726
09/30 09/29 RLFLOMASTER 616-897-9211 MI ~.
10/06 10/05 ~ EASY2NAME LTD NEWBURY
Foreign Currency: 13.66 Country Code: GBP
Rate: 0,645862 Date: 10/06
10/11 10/10 HAMILTON MARINE SEARSPOR SEARSPOR11~.~I'~
10/13 10/12 MID CiTY STEEL CORP BOZRAH
10/17 10/14 Bast Buy 00005496 WATERFORD CT
10/17 10/14 THE HOME DEPOT 6215 WATERFORD CT
10/20 10/19 PASSENGER VES ASSN 703-518-5005 VA
10/06 10/06 INTERNATIONAL TRANSACTION FEE
SCHMID, NINA
24072801272207899700088
74058571278523000232649
24733091283200299300142
24733091286200878700057
24399001287295072659995
24610431288010181169161
244921512928499~
7405857127~_5__ _'~3,~49
Account Number: 7724
09/28 09/'27 CALENDARS,COM 800-366-3645 TX
24445001271600275584894~ '~ ~ 16.2~----~
t0/03 09/29 VALENTI CHEVROLET MYSTIC CT
10/20 10/19 CROSS SOUND FERRY 860-443-7394 CT
10/21 10/20 THE DAY ADVERTISING 8604422200 CT
2403699'
24224431293103004119041
244921512938~9984743361
Your Annual Percentage Rate (APR) is the annual interest rate on your sccounL
Annual Balance Subject Finance Charges by
Percentage Rate to Interest Rate Transaction Type
PURCHASES 8.24% V $3,290.1~ $22.29
CASH 19.99% V $0.00 $0.00
V = Variable Rats (rate may vary), Promotional Balance = APR for limited time on specified transactions.
You are a valued customer and we want you to know that we have not received your current payment due, Please send your payment due today. If you have
already mailed it, thank you.
BankofAmerica
FISHERS ISLAND FERRY DST
4802 ~O0 9990.03~1~*
September 28, 2011 - October 27, 2011
Page 4 of 4
RI... F:'LO'"'MASTE]:~:
1000 I::'oreman Road
I..'.cx.~ell,, MI 49'331
! '.-~]iO0-.. 25:S....4642
Ir~vo:i.,:::e 058731-..d.
I::'O/F'hone Date
860-442.--.0165
09---.29..-ii. 1
I...n I 'tem/l::'ar t Order
H,:::, hlumber UM Q!.y
i 852524S ', O1 I<IT I::'L.IMI::' AE~4iilii]qBL.Y
tEA
B/O Sh:i. p Un :i. t lex ten c'led
Q.l:.y (;?f.y F:'r:i. ce I::'r :i. (::e
:1. :1. 0 ,, 000 0. (X)
fid,::l:i.'t:i.onal Charges
SH]]::I::'II,IG AND I-'IAIqDI...IIqG
PAID I1"1 F:'UI...I...
THAI'II< YOU .... BOIqI'IIIE
7.95 /
cora .
Sh:i.p V:i.a:
F:'I:i:ML
]'err:: HMS
Or'der'
I::'OB: 01:;,', I G I I'.1 'T'OTAI... ::
Terms:: CI:;'fEOIT CARD SAL.E:S
Sl'xi.p
Type: CI:/IE:OIT Cfll:b) OF;: F:'r'om: l...owe:l.]., MI
$7,,95
· Thanks for Your Order Page 1 of 1
vew ~ Join the Print Secured
Our ~ I I~,~lllm~' Order Form
2011 ~ II IYJI~M~'-J i~ForMailorFaxJ G,
~el MAINE'S DISCOUNT MARINE STORE ~ Ca~log~ , ~a~ ~,~
[ [ IAll Categories -I ~
Hamilton Marine Order 147320
Thank you fc~ your order! YOU may want to write down your order number for future reference. Additio~al shipping
SITE INFO CUSTOMER SERVICE COMPANY INFO ACCOUNT INFO
Pictures are for concept only. Actual product may vary from image. Always verify against descriptions and
manufacturer information.
file://C :~Documents and SettingsLnina~Local Settings\Temporary Intemet F... 11/18/2011
Page 1 of 1
Nina Schmid
From: "Mark Easter" <measter@fiferry.com>
To: "Nina Schmid (E-mail)" <fiferry@fishersisland.net>
Sent: Monday, October 10, 2011 10:13 AM
Attach: Thanks for Your Order.htm
Subject: Emailing: Thanks for Your Order. Mm
<<Thanks for Your Order.htm>>
Nina,
The attachment is the order confirmation for a credit card purchase from Hamilton
Marine for 3 industrial work life vests that I have ordered from Hamilton marine· I hope
it will serve in lieu of a receipt. The procurement is in association with our safety
program.
10/11/2011
Order Confirmation [ Checkout I Buy Calendars Online I Calendars.com Page 1 of 1
CALENDARS COM DOGBREEDSTORE COM Spend $25 and get Free Shipping! Hi FISHERS ISLAND Logout Store Locator He~p
CALENDARS:!
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Monet 2012 Desk Pad 1 $9 99
Orderld w12107548343 ~,;/" . Sub-Total $9.99
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https://www, calendars.com/checkout/confirmation.j sp?_requestid=3795149/27/2011
CALENDARS
Billing Address
Fishers Island Ferry
P.O. Box H
Fishers Island, NY 06390
US
Your Order of September 27, 2011
Shipping Address
Nina Schmid
Fishers Island Ferry District
P.O. Box H
Fishers Island, NY 06390
US
Order Information
OrderlD
w121075483
Shipping ID
2017870893
QTY Item Description ProductlD Location
1 Monet 2012 Desk Pad 201200005904 ecH048M2
m
mm
mm
mm
mm
mm
mm
mm
mm
mm
mm
Print Date: '
Warehouse ~Ca-~on ID Bin ID Pieces Wrapped Box Size Ship Type
Information j 1 0 5 Standard
9/27/2011 11:40:19AM
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Fishers Island Ferry 6317885523 p 1
Cross Sound Ferry- Ticket Reservation r~, ,~ ~
e-Ticket Confirmation
CFosfi
This is NOT a Boarding Pass. This
document with transaction number and
bamode(s) must he printed and
presented at the ferry terminal upon
check in.
Sound Ferry
Online reservatiort number 8256385
You have reserved the following departures:
NEW LONDON To ORIENT PO LNT October 21
- Fri 9:00 AM
ORIENT POINT To NEW LONDON October 21 lllllillll
- Fri 5:00 PM ~s
Ticket TygeQtyLength Rate DiseoontSur~har~
MDAL~) 1 18F $49.50 $0.00 $2.13~
Your con,act information is:
Contact Kandy Wyrofsky
Name:
Contact Address;
5 Waterfront Park
New London
CT
Your payment information is:
Credi~Card VISA
Type:
Card ************7724
Number:
Expires: 0912
Billing Nina Schm[d
Name: Fishers Island Ferry
hrtos://www, longislandferry.conffCommon/ResevationPrint, aspx?ID=6937... 10/19/2011
CUST0~ER'S RECEIPT rio No'~- SEN° THIS RECEIPT FOR PAYMEN1
KEEP IT FOR YOUR RECORDS
5082~9E7371 ~6],],~0 06~900 ,104.~9
48 STOC~HOUSE.RD.
· BOZRkH, CT g6334
SALE
VIS~
xxxxxxxxxxx~!2G
$ ~1,~
$ 21,02
TOTAL: $ ~S2,02
CUSTOH~R CO~V
12~51AN 10112111
48 STOCKHOUSE RD P.O. BOX 156
BOZRAH, CT 96334
SOLD TO:
~******CT COUNTER SALES ******
E R **********
ORDER NO.
ORDER DT.
CUSTONEI NO.
SHIP TO: IC~
FISHERS ISLAND DISTR
CUSTONER PXCK UP
Cust Phons 9:860 442-G16S
FAX NUNBER~
CONTACT NANE~ STEYE
CT RICK
REQ DEL[V DATE:
CARRIER:
DELIV INST,x
lO/12/Sl
TERNS=
CUSTONER
CASH/CHECK/CRD
PAGE: I
451963
19t12tll
CUS191
1B7161
CARD. TAX CODE: 3
TAX PERCENTt 6.359
WH:
R DUCT CO"E
ORDER ~TY.
DESCRIPTION
SIZE
WEIGHT
PRICEZUH ANOUNT
LN.1.B WH; 1BB TAX Y
SPGB4 I/4" STEEL PLATE 48" X 48"
I EA 48" X 48" 163 LB
LN.2.G NH= 199 TAX Y -'-
:~T-~~- 2 1/2' X 2 1/~~ ~.18B TUBING 2'2"
i EA 2~2" ~ 12 LB,
LN.3.~ WNt 19B TAX Y ~_~
SC96B~~~69 6" X 19,6~ HR'~NE~*HE~V~,~~ . 12'
4 EA 12" "~: g ~ ~ ~2 LB
138. OOgO/EA~
2 5. 9999
168.00
TOTAL ORDER WEIGHT: 217
All emlea are subject to the terms
listed on the reverse s~de of this
and o
SUB-TOTAL=
''DELIVERY CHAR~E =
TAX'~
TOTAL =
331.00
21.92
362.B2
· il/21/20n e?:52 86e444e320 NARK PAGE el/el
Cmmct fozm ~bmi~ion fzom e~s~2mme ~'~" ""~ ~ '
Claire
Claire
Cksiee Rimm~r
~ZN~te Custome: Service leanager
emvw.e~/2nen~c~m
0163§ 298326
Fr~m: ~a~ r...a.~ [ma#to:me~L.~flfe~y.com]
~ ~a~e,
M
To; M~ ~r
Hi,
Yes [~t's fine.
~an~
11/21/2011
Receipt
Account Number: D24103 Order Number: d00351831
Salesperson: Mary Labasi [ Printed on: 10/20/2011
Telephone: 860-701-4292 ext 4292 [ Fax: (860) 442-5443 Emoil: m.labasi~theday.com
47 Eugene O'Neill Drive
New London, CT 06320
860-442-2200
www.theday.com
FISHERS ISLAND FERRY DISTRICT
P.O. Box H
FISHERS ISLAND, NY 06390
860-44241165
Title: The Day I Class: Public Notices 01
Start date: 10/23/2011 I Stop date: 10/26/201
Insertions: 2 I Lines: 0 ag
Title: Day Website ] Class: Public Notices 010
Start date: 10/23/20111 stop date: 10/26/2011 I
Insertions: 21 Lines: 0 ag
A preview of your ad will appear batwccn the two solid lines.
Payment lnfo~") ~/~
Total Order Pric(~: $520..~
Payment Type: Day Credit Card I Exp: 09/2012
Nina Schmid
Page 1 of 2
From:
To:
Sent:
Subject:
"Mark Easter'' <measter@fiferry.com>
"Nina Schmid (E-mail)" <fiferry@fishersisland.net>; "Randy VWrofsky (E-mail)" <rwyro@yahoo.com>
Wednesday, October 19, 2011 7:56 AM
FW: Pumhase Confirmation No. 17617420 (Mr. Mark Easter)
Steve is not going. I am taking Jesse on Wednesday and Mike on Thursday. No
overnight stay.
..... Original Message .....
From: pvainfo@passengervessel.com [mailto:pvainfo@passengervessel.com]
Sent: Wednesday, October 19, 2011 7:52 AM
To: Mark Easter
Subject: Purchase Confirmation No. 17617420 (Mr. Mark Easter)
Dear Mr. Mark Easter,
~ank you for your purchase and continued suppurL of PVA.
Date/lime: 10/19/2011 7:51 AM
Purchased By:
Mr. Mark Easter
Customer ID: 3527
(Organization: Fishers Island Fern/Distil)
(631) 788-7463
mark@fiferry.com
Your c0nfirmaUon number is: :1.7617420 Please keep this numbe~ for any references.
Shopping Ca~ Items
2011 Odginal Colonies Registration
Group Registration Mr. Mark Easter
Event 201t Original Colonies Registration
Mr. Steve Burke
Event 2011 Original Colonies Registration
Amount Quantity Total
$390.00 1 $0.00
$195.00 I $195.00
$195.00 t $195.00
Subtotal $390.00
Taxes $0.00
Shipping $0.00
Invoice Total $390,00
Grand Total $390.00
Payment $390.00
Order Balance $0.00
Shipping & Billing Information
Billing Address:
Mark East~
P.O. Box H
Rshers Island NY 06390
Unit~l States
(631) 788-7463
10/19/2011
Page 2 of 2
mark@fifem/.com
Payment Znformation
Payment Amount:
Payment Method:
Card Type:
Card Number:
Card Expiratio~ Date:
Cardholder Name:
$390.00
Credit Card
Vise
************9726
04/2013
Mr. Mark Easter
10/19/2011
BOB VALENTI AUTO MALL
BOB VALENTI
CHEVROLET-OLDSMOBILE, Inc.
Jer~y Brown Road
MYSTIC CT 08355
(860) ~a~493~ []
VALENTI FORD, Inc,
J~¢rv Bnw~n Ro~d
MYSTIC, CT 06356 []
(880) 536-4931
VALENTI
CHRYSLER-PLYMOUTH
DODGE-JEEP, Inc.
Jerry Brown Road
MYSTIC, CT 06355~
(860) 5364931 ~ ]
CELL; 631-682-6190
=,o~.,.o 24679 ~ff~LES (;ALE 544[
KARLA S HEATH
FZSHERS ISLAND, NY 06390 ~,~mp C 5 S
~-5539 ~- 7528 ~ MO: 547~
: ,,'." · : . .. ,. .; ' . :- ¥:.*. ,~'.l.T~..~5:. : :,.',*I09::~: ,'.~'.': ". . :- ... '. .'...
· ' ":C~$I~R ~I~ .". '? : ".:-'?' ".:.. ',. :.~. :.':"' '~ ;: ' '. ':' · ' · :. ~ . .. . · · r': .... :' ~.:
~r,.,~,..... · ..... ...~~ ... . .. · . ._ ~.~,~ ~ ~... --~.. .... · · . ..... : ..... .
SEE REVERSE SIDE FOR WARRANTY INFORMATION
99~N OIR~ IIN39~A L§~Lc, ggB
C8/~0 39~d 33~N olrl~ IIN33~A LG~/§898 8~:S8 888~/I8/~0
Page 1 of I
Whitecavage, Diana
From: Nina Schmid [fiferry@fishersisland.net]
Sent: Friday, December 02,2011 3:55 PM
To: Whitecavage, Diana
Subject: Re: Bank of America
Diana;
The Home Depot receipt appears to be lost. I had it in with the originals when I turned the bills over to
Randy for review. I think it may have gotten lost in the shuffle. I can check with Mark to see if he has a
duplicate but I doubt it.
Also, the $30 rebate from Staples is because they issued us new credit cards and it is a first time user
credit. That's what they told Debbie when she called them.
Nina
..... Original Message ....
From: Whitecava,qe, Diana
To: Nina Schmid
Sent: Friday, December 02, 2011 1:00 PM
Subject: Bank of America
Hi,
Thinking this over a little more about what I said for the voucher, what I think would actually work better
is if you could attach a spreadsheet with the breakdown of each line for me so I can track the receipts
better and leave the voucher as is with just 1 total per account line.
Thanks for your help,
Diana
12/5/2011
FISHERS ISLAND FERRY DISTRICT
VENDOR 003370 CITY OF NEW LONDON 12/06/2011 CHECK 184
FUND & ACCOUNT P.O. # INVOICE DESCRIPTION AMOUNT
SM .1950.4.000.000
SM .1950.4.000.000
40404-010112
6614-010112
PERS PROP TAX DUE 1/1/12 342.50
REAL ESTATE TAX DUE 1/1 21,789.38
TOTAL 22,131.88
Town of Southold, New York - Payment Voucher
Vendor Tax ID Number or Social Securi[y Number Vendor Address
Vendor Name
City of New London-Tax Dept.
Vendor Telephone Number
Vendor Contact
Invoice Invoice
P.O. Box t305
Vendor No.
$$?0
Invoice
New London, CT 06320-1309
Net Purchase Order
.-66-14 ; 101112010
10/tl20t0
Total
21,789.38
342.50
Discount Amount Claimed Number Description of Goods or Services
Check No.
Entered by ~
Audit Date
Town Clerk --
General Ledger Fund mid Account Number
21,789.38 Real Estate Tax 8M1980~4.000.000
Installment Due 1/t/12
342.60
List of Oct 12010
Peru. Prop. Tax Duet/l/12
22,131.88 22,131.88
Payee Certification
The undersigned (Claimant) (Acting on behalf of the above named claimant)
does hereby cer~i~hat the foregoing claim is true and correct, that no pan has
d~u;nanpeid, t h:raitaxneSstaf~n~ twh ;tier ~; hb~on c e therein stated is a~;lledy'
Department Certification
I hereby certify that the mater/als above specified have been received by me
in good condition without substitution, the services properly
performed and tha e quantities thereof h ve been verified with the exceptions
Signature i~:~//°r screpancie noted, an is approved.
Town of Southold, New York - Payment Voucher
Vendor Tax ID Number or Social Security Number
Vendor Name
CiO/of New London-Tax Dept.
Vendor Telephone Number
Vendor Contact
Invoice
6614
Invoice
Date
101112010
10111201(~
Total Discount
21,789.38I
i Vendor No.
3370
Vendor Address
P.O. Box 1305
NeW Lond~ C~ 0632~-1306
Net
Amount Claime~
21,789.38
342.50
22,13t.88 I 22,131.88
Payee Certification
The undersigned (Claimant) (Acting on behalf of the above named claimant)
does hereby cer tif~,~hat the foregoing claim is frae and correct that no part has
been paid, therein stated, that the balance therein stated is actually
duc and~ret~t~loednat taxes from which the To~x~' exempt ar~.~excluded.
)./i
-r~ -~)~ //ty/ / / / ·
Number
Description of Goods or Services
Real Estate Tax
Installment Due 1/1/12
List of Oct/2010
Pers. Prop. Tax Duel/l/12
Check No.
Entered by
~own Clerk
SM1950.4.000.000
Department Certification
I bareby certify that the materials above specified have been received by me
in good condition without substitution, the services properly
performed and that/lbo quantities t hereof h)lT, e been verified with the exceptions
or ncie noted, an is approved.
Title /iA, Date
PERSONAL PROPERTY TAX BILL
WITHOUTSTATEASSISTANCE OF$33,803,021 CITY OF NEW LONDON
THE MILL RATE WOULD HAVE BEEN 47.17 MILLS 181 State Street · P.O. Box 1305
NO BILL-WILL BE MAILED FOR New London, CT 06320-1305
J?,NUARY 1 ST PAYMENT 860-447-5208
MANE CHECKS PAYABLE TO: CITY OF NEW LONDON
PROPERTY DESCRIPTION NON REGMV
RETURN WITH SECOND PAYMENT
LAST DAY TO PAY WI~-IOUT PENALTY FEBRUARY I 2012
40404
LI~NUMBER DI~ CODE ONGRANDUST ~LTAXDUE FIRST~YMENTDUE SECONDPAYMENTOUE
40404 ON October 1,2010
MiLL~TE G~$$~SEe~IENT EXEM~ION N~SE$$MENT July 1, 2011 Jan. 1, 2012
25.31 27064 0 27064 685.00 342.50 342.50
FISNERS ISLAND FERRY DIST
PO BOX H
FISNERS ISLAND NY 06390-0607
REAL ESTATE TAX BILL
WR'HOUTSTATEASSISTANCEOF$33~803,021 CITY OF NEW LONDON
THE MILL RATEWOULD NAVE BEEN 47J 7 MILLS 181 State Street, P.O. Box 1305
NO BILL WILL BE MAILED FOR New London, CT 06320-1305
JANUARY 1 ST PAYMENT 860-447-5208
MAKE' CHECKS PAYABLE TO: CITY OF NEW LONDON
PROPERTY DESCRIPTION STATE ST
RETURN WITH SECOND PAYMENT
LAST DAY TO PAY WITHOUT PENALTY FEBRUARY 1. 201 2
6614
LI~NUMBER DI~ CODE ONGRANDLIST TOTALTAXDUE FiRST~ENTDUE SECONDPA~ENTOUE
6614 CC October 1,2010
SOUTIiOLD TOWN OF
PO BOX H
FISHERS ISLAND NY 06390-0607
FISHERS ISLAND FERRY DISTRICT
VENDOR 005029 MARK EASTER 12/06/2011 CHECK 185
FUND & ACCOUNT P.O.~ INVOICE DESCRIPTION AMOUNT
SM .5710.4.000.950 112111 EXPS-PVA REGIONAL CONF 82.59
TOTAL 82.59
Town of Southold, New York - Payment Voucher
Vendor Tax 1D Number or Social Security Number Vendor Address
162 Gager.R~ad
Bozrah, CT 06334
Mark B. Easter
Vendor No.
Vendor Telephone Number
Vendor Contact
Invoice
Number
//~/ / /
Invoice
Date
11/21/2011
Total i Discount iAmount Claimec
82.59 i 82.89
82.591 ~ 82.59
Payee Certification
Thc undersigned (Claimant) (Acting on behalf of thc above named claimant)
does hereby certify that the foregoing claim is true and correct, that no part has
been ' t as therein stated, that the balance therein stated is actually
due an that taxes from which the Town ' exempt are excluded
/
Purchase Order
Number
5029
Check No.
Entered byc~
Town Clerk
Description of Goods or Services
laVA Reoional Conferenc
travel/Expense Relmb.
Toll, Parking, Lunch
Genelat Ledger Fund and Account Number
8M6710.4.000.950
Department Certification
I hereby certify that the materials above specified have been received by me
m good condition without substitution, the services properly
performed and tha the quantities thereof have been verified with the exceptions
Signature orl~f[~ ~'screpanc s noted payment is approved.~ t
Town of Southold, New York - Payment Voucher
Vendor. Tax ID Number or Social Security Number Vendor Address
Mark B. Easter
Vendor Telephone Number
Vendor Contact
Number
I h-~voice Invoice
Date Total
1112112011 82.59
82.59 I
Payee Certification
Discount
152 Gager Road
Bozrah, CT 06334
Amount Claime~ Number
82.89
82.59
The undersigned (Claimant) (Acting on behalf of the above named claimant)
does hereby certify that the foregoing claim is Uae and correct, that no part has
been ' t as therein stated, that the balance therein stated is actually
due an that taxes from which the Town exempt are excluded.
i Vendor No.
5029
Eheck No.
Entered by
Description of Ooeds or Services
PVA Regional Conferenc
Travel/Expense Reimb.
Toll, Parkin~l, Lunch
Town Clerk
SM5710.4.000.950
Department Certification
I hereby certify that the materials above specified have been received by me
in good condition without substitution, the services properly
performed and th the quantities thereof have been verified with the exceptions
or~ 'screpanc s noted payment is approved.
Signature l~req? >t ~
FISHERS ISLAND FERRY DISTRICT
VENDOR 005288 CATHERINE EDWARDS 12/06/2011 CHECK 186
FUND & ACCOUNT P.O.# INVOICE DESCRIPTION AMOUNT
SM .5710.4.000.000 112911 RECORD MINUTES-COMM.MTGS 420.00
TOTAL 420.00
Town of Southold, New York - Payment Voucher
Vendor Tax ID Number or Social Securily Number
Catherine Edwards
Vendor Telephone Number
Vendor Contact
Number
Date
t 112912011
Total Discount
420.00,
Payee Certification
The undersigned (Claimant) (Acting on behalf of the above named claimant)
does.~j~y,~r~i fy that the foregoing claim is true and correct, that no part has
t ~s therein stated, that the balance therein stated is actually
d that taxes from which the '~ 's exempt are excluded.
Title
~'
P.O. Box 693
FIs~hers Island, NY 06390
Net Purchase Order
Amount Claime( Number
420.00
i Vendor No.
Check No.
Entered by ~
Audit Date /
DEC 0 6 2011
Description of Goods or Services
Recorder of Minutes
Comm. Mt~ls
4.75 Hm ~$201hr - 7~ aa
13 Hm~$251hr ~ ~Z~ ~o
General Ledger Fund lind Account N~-aber
8M5710.4.000.000
Department Certification
that the materials above specified have been received by me
in good condition without substitafion, the services properly
luantities thereof have been verified with the exceptions
payment is approved
October 4, 2011
October 5, 2011
October 7, 2011
October 12, 2011
November 1, 2011
November 8, 2011
November 10, 2011
November 14, 2011
November 15, 2011
November 15, 2011
November 29, 2011
attend Ferry District meeting in New London
type minutes from meeting on 11/41//
research minutes per request of
Commissioner Brooks
revisions and e-mail to commissioners I hour
attend Ferry District meeting 2 hours
type minutes from meeting on 11/4 3 hours
assist Nina Schmid with minutes from 10/18 1 hour
revisions and e-mail to Nina Schmid 0.5 hours
attend Ferry District meeting and e-mail 2.5 hours
resolutions to Nina Schmid
type minutes from meeting on 11/15 3 hours
revisions, verify resolutions 1 hour
1.25 hours
2 hours
0.5 hour
TOTAL
4.75 hours @ $20/hour = $95.00
13 hours @ $25/hour = $325.00
$420.00
FISHERS ISLAND FERRY DISTRICT
VENDOR 005414 ELECTRICAL WHOLESALERS, INC. 12/06/2011 CHECK 187
FUND & ACCOUNT P.O.# INVOICE DESCRIPTION AMOUNT
SM .5710.4.000.000 S021391822 ELECTRIC/LL SUPPLIES-NL 52.01
TOTAL 52.01
Town of Southold, New York - Payment Voucher
Vendor Tax ID Number or Social Security Number Vendor Address
Vendor Name
Electrical Wholesalers Inc.
Vendor Telephone Number
Vendor Contact
Invoice
Invoice Invoice
Lockbox 9761
Vendor No.
5414
P.O. Box 8500
Philadelphia, PA 19178-9761
Net ; Purchase Order
Ch~kNo.
IS"/
Entered by ~
Audit Date
DEC 0 6 2011
Town Clerk
Number
S021391822
Date
11~12011
Total Discount
52.01
52.Ol
Payee Certification
The undersigned (Claimant) (Acting on behalf of the above named claimant)
Amount Claime~
62.01
52.01
does h~by certify that the foregoing claim is true and correct, that no part has
be ' , except as therein stated, that the balance therein stated is actually
da 'ng, and that taxes from which the To is exempt xcluded.
Number
Description of Goods or Services
Electrical Supplles-NL
General Ledger Fund and Account Number
8M6710.4.000.000
Department Certification
I hereby certify that the materials above specified have been received by me
in good condition without substitution, the services properly
performed and that the quantities thereof beve been verified with the exceptions
Signatare ori~ noted~ is approved.
Ele¢lrlclil II~holeN411er~ I#c.
ELECTRICAL WHOLESALERS INC.
P.O. BOX 261797
HARTFORD, CT 06126-1797
Branch: 163 STATE PIER ROAD NEW LONDON,CT 06320
860/443-4381
2151AB0.368 EO215X 10496D396277814P9208530001:0001
IIl,,,H.,hhml,,.dmH,Hl,,m.,,qh,,mll.q,,,m,
FISHERS ISLAND FERRY D,
PO BOX H
FISHERS ISLAND NY 06390-0607
INVOICE
Invoice #: S021391822.000
Invoice Date: 11/07/2011
Account #: 28370
Ticket #: B86810
Please Remit AII Payments To:
Electrical Wholesalers, Inc
Lockbox~ 9761
PO Box 8500
Philadelphia, PA 19178-9761
VISIT US AT: www.usesi.com/ew
SHIP TO
FISHERS ISLAND FERRY DI
Customer COUNTER P/U at:
NEW LONDON, CT 06320
2
1
2
12
LEV 7899-1 20A 125V NEMA 5-20R IVRY
LEV 54522-21 DP 20A 277V IV AC SW
GEL F26DBXI8411ECOI4P*G24Q3*
GEL 100A/RS-120V A21 RS LAMP *12PK*
11.98
804.05
4.61
0.64
NEW!
View, print, download and pay your Invoices with ease using
Electrical Wholesaler's new Invoice Gateway.
Electrical Wholesalers continues to service our customers by now allowing easy online
access to all your invoices and statements in one convenient location.
Please visit the web address at the bottom of this page and use your uniq.ue enrollment
token to begin experiencing the benefits of this great new service.
* PAYMENT IN FULL IS DUE BY DEC 25TH * 48.9O
LAMPS/BULBS MAY CONTAIN MERCURY PER FED/STATE LAW MAY NOT BE PLACED IN 3.11
GARBAGE FOR DISPOSAL! 52.01
TERMS OF SALE
SPECIAL ORDERED NON-STOCK MERCHANDISE CANNOT SE RETURNED FOR CREDIT. NO MERCHANDISE CAN BE RETURNED FOR CREDIT WITHOUT AUTHORIZATION. MINIMUM 30%
RESTOCKING CHARGE DEDUCTED FROM ALL RETURNED MERCHANDISE. ORIGINAL INVOICE NUMBER MUST ACCOMPANY ALL CLAIMS. A SERVICE CHARGE OF 1-t/2% PER MONTH, WHICH IS
THE EQUIVALENT OF 18% PER YEAR OR AT SUCH A HIGHER RATE AS SHALL BE ALLOWEO BY LAW) ON ALL PAST DUE BALANCES. REASONABLE ATTORNEY'S FEES, COURT FEES, AND
OTHER COLLECTION COSTS MAY BE ADDED TO DEL NQUENT ACCOUNTS.
NO DISTRIBUTOR WARRANTIES UNLESS OTHERWISE SPECIFIED IN WRITING. AS VENDOR OF THIS ARTICLE S , WE MAKE NO WARRANTIES OR REPRESENTATIONS, EXPRESSED OR IMPLIED,
AS TO WORKMANSHIP, PERFORMANCE, QUALITY, DURABILITY, FITNESS, OR MERCHANTABILITY. THE ONLY ~,~RRANTIES APPLYING TO THE ARTICLE(S) SOLD HEREUNDER ARE THOSE
SPECIFICALLY PROVIDED IN WRITING BY THE MANUFACTURER.
A USESI ........ CompanYiNvOiCE GATEWAY: http:llewlnc.billtrust.com Web Enrollment Token: VMV DKX FVX Page 1 of 1
FISHERS ISLAND FERRY DISTRICT
VENDOR 005442 EMPIRE DENTAL 12/06/2011 CHECK 188
FUND & ACCOUNT P.O.# INVOICE DESCRIPTION AMOUNT
SM .9060.8.000.000 4727298 DENTAL PREMIUM-12/ll 827.83
TOTAL 827.83
Vendor No. Eh~ck No.
Town of Southold, New York - Payment Voucher Jg/9/E.--
Vendor Tax ID Number or Social Security Number
P.O. Box 202837 IAudit Date
Empire Dental Department 83703
Vendor Telephone Number Dallas, TX 75320-2837
Invoice Invoice Invoice Net Purchase Order
Number Date Total Discount Amount Claime¢ Number Description of Goods or Services General Ledl~ Fund ~md Account Number
472?288 lll'~4/20'l'l 827.83 i 827.83 De¢/20'l'l Dental $M~080.8.000.000
i
Payee Certification l)epartment Certificafio~
The undersigned (Claimant) (Acting on behalf of the above named claimant) I hereby ce~ify that the materials above specified have been received by me
does hereby cerdfy that the foregoing claim is tree and correct, that no part has in good condition without substitution, the services properly
performed and that the quantities thereof hay ~een verified with the exceptions
been paid, except as therein stated, that the balance therein stated is actuallyg~'~\
due and ow~t~nd t/~_.N ~ hat taxes from which the Town is exempt~are ! tcluded or ~ 'screpancies: ed, nent is approved.
Si'~ Titl¢(~\,\. ~ Signature
EmpireO. . INVOICE PAGE I
EMPIRE
PO BOX 659
MINNEAPOLIS MN 55440-0856
ACCOUNT NAME
ACCOUNT #
BILLING DATE
BILLING/PYMT
FISHERS ISLAND FERRY DISTRICT
ENY45B1251 INVOICE# 4727288
11/14/2011 SUBSCRIBER PERIOD 12/01/2011 - 12/31/2011
877-606-3409 CLAIM PERIOD
FISHERS ISLAND FERRY DISTRICT
ATTN: ASSISTANT MANAGER MINA SCHMID
50 TRUMBULL ST
PO BOX H
FISHERS ISLAND NY 06390
REMIT TO:
EMPIRE DENTAL
PO BOX 202837
DEPARTMENT 83703
DALLAS TX 75320-2837
CUSTOMER NUMBER OF NUMBER OF CLAIM ADJUSTMENT RATE TOTAL
CURRENT CLAIMS AMOUNT AMOUNT AMOUNT AMOUNT
REPORTING NUMBER EMPLOYEES
456125-0001-0001-550 16 291.92
36.49lEE/MO
446.70
74.45/EE/MO
89.21
88.21/EE/MO
827.83
INVOICE TOTAL 15 0 $0.00 $0.00 i $827.83 $827.83
YOUR BALANCE IS DUE BY THE FIRST OF THE MONTH.
PLEASE INCLUDE A STATEMENT COPY WITH YOUR PAYMENT.
SUBSCRIBER LISTING 1
EMPIRE
PO BOX 859
MINNEAPOLIS MN 55440-0856
ACCOUNT NAME
ACCOUNT #
BILLING DATE
ENROLLMENT
FISHERS ISLAND FERRY DISTRICT
ENY4561251 INVOICE #
11/14/2011 SUBSCRIBER PERIOD
800-928-6459
4727298
12/01/2011 - 12/31/2011
FISHERS ISLAND FERRY DISTRICT
ATTN: ASSISTANT MANAGER NINA SCHMID
50 TRUMBULL ST
PO BOX H
FISHERS ISLAND NY 06390
REMIT ENROLLMENT CHANGES TO:
EMPIRE
PO BOX 838
MINNEAPOLIS MN 55440-0838
ATTN: ENROLLMENT DEPARTMENT
CUSTOMER REPORTING NUMBER 456125-0001-0001 FISHERS ISLAND FERRY DISTRICT
SUBSCRIBER EFFECTIVE COVERAGE CURRENT RETRO TOTAL
LAST NAME FIRST NAME REF # ID DATE TYPE AMOUNT AMOUNT AMOUNT
BARRETT FREDERICK N/A 883M11083 05/01/2011 EMPLOYEE 36.49
BRONN DONALO N/A 895Ml1083 05/0t/2011 EMPLOYEE+SPOUSE 74.45
DOMERTY THOMAS N/A 8861,111083 05/01/2011 EMPLOYEE+SPOUSE 74.46
DUMOUCHEL ROBERT N/A 885Ml1083 05/01/2011 EMPLOYEE+SPOUSE 74.45
FLORA MICHAEL N/A 878Ml1083 05/0t/2011 EMPLOYEE 36.49
FOLEY PAUL N/A 877M11083 05/01/2011 EMPLOYEE 36.49
HILLER dONATHAN N/A 262M11092 07/01/2011 EMPLOYEE 36.49
HOCH RICHARD N/A 882M11083 05/01/2011 EMPLOYEE 36.49
KNAUFF ROBERT N/A 884MI 1083 05/01/2011 EMPLOYEE+SPOUSE 74.45
LEFEVRE RAYMOND N/A 881Ml1083 05/01/2011 EMPLOYEE 36.49
LYNCH MATTHEN N/A 880Ml1083 05/01/2011 EMPLOYEE 36.49
MARSHALL dESSE N/A 896Ml1083 05/01/2011 EMPLOYEE+SPOUSE 74.45
MORGAN dOHN N/A 897M11083 05/01/2011 EMPLOYEE+SPOUSE 74.45
SCHMID NINA N/A 898Ml1083 05/01/2011 EMP+CHI LD(REN) 89.21
TRAU6 dAMES N/A 876M11083 09/01/2011 EMPLOYEE 36.46
8 INDIVIDUAL 281.92 0.00 291.92
6 EMPLOYEE+SPOUSE 446.7( 0.00 446.70
1 EMP+CHI LD(REN) 89.21 0.00 89.21
SUBSCRIBER TOTAL FOR HE ABOVE CUSTOMER RE ~ORTING NUMB 15 827.83 0.00 827.83
i Emp.,.ire . . SUBSCRIBER LISTING P^GE 2
EMPIRE
PO BOX 856
MINNEAPOLIS MN 55440-0856
ACCOUNT NAME
ACCOUNT #
BILLING DATE
ENROLLMENT
FZSHERS ISLAND FERRY DISTRICT
ENY4561281 INVOICE #
11/14/2011 SUBSCRIBER PERIOD
800-928-6459
4727298
12/01/2011 - 12/31/2011
CUSTOMER REPORTING NUMBER
LAST NAME FIRST NAME REF # SUBSCRIBER EFFECTIVE COVERAGE CURRENT RETRO TOTAL
ID DATE TYPE AMOUNT AMOUNT AMOUNT
8 INOIVIDUAL 291.92 0.00 291.92
6 EMPLOYEE+SPOUSE 446.70 0.00 446.70
I EMP+CHILD(REN) 89.21 0.00 89.21
GRAND TOTAL FOR ALL TI CUSTOMER REPORTING NUMBERS 15 827.83 0.00 827,83
ENROLLMENT CHANGES MUST BE RECEIVEO AT LEAST 5 BUS[NESS DAYS
PRIOR TO YOUR SCHEDULED BILL RUN DATE.
FISHERS ISLAND FERRY DISTRICT
VENDOR 005440 EMPIRE HEALTHCHOICE, INC. 12/06/2011 CHECK 189
FUND & ACCOUNT P.O. ~ INVOICE DESCRIPTION AMOUNT
SM .9060.8.000.000
SM .9060.8.000.000
598599-D2-1211 HEALTH INS PREMIUM-12/ll 11,369.44
598599H1S-1211 HEALTH SAV.ACCT-12/ll 911.94
TOTAL 12,281.38
Town of Southold, New York - Payment Voucher
Vendor Tax ID Number or Social Sccuri~/Number
Empire HealthChoice, Inc.
Vendor Telephone Number
Vendor Contact
P.O. Box 11744
Vendor No.
Newark, NJ 07101-4744
Numbe~
.~-~ d x' ? ?-
Invoice Invoice
Date Total
-'!t/12/2011 11,369.44
11,369.44
Payee Certification
Net
Discount Amount Claim~
11,369.44
11,369.44
The undersigned (Claimant) (Acting on behalf of the above named claimant)
does hereby certify that the foregoing claim is true and correct, that no part has
~been pal pt ~s therein stated, that the balance therein stated is actually
due an and that taxes from ~vhich the To ' exempt e excluded
p~me'~/I'~Tr~//'t~-q' I Date .~ /~ , / I
~-'~ " ' ' /f// "-/1I '
Purchase Order
Number
Description of Goods ~r Services
/~///
Dec 1Health Iml Premium
D2-EmpIre Prism EPO
Check No.
Entered b~
Audit Date
General Ledger Fund and Account Number
SM9060.8.000.000
Department Certification
I hereby certify that the materials above specified have been received by me
in good conditmn without substitution, the services properly
performed and that the quantities thereof have been verified with the exceptions
or discrepancies no and payment is approved.
Signatur ~
Title ~"~l~ ' ' Date I,I/~1,,
COHHUNZTY RATED
;IROUP NUMBER SUB GRP.
598599 D2
31LLING TYPE
REGULAR GI'LL
BIL~ING FREQUENCY
HONTHLY
BENEFITS CONSULTANT
SUZANNE COOLS-LARTZGUE
DATE BILLED FRoMBILLED PERIODTo I PAYMENTDuE DATE
11/12/11 12/Ol/111 Ol/Ol/121 12/01/11,
NINA SCHMID
FISHERS ISLAND FERRY
DISTRICT
PO DRAWER H
FISHERS ISLAND, NY 06390
PAGE: 1
THE PREMIUM BILLED IS SUBJECT TO
CHANGE UNDER APPL CABLE LAW
FOR BILLING INFORMATION:
(866) 422-2583
o
PRIOR BILLING PERIOD PRIOR AMOUNT BILLED PAYMENTS I RECEIVED DATE STATUS
CURRENT BILLING PERIOD CURRENT AMOUNT BILLED NET ADJUSTMENTS
CURRENT DUE ~ ~
12/01/11 - 01/01/12 11,369.66 0.00 11,369.66
TN~S ~NVO/CE REFLECTS ALL PAYHENTS AND ADJUSTHENTS PROCESSED THROUGH 11/12/11. ANY
ADJUSTHENTS PROCESSED AFTER THIS DATE HILL BE REFLECTED ON A SUBSEQUENT INVOICE.
PLEASE SEE THE REVERSE SIDE OF TH~S PAGE FOR HORE IHPORTANT NOTICES.
To receive proper crecht, please return the BOTTOM PORTION of this page w~th your payment.
NOTICE: AS required by Labor Law, Section 217, Insurance
Law, Section 4235 and Co(les, Rules and Regulations of the State
of New York, Title 11, Insurance, Section 55.2, Eml~re
HealthCedice Assurance, Inc. hereby advises you of certain
rights and obligations set forth in these sections.
A. All covered members, subscribers and their covered
dependents shall be afforded the following rights under the
terminating policy; 1. Any claims incurred during the effective
dates of the group contract will D~ processed and adjudicated in
accordance with the terms, cond~lons and provisions of said
group contract. 2. Aeditional benefits beyond the termination date
of the contract may be available under the termination contract
tot conditions which result in a total disability, pursuant to the
terms, conditions and provisions of the terminating group
contract. 3. Rights to convert to a direct pay contract between
Empire HealthChaico Assurance, Inc. and the covered member,
subscriber or certificate I~oloer, providing for coverage which is
currently offered a direct pay basis, may be available provided
the group doeS not obtain repiacemebt coverage.
B. Further, as required by the prowslons cited above, you, as
the policyholder, may be required to meet the following
obligations; 1. The policyholder, must give written notice of the
inteheed termination to each certifmate holoer resident in New
York State insured under this group policy by hand-delivering of
mailing to the certificate holder a copy of the notice of termination
and covering letter advising the cortif~:ate holders of the intended
termination. 2. The policyhoIder's notme to the certificate holder
shall be either; a) hand-delivered by the policyholder to tho
certificate holder at the certificate holder's place of employment
(e.g. by including the neboe in the certihcete
holder's pay envelobe) at least nine days prior to intended date ·
of termination; or: b) mailed by the policyholder to each certificate
holder at the certificate holder's last known residential address at
least nine days prior to the intended date of termination. 3. The
policyholder must also pest a copy of this notice of intent to
terminate and the required covering letter m conspicuous
locations chosen as most likely to give notice to the certificate
boloers. The net~ce shall be posted at least nine days prior to the
intended date of termination. 4. In accordance with the prowslons
of Labor Law, Section 217 (4), the provisions of the Cedes, Rules
and Regulahons of the State of New York, Title 11, Insurance
Section 55.2 and Labor Law, Section 217 (3) shall not bo deemed
to appty if, at least 10 days prior to the date of the intended
term~netlon, as specified in the nobt;e of intent to terminate, the
policyholder has: a) taken necessary steps whereby the intended
termination is rendered null and void; or: b) contracted with
another insurer to replace the existing insurer for the providing of
similar coverage for the same certificate holoers, and filed an
affidavit with the Commissioner of Labor and Superintendent of
Insurance to that effect. Affidavits filed with the Commissioner of
Labor shall refer to Labor Law, Section 217, and bo addressee to:
D~rector of Labor Standards-Oepartment of Labor-Agency Bmldmg
12, State Off, ce Building Campus-Albany, New York, 12240.
A~l'idavits tiled with the Superintendent of insurance shall refer to
Labor Law, Section 217 and the Cedes, Rules and Regulations of
the State bt New York, Title 11, Insurance, Section 55.2 Part, and
shall bo addressed to: Chief, Health and Life PolJcy Bureau New
York State Insurance Department-Agency Building 1-Albany, New
York 12223.
IMPORTANT NOTICES
Fall payment of this invoice is required in order to avoid termination of your coverage. If you have any individual
adjustments that require processing, please use the attached .4djustments Worksheet. Do NOT increase/reduce your
payment of this invoice on the basis of the adjustments detailed on the worksheet. Your next invoice will show
any credits allowed or additional charges due as a result of processing the adjustments.
Payment of this invoice is due upon receipt. Please pay promptly, as no reminder notice will be sent. If payment is
not received within the 30-day grace period, your coverage will AUTOMATICALLY BE CANCELLED as of the
date to which prermums have been paid. Empire is not financially responsible for claims incurred beyond the
premium paid to date.
In order to ensure proper crediting of your payment, you must mail your remittance to the address appearing on the
face of this invoice. Sending payments to any other address may delay processing and cause your coverage to be
terminated.
Group Number: 598599 D2
Group Name: FISHERS ISLAND FERRY
INDIVIDUAL
DETAIL
Bill Period: 12/01111 To 01/01112
Paymeht Due Date: 12/01111 SXPCANAT~ON OF C,ANGE TYPE CODES:
Prepared Date: 11112111 T[.. - Tlralflltio. CHGOUT - Contract Chanl. Out
PAGE: 2
SUB INDIVIDUAL'S CONT CHANGE
INDIVIDUALS NAME GRP IDENTIFICATION N¢)KG TYPE TYPE ADJUSTMENT PERIOD AMOUNT DUE
B~pire HealthChotce
Assur&noe, Znc
BARRETT FREDERZCK 88886607 001 12 568.82
BROHN DONALD 85377836 001 15 1,136.48
BURKE STEPHEN G 855X5734 OOX X2 568.82
DOHERTY TNONAS 88240378 OOX X5 1,136.48
DUHOUCHEL ROBERT # 85785679 OOX X5 1,X36.48
EASTER HARK B 88955198 001 12 568.82
HXLLER JONATHAN X 84838644 001 12 S68.82
HOCH RXCNARD E8742559 OOX 22 $68.82
LEFEVRE RAYHOND 86638861 001 12 568.82
NARSHALL JESSE 89420041 001 15 1,136.48
HORGAN JOHN E 87023977 001 14 1,704.14
RXCKER KENNETH H 88006302 001 12 568.82
SCHHXD NXNA 89633561 001 12 568.82
TRAU~ JANES G 8?.517144 001 12 568.82
PAGE TOTAL: 11,369.44
TOTAL CURRENT AHOUNT PLUS CHANGES: 11,369.44
BALANCE DUE FROH PRXOR BZLL(S): 0.00
TOTAL AHOUNT DUE: 11,369.44
Group Number: 596599 D2
Group Name: FISHERS ISLAND FERRY
Bill Period: 12101/11 To 01/01/12
Paym,~nt Due Date: 12101111
Prepared Date: 11/12111
PAGE:
CONTRACT I RATES I COUNTS SUMMARY
GROUP / PACKAGE CONTRACT TYPE RATE COUNT
598599 D2 / 001 12 568.82 8
14 1,704.14 1
15 1,136.48 4
22 568.82 1
PACKAGE SU~ TOTAL
GROUP TOTAL
PLEASE SEE REVERSE OF THXS PAGE FOR A SUNHARY OF COVERAGE DESCRXPTXONS
CONTRACT TYPE TOTALS
CONTRACT TYPE SXNGLE TNO PERSON FANXLY GRAND TOTAL
NO. OF CONTRACTS 9 4 I 14
3
GROUP / PACKAGE DESCRZPTZON OF COVERAGE
598599 ~Z / OOX
EHPZRE PRXSH EPO
CARVEOUT EHPZRE PRXSH EPO
HARAGED CARE
DRUG AND VXSXON
www.~np~b~.com
Member Change/Termination/Reinstatement Worksheet
To be completed by employer for Empire members.
Group Name
FISHERS ISLAND FERRY DISTRICT
Name aad Title
Group Number
598599
Signature
SubdivisionD2 Dale
See reverse side for instructions. Do not return
with your payment. Fax your completed
worksheet to 1-800-780-1224. Or go to
www.~npireblue..com to process these
transactions online.
Member Chan e Termination Reinstatement Worksheet Instructions
How To Complete The Worksheet
Please print legibly ia ballpoiat pen. Fill ia all fields that apply.
COLUMN
INSTRUCTIONS
1. Member ldenth~wation Number Enter the member's identification number under which the member is covered.
2. Member Name Enter the full name: last name followed by first name and middle initial.
3. Member Address Enter the member's most current address.
4. Type Enter the type of request. Member Request types include:
C = Ciaange
T = Termination
R = Reinstatement
Please note: For change requests you may only make changes to downgrade a contract (i.e. change from family policy
to single policy). For all other changes, please submit an application.
5. Reason Code En~r the reason code for the request. Reason codes include:
D = Deceased
LE = Left Employment
ME ---Medicare Eligible
O = Other
TIE = Terminated In Error
TOC = Transferred to Other Coverage
· Sixty (60) days' notification is required when a portion of or the entire group is being transferred.
A copy of the health maintenance organization's (HMO) invoice, if applicable, must accompany the request.
·
6. Last Date Employed Enter the last date the member was employed.
7. Requested Termination Date When you terminate a member's coverage, enter the effective date of termiaation that is being requested.
The effective date is the date of the termination or your group's billing day ia the month ia which the termination occurred.
How To Submit The Worksheet:
Fax yollr completed worksheet to 1-800-78~- 1224. To avoid delays, do not return this worksheet with your payment. Keep a copy of your completed worksheet for
your records.
As a fast alternative, go to Employer Online Services at www.empireblue.com to process these transactions online:
1. Click on 'Employersx Tab
2. Select 'Log In*
3. Under 'Select Employee~, enter your emplo?ee's Empire ID or name. Hit 'Go'. ,
4. On your 'Employee Administration: Profde page, click on the type of change you d like to make.
After you receive a confirmation screen, print and file this screen for your records.
You can also mail your completed worksheet to: Empire, PO Box 1407 Church Street Station, New York, NY 10008-1407
If you are reinstating a terminated member, please fax or mail proof of the member's employment during the period of termiaation or a COBRA election form
Cff applicable) along with your worksheet.
Reminders
in order to comply with your plan's policies, member changes, terminations and reinstatement requests must be reported promptly.
·
The 'Important Notices' section of your invoice details the maximum allowable retroactivity rules.
·
Member Reinstatements will be considered within 3il days from the day we process your request for termination. After that period, a new application (Notice of Election)
·
will be required, subject to new em'ollment eligibility.
SgMB2K (07/11)
Town of Southold, New York - Payment Voucher
Vendor Tax ID Number or Social Security Number
Empire HealthCholce Assurance, Inc.
Vendor Telephone Number
VendorContact
Invoice
Date
._///1212011
Invoice I
Total Discount
P.O. Box 11744
Newark, NJ 07101-4744
Vendor No.
Net
Amount Claimed
91'~,04i : 911.94
Purchase Order
Number
Description of Goeds or Services
Health Savln~ls Accounts
Decemberl2011 Premium
Hsl
Check No.
Audit Date
General Ledgex Fund and Account Number
8M9060.8.000.000
Payee Certification
The undersigned (Claimant) (Acting on behalf of the above named claimant)
does hereby certify that the foregoing claim is m~e and correct, that no pert has
been peid t as therein stated, that the balance rein stated is actually
due~e~~]and that taxes from which, theTitlTO~empt excluded.
Department Certification
I hereby certify that the materials above specified have been received by me
in good condition without substitution, the services properly
performed and that the quantities thereof have been verified with thc exceptions
COMMUNZTY RATED
~ROUP NUMBER SUB GRP.
598599 HIS
31LUNG TYPE
REGULAR BZLL
31LLING FREQUENCY
HONTHLY
)ENEFITSCONSULTANT
SUZANNE COOLS-LARTZGUE
DATE BILLED
11/12/11
12/01/11 01/01/12
PAYMENT
DUE DATE
12/01/11
NINA SCHMID
FISHERS ISLAND FERRY
DISTRICT
PO DRWAER H
FISHERS ISLAND, NY 06390
PAGE: 1
THE PREMIUM BILLED IS SUBJECT TO
CHANGE UNDER APPL CABLE LAW
FOR BILLING INFORMATION:
(866)422-2583
PRIOR BILLING PERIOD PRIOR AMOUNT BILLED PAYMENTS I RECEIVED DATE STATUS
CURRENT BILLING PERIOD CURRENT AMOUNT BILLED NET ADJUSTMENTS CURRENT DUE
12/01/11 - 01/01/1:) 911.94 0.00 911.94
THZS ZNVOZCE REFLECTS ALL PAYMENTS AND ADJUSTHENTS PROCESSED THROUGH 11/12/11. ANY
ABJUSTHENTS PROCESSED AFTER THZ$ DATE MZLL BE REFLECTED ON A SUBSEQUENT ZNVOZCEo
RATES ~NCLUDE AN EHPZRE TOTAL BLUE(SN) ADNZN~STRAT~ON FEE FOR ALTERNATE FUNDING
ARRANGENENT$ (HNA/HSA).
THE COST OF PROVZDZNG THE NENTAL HEALTH BENEFZTS REQUZRED BY "TZHOTHY'S LAM", STARTZNG
ZN :)007, ZS ESTZHATED TO BE ~2.68 PER HEHBER PER HONTH. "NEI4BER" HEANS EACH COVERED
EHPLOYEE, SPOUSE AND DEPENDENTS. THZS AHOUNT ZS FULLY SUBSZDZZED BY N.Y. STATE AND ZS
EXCLUDED FROH THE AHOUNT BZLLED TO YOU. THE SUBSZDY AHOUNT REFLECTED ON YOUR B~LL ZS
SUBJECT TO ANNUAL REV~EN BY THE NEM YORK STATE ZNSURANCE DEPARTHENT BEGZNNZNG EACH
YEAR ON NARCH 31ST. THE NEM RATE NZLL BE REFLECTED ONCE APPROVED.
PLEASE SEE THE
NOTICE: AS require~ by Labar Law, Section 217, Insurance
Law, Section 4235 and Codes, Rules and Regulations of the State
of New YorK, Title 11, Insurance, Section 55.2, Empire
HealthChoice Assurance, Inc. hereby advises you of certain
rights and obligations set forth in these sections.
A. All covered members, sut~scribers and their covered
dependents sllall be afforded the following rights under the
terminating policy; 1. Any claims incurred during the effective
dates of the group contract will be processed and adjudicated in
accorOance with the terms, conORions and provisions of said
group contract. 2. Additional benefits beyond the termination date
of the contract may be available under the termination contract
for conditions which result in a total disability, pursuant to the
terms, conditions and prowsions of the terminating group
contract. 3. Rights to convert to a direct pay contract between
Empire HealthCholce Assurance, Inc. and the covered member,
subscriber or certificate holder, providing for coverage which is
currently offered a direct pay basis, may be available provided
the group Ooes not o~ain replacement coverage.
B. Furtrer, as required by the provisions citecl apove, you, as
the policyholder, may be required to meet the FOllOwing
obligations; 1. Tl~e policyholder, must give written notice of the
intended termination to each certificate holder reslcFoot in New
York State insured ufa:tar this group policy by ha~Cl-delivering of
maihng to the certificate holder a copy of the notice of termination
ar~ covering letter aclvis~ng the certificate holders of the intenclecl
termination. 2. The policyholder's notice to the certificate holder
shell be either: a) hand-delivered by the policyholder to the
certificate holder at the certificate holder's place of employment
(e.g. by including the notice in the certificate
holder's pay envelope) at least rune days prior to intended date
of termination; or; b) mailed by the policyholcier to each certificate
holder at the certificate holder's last known residential address at
least nine days prior to the intended date of termination. 3. The
policyhoMer must also post a copy of this notice of intent to
terminate and the required covering letter m conspicuous
locations chosen as most likely to give notice to the certificate
holders. The noboe shell be posted at least nine days prior to the
inteheed date of termination. 4. In accordance with the provisions
of Labor Law, Section 217 {4), the provisions of the Codes, Rules
and Regulations of the State of New YorK, Title 11, Insurance
Section 55.2 and Labor Law, Section 217 (3) shell not be deemed
to apply if, at least 10 days prior to the date bt' the intended
termination, as specified in the notice of intent to terminate, the
policyholcier has; a) taken necessary steps whereby the intended
termination is rendered null and void; or; b) contracted with
another insurer to replace the existing insurer for the providing of
simdar coverage for the same certihcate holders, and hle~ an
affidawt with the Commissioner of Labor and Superintendeot of
insurance to that effect. Affidavits filed with the Commissioner of
Labor shall refer to Labor Law, Section 217, and be addressed to:
D~rector of Labor Star.lards-Department of Labor-Agency Builcling
12, State Off, ce Builcling Campus-Albany, New York, 12240.
Aff~avits hied with the Superintendent of Insurance shell refer to
Labor Law, Section 217 and the Codes, Rules and Regulations of
the State of New York, Title 11, insurance, Section 55.2 Part, and
shell be addressed to: Chief, Health and Life Policy Bureau New
York State Insurance Department-Agency Bui~ling 1-Albany, New
York 12223.
IMPORTANT NOTICES
Fall payment of this invoice is required in order to avoid termination of your coverage. If you have any individual
adjustments that require processing, please use the attached Adjustments Worksheet. Do NOT increase/reduce your
payment of this invoice on the basis of the adjustments detailed on the worksheet. Your next invoice will show
any credits allowed or additional charges due as a result of processing the adjustments.
Payment of this invoice is due upon receipt. Please pay promptly, as no reminder notice will be sent. If payment is
not received within the 30-day grace period, your coverage will AUTOMATICALLY BE CANCEl. LED as of the
date to which premiums have been paid. Empire is not fmanciaily responsible for clatms incurred beyond the
premium paid to date.
In order to ensure proper crediting of your payment, you must mail your remittance to the address appearing on the
face of this invoice. Sending payments to any other address may delay processmg and cause your coverage to be
terminated.
Group Number: 598599 HIS 3 of s
Group Name: FISHERS ISLAND FERRY 05700).
Bill Period: 12101111 To 01101/12
Payment Due Date: 12101111
ADD
IHDIVIDUAL
DETAIL
EXPLANATION OF CHANGE TYPE CODES:
PAGE: 2
SUB INDIVIDUAL'S CONT CHANGE
INDIVIDUAL'S NAME GRP IDENTIFICATION NC)KG TYPE TYPE ADJUSTMENT PERIOD AMOUNT DUE
E~ptre NealthChoice
Assurance, Znc
FZORA HZCHAEL 8305418& 001 12 45S.97
LYNCH HATTHEN B 88138034 001 12 455.97
PAGE TOTAL: 911.94
TOTAL CURRENT ANOUNT PLUS CHANGES: 911.94
BALANCE DUE FROH PRZOR BZLL(S): 0.00
TOTAL AHOUNT DUE: 911.94
Group Number: 598599 H1S
Group Name: FISHERS ISLAND FERRY
Bill Period: 12101/11 To 01/01112
Payment Due Date: 12/01111
Prepared Date: 11/12/11
PAGE:
CONTRACT I RATES ! COUNTS SUMMARY
GROUP / PACKAGE CONTRACT TYPE RATE COUNT
598599 HXS / 00! 1:~ 455.97 2
PACKAGE SUB TOTAL 2
GROUP TOTAL 2
PLEASE SEE REVERSE OF THZS PAGE FOR A SUNNARY OF COVERAGE DESCRZPTTONS
CONTRACT TYPE TOTALS
CONTRACT TYPE SZNGLE GRAND TOTAL
NO. OF CONTRACTS 2 2
3
ALL PACKAGES CONTAZN HSA PARTZCZPATZON
GROUP / PACKAGE DESCRZPTZON OF COVERAGE
598599 HIS / OOl
CDHP PPO SG
CARVEOUT CDHP PPO SG
HAHAGED CARE
DRUG AND VZSZON
FISHERS ISLAND FERRY DISTRICT
VENDOR 006155 FEDEX 12/06/2011 CHECK 190
FUND & ACCOUNT P.O.# INVOICE DESCRIPTION AMOUNT
SM .5710.4.000.000 7-693-99929 5-AIRBILLS-PAYROLL/WARR 106.31
TOTAL 106.31
Town of Southold, New York - Payment Voucher
Fedex
Vendor Telephone Number
Vendor Contact
Invoice
Toml
Vendor Address
P.O. Box 371461
Pittsburgh, PA 15250-7461
Number Da~ ! Discount
7-693-99929 11114/2011 106.3t , 106.3t
Vendor No.
106.31 106.31
Payee Certification
The undersigned (Claimant) (Acting on behalf of the above named claimant)
does hereby certify that the foregoing claim is tree and correct, that no part has
'TA/1/
6155
Description of C.~gts or Se~ic~s
Airbills-PayrolI,Warrant
Check No.
Town Clerk
Octmatl L~dl~r Fund and Account N~nb~
8M5710.4.000.000
Department Certification
I hereby certify that the materials above spaaified have been received by me
in good condition wlthoat subslitation, the services properly
performed and t the quantities thereof have been verified with the exceptions
o discrepanai n payment is approved.
Signature /~ ~
Invoice Number
7-693-99929
Invoice Date
Nov14,2011 '~ AccountNumber
1206-0334-5
FedExTaxlD: 71-0427007
Page
1 of 5
Billinq Address:
FISHERS ISLAND FERRY DISTRICK
NINA SCHMID/TOM DOHE
PO BOX H
FISHERS ISLAND NY 06390-0607
Invoice Summary Nov 14, 2011
Shippinq Address:
FISHERS ISLAND FERRY TERMINAL
FERRY TERMINAL
NEW LONDON CT 06320
Invoice Questions?
Contact FedEx Revenue Services
Phone: (800) 622-~147 M-Sa 7-6 (CST)
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FedEx Express Services
Transportation Charges
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Special Handling Charges
Total Charges
TOTAL THIS INVOICE
You saved $12.89 in discounts this period!
Other discounts may apply.
USD
USD
154.85
-12,89
34.55
Detailed descriptions of surcharges can be located at fedex.corn
7-693-99929 Nov 14, 2011 1206-0334-5
Adjustment Request
Fax to (800) 548-3020
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R Tracking Number Bill to Account $ Amount
I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I.I I I
~1 I ~ I I I I I t I I I I I I I I IIlllllll I t I I I Io III
Ici AD"- Add,., Correction
~.l DVC- Declared Value
P lAN- Invalid Acct#
INW - Incorrect Weight
INS - Incorrect Service
OCF - Grd Pick-up Fee
OCS - Exp Pick-up Fee
OVS - Oversize Surcharge
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PND - Pwrshp Not Delivered
SDR - Saturday Delivery
For ali Service failures or other
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Tracking Number Code $ Amount
Rerate information only (round to nearest inch)
LBS L W H
I I I II I I Ixl I I Ixl I I
I I I II I I Ixl I I Ixl I I
I I I II I I Ixl I I Ixl I I
I I I II I I Ixl I I Ixl I I
I I I II I I Ixl I I [xl I I
~ Invoice Number
7-693-99929
FedEx Express Shipment Summary By Payor Type
FedEx Express Shipments (Original)
invoice Date
Nov 14, 2011
Account Number '~ Page
1206-0334-5[ 3 or 5
Shipper 1 5.0 51.70 18.50
Recipient 4 3.0 75.85 9.70
Third Party 1 27.30 6.95
70.20
-8.52 77.03
-4.37 29.20
Total This Invoice
USD $176.51
1316-01-00-(×)15061 0002-0038924
Invoice Number
7-693-99929
FedEx Express Shipment Detail By Payor Type (Original)
Invoice Date ~ Account Number '~ Page
Nov 14, 2011 1206-0334-5 4 of §
Fuel Surcharge - FedEx has app{ied a fueJ surcharge of ~4 50% to mis sflipmenc
Distance Based Pricing, Zone 2
Package sent from:O~390 zip code
Automation USAB Sender
Tracking ID 875818176685 FISHERS ISLAND FERRY TERMINAL
Service TyRe FedEx First Overnight FERRY TERMINAL
Package Type Customer Packaging NEWLONDONCT 06320 US
Zone 02
Packages 1
Rated Weight 5.0 lbs, 2.3 kgs
Delivered Oct 00, 2011 07:58 Transportation Charge
Svc Area A2 Account Number Correction
Signed by .BOCHICCHIO Fuel Surcharge
FedEx Use 027801026/0000006/_ Total Charge
H2 N1 LABS INC
575 BREND HOLLOW RD
MELVILLE NY 11747 US
51.70
11.00
7.50
USD $70.20
Shipper USD $70.20 __
Fuel Surcharge - FedEx has applied a flJel surcharge of 14.50% to ~is shlpment
Distance Based Pricing, Zone 2
FedEx has audited this shipment for correct packages, weight, and service. Any changes made are reflected in the invoice amount
The package weight exceeds t~e maxirnurn for the packaging Wpe, therefore, Fed Ex Envelope was rated as FedEx Pak
Automation OSAB Sender
Tracking ID 814181509089 JANICE L FOGLIA
Service Type FedEx Priorily Overnight TOWN OF SOUTHOLD
Package Type FedEx Pak 53095 ROUTE 25
Zone 02 SOUTHOLD NY 11971 4642 US
Packages 1
Rated Weight 1,0 lbs, 0.5 kgs
Delivered 0ct 21, 2011 09:56 Transportation Charge
Svc Area PM Fuel Surcharge
Signed by P.FOLEY Discount
FedEx Use 029302611/0001486/_ Total Charge
Recipient
RANDY VCIROESKY
FISHERS ISLAND FERRY DISTRICT
FISHERS ISLAND NY 00300 US
USD
21.30
2.78
2.13
$Z1.98
FuelSurcharge FedExhasapplledafuelsurchargeof1450%tothisshipment
Distance Based Pricing, Zone 2
PedEx has audited this shipment for correct packages, weight, and service. An'/changes made are reflected in the invoice amount
The package weight exceeds the maximum for the packaging type, therefore, Fed Ex Envelope was rated as FedEx Pek
Automation USAB Sender
Tracking ID 874181509104 DIANA WHITECAVAGE
Service Type FedEx Standard Overnight TOWN OF SOUTHOLD
Package Type FedEx Pek 53095 ROUTE 25
Zone 02 SOUTHOLD NY 11971-4642 US
Packages 1
Rated Weight 1.0 Ihs, 0.5 kgs
Delivered Oct 27, 2011 10:11 Transportation Charge
Svc Area A4 Fuel Surcharge
Signed by N.LEFERDE Discount
FedEx Use 029901963/O001283/_ Total Charge
Recioient
RANDY ~PIROFSI(Y
F T FERRY DISTRICT
5 WATER FRONT PK
NEW LONDON CT 06320 US
USD
17.75
2.32
-1.78
$18.29
1~16 01-00-0015061 0002-0038924
Invoice Number
7-693-99929
Invoice Date
Nov 14, 2011
Account Number '~ Page
1206-0334-5! 5 of 5
Fuel Surcharge - FedEx has applied a fuel surcharge of ~450% to this shipment.
Distance Based Pricing, Zone 2
FedExhas audited this shipment for correct packages, weight, and service Any changes made are reflected in the invoice amount
The package weight exceeds the maximum for the packaging type, therefore, FedEx Envelope was rated as FedEx pak.
Automation USAB Sender
Tracking ID 874181509115 JANICE L FOGLIA
Service Type FedEx Prior~ Overnight TOWN OF SOUTHOL9
Package Type FedEx Pak 53095 ROUTE 25
Zone 02 SOUTHOLD NY 11971-4642 US
Packages I
Rated Weight 1,0 lbs, 0~5 kgs
Delivered Nov 04, 2Oll 09:40 Transportation Charge
Svc Area PM Fuel Surcharge
Signed by R.LEFEVERE Discount
FedEx Use 030702845/0001486/_ Total Charge
Recinie#t
RANDY WYRNESI~'
FISH£RS ISLAND FERRY DISTRICT
FISHERS ISLAND NY 06390 US
21.30
2.78
-2.13
USD $21.95
· Fuel Surcharge - FedEx has applied a fuel surcharge of ~400% to this shipment.
· Distance Based Pricing, Zone 2
AutomaRon USAB Sender
Tracking ID 874181509126 DIANA WHITECAVAGE
Service Type FedEx Standard Overnight TOWN OF SOUTHOLD
Package Type FedEx Envelope 53095 ROUTE 25
Zone 02 SOUTHOLD NY 11971 4642 US
Packages 1
Rated Weight N/A
Delivered Nov 11,2011 09:38 Transporta*Jon Charge
Svc Area A4 Discount
Signed by R.LEFERVERE Fuel Surcharge
FedEx Use 031402475~0000200/_ Total Charge
Recipient
RANDY WYROFSKY
FI FERRY DISTRICT
5 WATERFRONT PK
NEW LONDON CT 06320 US
15.50
-248
1.82
USD $14.84
Recipient Subtotal
USD $77.03
FuelSurcharge FedExhasappliedafuelsurchargeof1400%tothisshipment
Distance Based Pricing, Zone 8
Package Delivered to RecipientAddress Release Authorized
Automation USAB
Tracking ID 875071430030
Service Type FedEx Standard Overnight
Package Type FedEx Envelope
Zone 08
Packages 1
Rated Weight N/A
Delivered Nov 09, 2011 12:35
Svc Area A1
Signed by see above
FedEx Use 031203137/0000266/02
Sender Recipient
N SCHMID LINDSAY KOENIG
FISHERS ISLAND NY 06390 US PARAMOUNT PICTURES
5555 NELSON AVE 2ND FLR MARTLE
LOS ANGELES CA 90038 US
Transportation Charge
Fuel Surcharge
Residenbal Delivery
Discount
Total Charge USD
27.30
3.60
2.75
4.37
USD
Third Party Subtotal
Total FedEx Express
1316-0l 00-00150610001-0038923
FISHERS ISLAND FERRY DISTRICT
VENDOR 006350 FISHERS ISLAND FERRY DIST 12/06/2011 CHECK 191
FUND & ACCOUNT P.O.# INVOICE DESCRIPTION AMOUNT
SM .5710.4,000.000 110611 PETTY CASH-NL-7/13-11/6 246,01
TOTAL 246.01
Town of Southold, New York - Payment Voucher
Vendor Tax ID Number or Social Security Number Vendor Address
Vendor Name
Fishers Island Ferry Olstrict-M.O.M.
Vendor Telephone Number
Vendor Contact
Invoice
Number
P.O. Drawer H
Fishers Island, NY 06390
Ve"a~rN0.
' 6350
Check No.
Entered by
~udit Date
DEC 0 6 2011
Invoice Invoice
Date Total
111612011 246.01
Net
Discount i Amount Claimel
i 246.01
246.0t i ~ 246.0t
Payee Certification
The undersigned (Claimant) (Acting on behalf of the above named claimant)
does hereby certify that the foregoing claim is true and correct, that no part has
been pa' except as therein stated, that the balance therein stated is actually
due~' , and that taxes from which theTitle ~'-'~T°wn xempt excluded
Purchase Order
Number
Description of Goods or Services
General Ledger Fund and Account Number
Petty Cash-New London 8M6710.4.000.000
71t3111-1116111
Department Certification
I hereby certify that the materials above specified have been received by me
in good condition without substitution, the services properly
performed and that e quantities thereof have been verified with the exceptions
or di repancies noted, an ayment is approved.
~ ' [I ' I I
Town of Southold, New York - Payment Voucher
Vendor Tax ID Number or Social Security Number Vendor Address
Vendor Name
Fishers Island Ferry Oistrict-M.O.M.
Vendor Telephone Number
Vendor Contact
!nvoi~ Invoice
Vendor No.
6350
P.O. Drawer H
Fishers Island, NY 06390
Net Purchase O~der I
Check No.
Entered by
Town Clerk
Number Date Total Discoum
111612011 246.01
246.01
Pa ~ee Certification
The tmdersigaed (Claimant) (Acting on behalf of the above named claimant)
does hereby certify that the foregoing claim is tree and correct, that no part has
been~ paiflNex?pai except as therein stated, that thc balance therein stated is actually
due
~.~. and that taxes from which the Town~xempt a~fxcluded.
Si -. ~ ,. . ___ Title ~'4'k
Com yN e , Date
· '~'~;17'
Amount Claimed
246.0t
246.01
Number
Description of Goods or Services
Pett~ Cash-New London
7113111-1116/11
General Ledger Fund ~nd Account Number
8M5710.4.000.000
Department Certification
I hereby certify that the materials above specified have been received by me
in good condition without substitution, thc services properly
performed and that Se quantities thereof have been verified with the exceptions
or dj, repancies noted, an ayment is approved,
Quick Sand Blasting LLC
107 Jerome Road
Uncasville, CT 06382
(860) 848-4482
Invoice
1 I/6/2011 26~7
~To
Fi~.s Isllnt F~'~y Dis~ricl
P.O. Box H
Fi,~'rs Islmd, NY 06390
P.O, No. Terms
~ T= 6,3~% 2.39
PETTY CASH
DATE PAYED TO
15-Jul Shop Rite
7/27/2011 Citgo
7/2812011 Johnson Hardware
8/11/2011 CVS
8/27/2011 Shop Rite
9/8/2011 Home Depot
9/14/2011 Home Depot
9/26/2011 Postal Service
10/3/2011 Lowes
10/5/2011 Home Depot
10/7/2011 Postal Service
Oct~l 1 Postal Service
10/20/2011 Home Depot
10/31/2011 Bennys
11/6/2011 Quiksand Blasting
REIMBURSEMENT REQUEST 11-11-7
FOR
Toilet paper
Batteries for ticket office mouse
Hardware for eng rm electric panels
Batteries
Hurricane food
GFI receptacle, RP ramp
Deck box hinges and form plywood
Stamps
Epoxy glue, shop stock
Electdc plug and plasUc bags
Postage
Postage
Rachet straps and eyebolts fo tank carrier
Sandpaper
Sandblast MU eng rm vent grate
AMOUNT
20.2
3.18
8.07
4.24
74.88
22.32
29.68
8.8
5.3
5.79
1.28
1.08
16,4
4.79
40
246,01
FISHERS ISLAND FERRY DISTRICT
VENDOR 006482 PAUL J. FOLEY 12/06/2011 CHECK 192
FUND & ACCOUNT P.O.# INVOICE DESCRIPTION AMOUNT
SM .9060.8.000.000 110111 REIMB/RX-NOV 2011 95.94
TOTAL 95.94
Town of Southold, New York - Payment Voucher
Vendor Tax ID Nmber or Social Security Number Vendor Address
Paul J. Foley
Vendor Telephone Number
690 Williams Street
New London, CT 06320
Vendor Contact
Invoice Net Purchase Order
Number i Discount Amount ClaimeC Number
HO/l~ 95.94
Vendor No.
Check No.
Entered by~.~/
Audit Dater
Invoice Invoice
Date Total
tt/1/201t 95.94
Payee Certification
The undersigned (Claimant) (Acting on behalf of the above named claimant)
does hereby certify that thc foregoing claim is mae and correct, that no part has
been paid, x t as therein stated, that the balance therein stated is actually
~,nthem Retiree
Prescription Plan
90% Reimbursement
;106.60 less t0% ($95.94)
Paul Foley Ck #2140
Monthly in Arrears-Novlt'l
General Ledger Fund and Account Nmnber
SM9060.8.000.000
Department Certification
I hereby certify that thc materials above specified have been received by me
in good condition without substitution, thc services properly
performed and that the quantities thereof have been verified with the exceptions
or screpancies noted, and payment is approved
Signatu!e ~ (~ ! /
Title ~4~ h~'~ Date
'--Anthem.
Blue MedicareRx' (PD P)
902640731
G0230330801
IIh,,.Ih,,,Ih,.hllh,,.h,h,,Ih,lh,,hlh h,lh.lh,,I
PAUL J FOLEY
690 WILLIAMS ST
NEW LONDON CT 06320-4132
Balance Due 12/01/2011
$106.60
Please return the top portion of this form with your payment.
See reverse side for ixqyment oplions.
Retain the botlom portion of this form for your records
Per your Evidence of Coverage booklet, if you and your spouse are both enrolled in the plan, your monthly
premium payments must be paid separately. We require on~ remittance advice and one payment per account.
The remittance advice is located on the reverse side of this statement. This will ensure each member accounl is
credited appropriately and timely to prevent disenrollment from the plan, which will result in a lapse of
coverage, lfyou are disenrolled from the plan, you may only re-enroll during a valid election period.
Anthem.
Participant ID: G0230330801
Date: 11/07/2011
Fransaetion Date Description
~remium 11/01/2011 November 2011
Blue MedicareRx'(POP)
Amount
106.60
Balance Due
106.60
FISHERS ISLAND FERRY DISTRICT
VENDOR 008732 BRUCE W. HUBERT 12/06/2011 CHECK 193
FUND & ACCOUNT P.O.# INVOICE DESCRIPTION AMOUNT
SM .5709.2.000.100 110111 BLDG 240-PNT 2ND FL BDRM 3,550.00
TOTAL 3,550.00
Town of Southold, New York - Payment
Bruce W. Hubert
Vendor Telephone Number
Vendor Contact
lnvoic¢
1111/ZUll
3,550.00!
Discount
Voucher
Vendor Addr~s
P.O. BOX 633
rishe,a Island, NY 06390
i 3,66o, oo
Pa ee Cerfiflesiion
IbC ulldcrsign~ (Claimant) (Actin8 o~ b=half of thc above named claimant)
docs hereby certify that thc foregoing claim ia t~ue and correct, that ao pan has
VendorNo.
Ichcc' °' lq5
Audit Date
0EC 0 6 2011
~Id~ 240
Paint 2nd Fir Bedrms
Department Certification
I hereby ccffify that the mate~,als above specified haw bcea rec~i~¢{l by me
Title
SM&709.2.000.1 O0
without substitution, the services properly
,e Men verified vdth the exceptions
Town of Southold, New York - Payment Voucher
Vendor Tax ID Number or Social Security Number Vendor Address
Vendor Name
Bruce W, Hubert
Vendor Telephone Number
Vendor Contact
P.O. Box 633
Fishers Island, NY 06390
Vendor No.
Check No.
Entered by ~
Audit Date
OEC 0 6 2011
Town Clerk
Invoice
Number
Invoice
Date
111112011
Invoice ; Net
Total : Discount i Amount Claime~
3,660.00 3,550.00
Description of Goods or Services
Bldg 240
Paint 2nd Fir Bedrms
i 3,560.00: , 3,550.00
Payee Certification
The undersigned (Claimant) (Acting on behalf of the above named claimant)
does hereby certi~ that the foregoing claim is true and correct, that no pan h~s
been paid, except as therein stated, that thc balance therein stated is actually
dUes~~that I.and o ' , that taxes fromT which theTi~mf~. /~ ].T° pt are excluded.
Gen~cat ~ Fund and Account Number
8M6709.2.000.100
Department Certification
I hereby ceftin: that the materials above specified have been received by me
~tin g condition without substitution, the services properly
perform~at the quantities thereof have been verified with the exceptions
gnat~Ol discrepancies noted, and payment is approved
si k ' . / . ,/
Phone 631-788-7174
Fax 631-788-7001
Fishers Island Ferry District
Drawer H
Fishers Island, NY. 06390
Fishers
Bruce W. Hubert
P.O. Box 633
Island, NY. 06390
December 1, 2011
For work performed on property located on Fishers Island as folows:
NINA SCHMID'S HOUSE
2nd floor bedrooms (2)
Prep and paint ceiling, walls, woodwork and raidators.
Total cost as per contract
$3550.00
Thank You
Bruce W. Hubert
P.O. Box 633
Phone 631-788-7174
Fax 631-788-7001
Fishers island F~rry District
Drawer H
Fishers Island, NY. 06390
Bruce W. Hubert
P.O. Box 633
Fishers Island, NY. 06390
April 2, 2011
For work to be performed on property located on Fishers Island as folows:
NINA SCHMID'S HOUSE
2'~ floor bedrooms (2)
Ceiling
Scrape any loose paint.
Patch all holes, tape any cracks.
Sand patched areas smooth.
Prime patched areas.
Paint one (1) full coat Benjamin Moore flat
latex white.
Wails
Scrape any loose paint.
Patch all holes, tape any cracks.
Sand patched areas smooth.
Spot prime patched areas.
Paint two (2) full coats Benjamin Moore
eggshell latex (color unknown).
Woodwork (windows, radiators, baseboards and doors)
Scrape all loose paint.
Sand scraDed areas smooth.
Spot prime any bare wood.
Caulk all cracks, putty all holes.
Faint one (1) full coat Benjamin Moore
satin-impervo latex white.
Total cost of all labor, materials an~ $3550.00
Thank You
Bruce W. Hubert
P.O. Box 633
Page 1 of 1
Whitecavage, Diana
From: Nina Schmid [fiferry@fishersisland.net]
Sent: Wednesday, December 07, 2011 1:56 PM
To: Whitecavage, Diana
Subject: Bruce Hubert
I just spoke with him and he said there were no taxes charged
12/7/2011
FISHERS ISLAND FERRY DISTRICT
VENDOR 011557 ANN KOWALCZYK-BANKS 12/06/2011 CHECK 194
FUND & ACCOUNT P.O.~ INVOICE DESCRIPTION AMOUNT
SM .5710.4.000.600 113011 JANITORIAL-NOV 2011 250.00
TOTAL 250.00
Town of Southold, New York - Payment Voucher
Vendor Tax ID Number or Social Securiw Number
Vendor Telephone Number
Vendor Contact
Vendor Address
P.O. Box ~
Fishers Island, NY 06390
Invoice Invoice
Net P~rch~se Order
i~endor No.
11557
Check No.
Entered by
Audit Date
DEC 0 6 2011
town Clerk
Number Date Total i Discount Amount Claime~ Number Description of Goods or Services General Ledger Fund and Account Number
~)[[ tt/30/2011 250.00 250.00 JanltorlallNov/11 SM5110.4.000.600
250.00 250.00
Payee Certification
Thc undersigned (Claimant) (Acting on behalf of tbe above named claimant)
does hereby certify that the foregoing claim is true and correct, that no part has
been paid, except as therein stated, that the balance therein stated is actually
due and o ' and that taxes from which the Town is exempt e excluded.
Si Tiff
Department Certification
I hereby certify that the materials above specified have been received by me
in good condition without substitution, the services properly
performed and th the quantities thereof ye been verified with the exceptions
or~ screpanci no m is approved
FISHERS ISLAND FERRY DISTRICT
VENDOR 011564 THOMAS KRAFT 12/06/2011 CHECK 195
FUND & ACCOUNT P.O.# INVOICE DESCRIPTION AMOUNT
SM .5710.4.000.300
SM .5710.4.000.300
SM .5710.4.000.300
SM .5710.4.000.300
39345
39345
39345
39345
RP 5236 @ $3.2538000 17,036.90
CT EXCISE TAX-$.04620/GA 2,419.03
S-F COST RECOVERY .0019 9.95
LUST TAX-$.0010/GAL 5.24
TOTAL 19,471.12
Town of Southold, New York - Payment Voucher
Vendor T~x ID Number or Social Sceurity Number
Thomas Kraft dba Dims OII Company
Vendor Telephone Number
Vendor Contact
39346
Date
1111712011
Invoice
Total Discount
17,036.90
2,419.03
9.95
Invoice
Number
, 19'471'12i
19,471.12
Payee Certification
The undersigned (Claimant) (Acting on behalf of tbe above named claimant )
due and ~d that taxes from which the Town is exempt are cxclude/J.
Vendor No.
11564
P.O. Box 11125
Waterbury, CT 06703
Net Purchase Order
Amount Claime~ Number
17,036.90
2,419.03
9.95
5.24
Check No.
Entered by ~
~,udit Date
OEC 0 6 2011
Description of Goods or Services
RP 5236 ~ .$3.25380001
CT Excise Tax * $.04620/g;
S-F Cost Recovery .0019
LUST Tax - $.00101gal
Genoa] L~dg~r Fund and Account Number
$M5710.4.000.300
Department Certification
I hereby certity that the matefials above specified have been received by me
m good condition without substitution, the services properly
performed and that the quantities thereof beve been verified with the exceptions
discrepanc'es noted, and payment is approved
Signature ~i~
Title ~x~ Lt,~ t*0f~-VL~ Date
DIHE OIL COHPANY
P,O, BOX 11125
'WATERBURY~ C1 06703
P homz ', (203)754-5334
Date; 11/17//2011
F~sher's Island Fer'r'y District
PO Box H
Attn Accounts Payable
Fishel's Island, NY 06390-
Fishecs Zsland Ferry Dist
5 Water'front Par'k-Race Point, New London
ACCOUNT NUMBER:
AHOUNT ENCLOSED:
~4~20165
Page ; 1 lei'InS; ~4E'¥ 30 D,~lys Fi'om Invoice Da'Ee
~r:,,::,te li]vo~ce, Charges anc' Cr'e,;Ift:_~ Amount
11/17/11 39345 Fuel Znvoice Total
11/17/1I 39345 ~2OR Off Road Diesel 5238.0 GAL6 La 3.253800 17036.90
Dyed Diesel Fuel for Off Road Use Ot4L¥,
6-F Dost Recowsr'y i~ 0.0019 9.95
State Excis.s Tax DSL (~ 0.a620 2419.03
LUST TAX L~ 0.0010 5.24
19671.12
19~71,12
Amount Due
~ Please include account number with paymemt ~
~Fed IDCf 060967353
DZME OTL COHPAN¥
( 203 ) 75~
Accoun~:
FISHERS ISLAND FERRY DISTRICT
VENDOR 014021 NATIONAL AUTO PARTS SVCE, INC. 12/06/2011 CHECK 196
FI/ND & ACCOUNT P.O. ~ INVOICE DESCRIPTION AMOUNT
SM .5710.2.000.200
SM .5710.2.000.200
885698 4-OIL FILTERS-RP 109.56
885915 5-FUEL FILTERS-RP 67.55
TOTAL 177.11
Town of Southold, New York - Payment Voucher
Vendor Tax ID Number or Social Security N~m~har Vendor Address
Vendor Name
NAPA
Vendor Telephone Number
Vendor Contac~
106 Boston Post Road
i Vendor No.
14021
885698
11/1112011
Total I Discount
109.56:
Waterford, CT 06385
Purchase Order
Number
109.66
Check No.
Entered by~
Audit Date
8M57t0.2.000.200
885915 11/14/2011 67.56 67.55 '!
$177.1t 177.11
Payee Certification
Thc undersigned (Claimant) (Acting on behalf of the above named e]
does hereby certify that the foregoing claim is true and correct, that no pert has
been except as therein stated, that thc balan rein stated is acixmlly
due , and that taxes from which the T xempt xcluded
Department Certification
I hereby certify that the materials above specified have been received by me
in good condition without substitution, the services properly
performed and t t tha quantities thereof have been vet/fled wah the exceptions
discrepenales noted d peyment is approved.
Title ~d~.~ Date ((( o~ l {
Town of Southoid, New York - Payment Voucher
Vendor Tax ID Number or Soci~ Secudty Number
NAPA
Vendor Telephone Number
Vendor Contact
thvoic~
Number
Invoice
Date
Total
!Vendor No.
' 14021 '
Vendor Address
106 Boston Post Road
Waterford, CT 06385
Discount
885698 1111112011 109.56 109.56
885918 1t11412011 67.55 67.55
$177.111
477.11
Payee Certification
The under signed (Claimant) (Acting on behalf of the above named claimant)
does hereby certify that the foregoing claim is true and correct, tlmt no part has
been except as tberein stated, that the balan eln stated is actually
due [ and that taxes from which the Ti empt xcluded.
RP M.E. Oil Filters
RP Fuel Filters
Check No.
Entered by
Audit Dat~
SM5710.2.000.200
Department Certification
I hereby certify that the materials above specified have been received by me
in good condition withou~ subslilution, the services properly
~ffonned and t t the quantities thereof have been vetifled with the exceptions
National Parts Service Inc.
150 Bridge Street
Groton, Ct. 03640, CT 06340
(860) 445-8181 ·
Fib. hers Ts]and Ferry District
PO Box 4H
Fishers Island, NY 06390
Time: 10:40
Page: 1/1
Invoice Number 885698
Employee: 33 Forte, Joe
Sales Rep: 9 Sposito, Chet
Accountlng Day: 10
1792
Part Number
FIL
NAPAGOLD OIL FILTER ~, ~'%~ ~ 4.00 52.27 27.3900 109.56
Delivery:
Attention:
Tax Exemption:
PO#:
Terms: Net 20th
Customer Signature
NAPA AUTO PARTS
150 BRIDGE STREET
GROTON, CT. 06340
CUSTOMER COPY
Subtotal 109.56
TABLE 1 6.3500% 0.00
Charge Sale 109.56
National Parts Service Inc.
150 Bridge Street
Groton, Ct. 03640, CT 06340
(860) 445-8181
Time: 11:21
Date: 11/14/2011
Page: 1/1
Invoice Number 885915
]297
Eishers Island Ferry District
Box 4H
}.ishers Island, NY 06390
Employee: 35 CLARK, ERIK
Sales Rep: 9 Sposito, Chet
Accounting Day: 12
Part Number
Line j ] ~s6ription ~ Qnan~ity ?rf~e? ! i N~t ~
FIL NAPAGOLD FUEL FILTER 2.00 28.22 14.7900
FIL NAPAGOLD FUEL FILTER 2.00 24.78 12,9900
FIL NAPAGOLD FUEL FILTER 1.00 22,83 11.9900
Tdtal
29.58
25.98
11.99
Delivery:
Attention:
Tax Exemption:
Terms: Net 20th
Customer Signature
ALL GOOOS RETURNED MUST BE ACCOMPANIED 8Y THIS INVOICE
NAPA AUTO PARTS
150 BRIDGE STREET
CROTON, CT. 06340
CUSTOMER COPY
Subtotal 67.55
TABLE 1 6.3500% 0.00
Charge Sale 67.55
FISHERS ISLAND FERRY DISTRICT
VENDOR 014290 NYS & LOCAL EMP RETIREMENT SYS 12/06/2011 CHECK 197
FUND & ACCOUNT P.O. # INVOICE DESCRIPTION AMOUNT
SM .9010.8.000.000
SM .480
30020Ell1215A ERS PAYMENT DUE 12/15/11 133,807~50
30020Ell1215A ERS PAYMENT DUE 12/15/11 44,602.50
TOTAL 178,410.00
Town of Southold, New York - Payment Voucher
Vendor Tax ID Number or Social Security Number Vendor Address
110 State Street
Vendor Name
New York State & Local Retirement System
Vendor Telephone Number
Vendor Contact
Invoice Invoice
Number Date
~ .11115/2011
30020EIlI215ACS0' 11115/2011
30020E111215ACS~)' 11115/2011
30020Ell1215ACS0' 1111512011
30020Elll 21 SACS0' 11115/20.1~
:~0020Et~ 1111512011
30020E111215ACS0' 11115/2011
30020E111215AC$0' ' 1111 5/20t t
~d0~20 E1_~1 ~ 21 $A.~C$0: A'l pi _R/~ ~
~lfl~g0E~ 1 lja.S,~O' "'c1~5/2 01'
Alban~y,_NY_122_44-01)
Invoice Net
Total ] Discount Amount Claimed
765,957.75 i 765,957.75
~ ~ 255,319.25
238,076.25
79,358.75 i ~ 79,358.75
133,807.50 i 133,807.50
44,602.50 I 44,602.50
.--118'530'75~;: I 118,530.75_
Purchase Order
Number
14290
Description o fO:ods or Services
ERS Payment Due 1211511
ERS Payme~
ERS Payment Due 12/15/'!/
~.R~._Payment Due 12/15/1
ERS Payment Due ~
ERS Payment Due 12/15/1
ERS Payment Due 12/15/1
ERS Payment Due 12/1511
ERs
Payee Certification
The undersigned (C~a~mz~n:) (Acting on behalf of tbe above named claimant)
does hereby certify that the foregoing claim is true and correct, that no part has
been paid, except as therein stated, that the balance therein stated is actually
due and owing, and that taxes from which the Town is exempt are excluded.
Signature ~~--
~ Title Town C ptroller
Co~/ame Town of Southold Date
Department Certification
I hereby certify that the materials above specified have been received by me
in good condition without substitution, the services properly
performed and that the quantities thereof have been verified with the exceptions
or discrepancies noted, and ayment is approved.
Signatur
FISHERS ISLAND FERRY DISTRICT
VENDOR 016170 H.0. PENN MACHINERY INC. 12/06/2011 CHECK 198
FUND & ACCOUNT P.O.# INVOICE DESCRIPTION AMOUNT
SM .5709.2.000.200 PSCE4572026 REPAIR PARTS FI BACKHOE 375.65
TOTAL 375.65
Town of Southold, New York - Payment Voucher
Vendor Tax ID Number or Social S~curity Number
Vend~Name
H.O. Penn Machiner,/Co.
Vendor Telephone Number
Vendor Contact
Invoice Invoice
Number Date
Invoice
Vendor No.
16170
Description of Goods or Services
Repair Parts FI Backhoe
Vendor Address
122 Noxon Road
Poughkeepsie, NY 12603-2940
Total Discount Amount Claime~ Number
PSCE457202E 712612011 375.65
does hereby c
been paid,
due and c
375.65
Company Name
375.65i 375.65
Payee Certification
on behalf of the above named claimant)
Check No.
s exempt are excluded.
Entered by
Audit Date
DEC 0 6 2011
General Ledger Fund md Account Number
8M5709.2.000.200
Department Certification
I hereby certify that thc materials above specified have been received by me
in good condition without substitation, the services properly
performed and that the quantities thereof have been verified with the exceptions
Title ~¥~ ' ' Date ttl~[tl
NOV-01-~01! 13:~ H.O. PENN NEWINGTON 8G0 GG? ~70
' ~';' H.O. PENN MACHINERY COMPANY,
~ TO
IHIP ~ro
FISMERS ISL/~ FERRY , ~ ,' ':,.';,'.
DISTRIC ' ,_' : ~'
PO SOX H $ WAT~RF~QNT'P~K · .;,',:,"'%~:'%
· , , .,~'~ ~': :,~
[- ~:;'-;ql
~ ~~ ,o,~ ~ ~.~.~.. '~? ,~,:,,.,
. ~ ::...'.'~
PARTS SA~ES PERSON: MEL J. FENR
I 6L-4714 *FILTER-- AIR S 9~k~4
1 6N-2147 TUBE A N .20S'.91
I 1S-1476 CLIP N .4.94 '
TOTAL pARTS
FREIGHT OUT
TOTAL MISC CHARGES
FRT IN
CONN'SA-LES TAX /
FISHERS ISLAND FERRY DISTRICT
VENDOR 016659 PRINCIPAL LIFE GROUP 12/06/2011 CHECK 199
FUND & ACCOUNT P.O.# INVOICE DESCRIPTION AMOUNT
SM .9060.8.000.000 H19730-1-12/11 LIFE PREMIUM-12/ll 108.06
TOTAL 108.06
Town of SouthOld, New York - Payment Voucher
Vendor Tax ID Number or Social Security Number
Principal Life Group
Vendor Telephone Number
Invoice
Invoice Invoice
Vendor No.
V~ndor Address
P.O. Box 14813
Des Molnes, IA 50306-35t 3
16659
Check No.
Entered by ~./ J
Number Date Total Discount Amount Claime~ Number Description of Goods or Services General Ledger Fund and Account Number
H19730-~' 1111712011 $108.06 i $108.05 Life Prem-12/11 $M9060.8.000.000
I
lO8.O61 108.06
Payee Certification
The undersigned (Claimant) (Acting on behalf of the above named claimant)
does here, J~ify that the foregoing claim is true and correct, that no part has
been as therein stated, that the balance therein stated is actually
due~.d that taxes from which theTit~..~t~/T° ' exempt excluded
Department Certification
I hereby certify that the materials above specified have been received by me
in good condition without substitution, the services properly
performed and t the quantitie~ thereof have been verified with the exceptions
Signature ~~~° iscmp ties no and payment is approved.
Title '~b~ Date
Town of Southold, New York - Payment Voucher
Vendor Tax ID Number or Social Security Number Vendor Address
Principal Life Group
Vendor Telephone Number
Vendor Contact
P.O. Box 14513
iVendor NO.
16659
Invoice
Date
Invoice
Total
Des Moines, IA 50306-3613
Net Purchase Order
Discount Amount Claime Number
Check No.
Entered by
Town Clerk
H19730-'
108,06t
i 108.06
Payee Certification
The undersized (Claimant) (Acting on behalf of the above naraed claimant)
do~s her~.~i fy that the foregoing claim is tree and correct, that no pan has
1111712011
$108.06
$108.06
Life Prem-12/11
$M9060.8.000.000
Department Certification
I hereby certi~ that the materials above specified have been received by me
in good condition without substitution, the services properly
performed and tl~ the quantities thereof have been verified with the exceptions
Signature t~~° iscrc cies not and payment is approved.
· -,'
Description of Gonds or Services General 1 ~lg~ Fund and Accmmt Nuraber
Group
THZS 'rs YOUR COPY.
Principal Financial Group Principal Life
Des Moines, A 50392-0002 Insurance Company
PLEASE KEEP FOR YOUR RECORDS,
PREMIUM STATEMENT
This statement in no way changes the
contract or waives any overdue payment
ACCOUNT ND. H19730-1
FISHERS ISLAND FERRY
LB. NO. 0819730 00001 93
DUE DATE: 12/01/11 STMT DATE: 11/17/11
NUMBER NAME
9293SS154 BCHM[D
920098292 TRAUB dAME
LIFE/AD&D
BNFT PREM
CHARGE/
CREDIT
6,49
6.49
6,49
4.22
6,49
CHARGES THIS STMT 108.06
TOTAL AMT DUE 216. 12
L[FE / AD&D PREMIUM TOTALS
$108.06
1-800-843-1371
FOR ASS[STANCE, PLEASE CALL TOLL FREE:
F396GP-4
ACCOUNT NO. H19730-1 12/01/201 I 000 000000 000000 CGS63181321115584~001002 0001497 002 OF 002
Financial
Group
Principal Financial Group
Des Moines, IA 50392-0001
IPrincipal Life
Insurance Company
PREMIUM STATEMENT
This statement in no way changes the
contract or waives any overdue pavmenl
Account Number
000582
FISHERS ISLAND FERRY
ATTN NINA SCHMID
PO BOX H
FISHERS ISLAND NY 06390
H19730-I Lb. No. 0819730 00001 93
Due Date 12/01/11 ~mtDa~ 11/17/11 Billing Period 12/01/11 - 12/31/11
Please Pay Balance Due
$ 216.12
PLEASE REVIEW ALL MESSAGES BELOW. THEY CONTAIN INFORMATION RELATED TO YOUR PREMIUM
PAYMENTS AND THE ADMINISTRATION DF YOUR PLAN. IF YOU HAVE QUESTIONS REGARDING ANY
OF THESE MESSAGES, PLEASE CONTACT US AT THE NUMBER LISTED BELOW.
IT IS IMPORTANT TO REPORT NEW ENROLLMENTS, TERMINATIONS, AND CHANGES IN DEPENDENT
STATUS PROMPTLY TO OUR WEBSITE AT WWW.PRINCIPAL.COM OR NOTIFY OUR ADMINISTRATION AREA.
WEB REPORTING REQUIRES A PIN. IF YOU DO NOT HAVE A PIN, PLEASE CALL 800-621-6280.
REPORTING CHANGES PROMPTLY WILL RESULT IN A MORE ACCURATE PREMIUM STATEMENT. CHANGES
SHOULD NOT BE SENT WITH YOUR PAYMENT.
FOR ASSISTANCE, PLEASE CALL TOLL FREE: 1-800-843-1371
NOTICE--TO AVOID DISCONTINUANCE OF YOUR PLAN, PLEASE BE SURE YOUR $108.06
BALANCE IS PAID AND RECEIVED IN THIS OFFICE BEFORE THE GRACE PERIOD
ENDS ON 11/30/11. IF YOU HAVE PAID, PLEASE DISREGARD THIS NOTICE.
PROVIDING YOU WITH GOOD SERVICE IS IMPORTANT. PLEASE REVIEW YOUR
STATEMENT EACH MONTH TO ENSURE PROMPT AND ACCURATE CLAIM PAYMENT.
FISHERS ISLAND FERRY DISTRICT
VENDOR 017991 RACE ROCK GARDEN CO. 12/06/2011 CHECK 200
FUND & ACCOUNT P.O.~ INVOICE DESCRIPTION AMOUNT
SM .5709.2.000.200 14023 FLUSH FUEL TANK-TRACTOR 75.00
TOTAL 75.00
Town of Southold, New York - Payment Voucher
Vendor Tax ID Number or Social Security Number Vendor Add~ss
Vendor Name
Race Rock Garden Co.
Vendor Telephone Number
Vendor Contact
Number
14O23
does hereby certify
been paid, excc
dUeS~and o '
Company Nam~
1013112011
P.O. Box 5t7
Fishers Island, NY 06390
Invoice Net
Total i Discount ~ Amount Claimed
' 75.00
75.00 '
l Vendor No.
17991
75.00 75.00
Payee Certification
The undersigned (Claimant) (Acting on behalf of the above named claimant)
mt the foregoing claim is true and correct, that no part has
~eraln stated, that tbe balance themig. m s~ in stated is actually
at taxes from which the Town i~x~ml t m ~ excl~ uded.
% Title / ) ~-[-~
t _.r'~ \J /V'~ I-,,I I,
:-'r~ 3 ~x~/,? i V ( II ~
Number
Description of Ooeds or Services
John Deere Tractor
Not starting-Flush Fuel Tk
Check No.
Entered by~
Audit Date /
General L~r Fund and Account Number
SM$709.Z000.200
Department Certification
I hereby certify that the materials above specified have been received by mc
in good condition without substitution, the services properly
performed and th t the quantities thereof have been verified with the exceptions
o iscrep les t nd payment is approved
Town of Southold, New York - Payment Voucher
Vendor Tax ID Number or Social Security Number
Vendor Name
Race Rock Garden Co.
Vendor No.
17991
Vendor Telephone Number
Vendor Contact
Invoice Invoice
Number Date
1402: 1013112011
Invoice
Total Discount
75.00
Box 517
75.00
Payee Certification
The undersigned (Claimant) (Acting on bebelf of the above named clmmant)
does hereby certifi~
been paid, exce
due and owl i
Company Nam
Fishers Island, NY 06390
Net Purcbesc Ord~
Amount Claime Number
75.00
75.00
,at the foregoing claim is true and cmxect, that no part has
; erein stated, that the balance th in stated is actually
~t taxes from which the Town i~pt are excluded.
ntcred by
-Town Clerk ' '
Description of Goods or Services
John Deers Tractor
Not startin![I-Flush Fuel Tk
SM5709.2.000.200
Department Certification
I hereb)~ certify that the materials above specified have been rece veal by me
m good condition withou substitution, the services properly
performed and thilt tbe quantities thereof have been verified with the except ons
oI iscrepa les t nd payment s approved
Race Rock Garden Company, Inc.
PO Box 517
Fishers Island, NY 06390
Invoice
Date Invoice #
10/31/2011 14023
Bill To
FI Ferry District
Drawer H
Fishers Island, NY 06390
Project Terms Account #
Quantity Serviced Rate Amount
Phone # Fax # E-mail Total$75.00
631-788-7632 631-788-7634 rrgarden~fishersisland.net
FISHERS ISLAND FERRY DISTRICT
VENDOR 014022 RING'S END, INC 12/06/2011 CHECK 201
FI/ND & ACCOUNT P.O.# INVOICE DESCRIPTION AMOUNT
SM .5710.2.000.000 733533 4-WHITE ALKYD ENAMEL 127.48
TOTAL 127.48
Town of Southold, New York - Payment Voucher
Vendor T~x ID Number or Social Security Number Vendor Address
P.O. Box 714
Niantic, CT 06557-0714
Niantic Lumber/Div of Ring's End Lumber
Vendor Telephone Number
i Vendor No.
' 14022
Vendor Con~act
Check No. ~ ]
Entered by
Town Clerk
Number Date Total Discount Number
733533 1111512011 127.48 127.48
Description of Goods or Services Cren~ Ledger Fund ~nd Account Number
Alkyd Enamel
SM57t0.2.000.000
127.48 127.48
Payee Certification
The undersigned (Claimant) (Acting on behalf of the above named claimant)
does hereby c*~i fy that the foregoing claim is t~ue and correct, that no part has
been paid, except as ~ereth stated, that the balance therein stated is actually
due and owing, and~. t taxes from which the Town is~.tl ~:i)mpt are eluded.
.ompan,' ,am,. . Da,e.'.,', y_
f
Department Certification
1 hereby certify that the materials above specified have been received by me
in good condition without substitution, the services properly
performed and that the quantities thereof have been verified with the exceptions
s_
Town of Southold, New York - Payment Voucher
Vendor Tex ID Number or Social Security Number
Nlantlc Lumber/DIv of RIn~'s End Lumber
Vendor Telephone Number
Vendor Contact
Vendor Address
P.O. Box 714
Nlantic, CT 063574)714
Vendor No.
14022
AUdit Date
Number
733533
Invoice Invoice
Date Total
11/1512011 t27.48
nzv.4aI
Payee Certification
Discount Amount Claimed
127.48
27.48
The undersigned (Claimant) (Acting on behalf of tbe above named claimant)
does hereby certify that the foregoing claim is tree and correct, that no part has
been paid, except as erein stated, that the balance therein stated is actually
due and owing, and t taxes from which the Town is pt are luded.
;iogmpany Name ~ Date,J~ ~t~ , /~
- oc >,x ,-
Pumbese Order
Number ~/--Descripti°n of Goods or Services
White A~mel '~
Goneral Lodger Fund and Account Number
8M6710.2.000.000
Department Certification
I hereby certify that thc materials above specified have been received by me
in good condition without substitution, thc services properly
performed and that the quantities thereof have been verified with the exceptions
Title ~t[ ~t~ Date t< /~q~h t
Page # 1
Bethel, CT Branford, CT Darien, CT Lewiaboro, NY
(203) 797-1212 (203) 488-3551 (203) 655-2525 (914) 533-2517
308 South Frontage Road (800) 797-6511 (866) 758-3551 (800) 390-1000 (888) 533-2517
New London CT 06385
New London, CT New Milford, CT Niantlc, CT Wilton, CT
T: (860) 439-0155 (860) 439-0155 (860) 355-5566 {860) 739-5441 (203) 761-1000
F: (860) 439-1369 (866) 439-0155 (888} 350-8966 (800) 303-6526 (866) 842-7883
TRaNsAcTION
T PE ,,,
Charge Invoice * * * THANK YOU FOR SHOPPING RING'S END * * * New London, CT
BILL TO: ,, ,,
2 FERRY STREET
NEW LONDON CT 06320
860-442-5349
CUSTOMER TRANSACTION CUSTOMER
cODE :DATE NUMBER TIME PURCHASE ORDER NUMBER 8A~PERSON
ETHAMSH 11/15/2011 733533 14:29 275 - Matthew Davis
~IGINAL
APPLYTD, OR~ERD~TE ORDIQTEN0; TERMS ~A~JURISDIC~ION
ITEM 0RDERoTy SHipOTy LOC OES~PTiON PRICING UNIT ~i(3NG PER uoM ' NETAMoU~
P220801 4 4 URETHANE ALKYD GLOSS SAFETY WH G 4.00( 31.870/EACH 127.48
RECEIVE~: i~ ~D CONDITION BY: SEE REVERSE SIDE FOR TERMS AND CONDITIONS
· Mi~C S~LES REMAINING II~/OICE
NET AMT CHARGE FREIGHT TAX DEPOSIT, , TOTAL
X 127.48 0.00 0.00 127.48
CUSTOMER COPY
The following terms and conditions govern the sales of The Seller, whether pursuant to oral or written orders to its representatives or salespeople.
RETURNED GOODS
Stock,items, in original units or full packages, will be accepted for credit or exchange when returned in good condition. Within 30 days of purchase,
AND ACCOMPANIED BY ORIGINAL SALES TICKET. A restocking charge will be assessed by the Seller on all returned goods. No special orders will be
accppted for return or credit.
TAX~S '
Buyer shall pay to Seller the amount of any and all taxes, excises or other charges which Seller may be required to pay or to collect for any
government, national, state or local, upon, or measured by the production, sale transportation, delivery or use of the merchandise sold hereunder.
FORCE MAJEURE
Delay in delivery or non-delivery in whole or in part by Seller shall not be a breach of this sale if performance is made impracticable by the occurrence
of any one or more of the following contingencies, the non-occurrence of which is a basic assumption on which the agreement is made: (a) Fires,
Floods, or other casualties; (b) Wars, Riots, Civil Commotion, Embargoes, governmental regulations or martial law; (c) Seller's inability to obtain
necessary materials (finished or otherwise) from its usual sources of Supply; (d) Shortage of cars or trucks or delays in transit; (e) Existing or future
strikes or other labor troubles affecting production or shipment, whether involving employees of Sel~er or employees of others and regardless of
responsibility or fault on the part of the employer; and (f) Other contingencies of manufacture or shipment, whether or not of a class or kind
mentioned herein and not reasonably within Seller's control.
WARRANTY
Selrer agrees that any merchandise delivered hereunder found to be defective in material or workmanship will be repaired or replaced by the Seller
without additional charge for the merchandise. This warranty is made in lieu of any other warranties or conditions including merchantability or
fitness for a particular purpose. The remedies under this warranty are exclusive and by accepting this merchandise the Buyer agrees to these
conditions and waives any other warranties conditions expressed or implied. All claims for damaged or defective materiat must be made within 5
days and we are limited to the purchase price of the materials sold or the replacement thereof at our option. We are not responsible for extra costs,
indirect damages or consequential damages.
Buyer assumes all risk und liability with respect to results obtained by thc use cf such merchandisc whether used a!one or in a combination with
other products. No claims of any kind whatsoever, whether based on breach of warranty, the alleged negligence of seller, or otherwise, with respect
to merchandise delivered or for failure to deliver any merchandise shall be greater in amount than the purchase price hereunder of the merchandise in
respect of which damages are claimed; and failure of buyer to give written notice claim within 30 days after delivery of merchandise shall constitute
a waiver of buyer of alt claims with respect to such merchandise.
TERMS AND CONDITIONS TO GOVERN
THIS INVOICE CONSTITUTES THE ENTIRE CONTRACT WTH RESPECT TO THE SALE AND PURCHASE OF THE MERCHANDISE SPECIFIED HEREIN.
No modification of this sale shall be effected by the acceptance or acknowledgement of purchase order forms specifying different conditions, and no
modifications shall be effective unless in writing signed by the party claimed to be bound thereby.
STATE OF JURISDICTION
This sale shall be deemed to have been made in, and shall be construed in accordance with the laws of the State shown in the Seller's address.
DELIVERY ~.ND/~.CCEPT~NCE OF TITLE OF GOODS
Title to the materials shall pass from the Seller to Buyer upon delivery thereof to Buyer or his agent and thereafter shall be Buyer's risk. Claims for
shortages, breakages or for any nonconformance with the terms and conditions of the order shall be noted on the Seller's delivery receipt by the
Buyer at the time of delivery, otherwise, the Seller shall not be responsible for any such claims. If delivery is by common carrier, delivery by the
Seller to the carrier at point of origin shall constitute delivery to the Buyer and thereafter the shipment shall be at Buyer's risk, and claims for loss or
damage _m, ust be f ed by the Buyer against the carrier. Title to goods loaded onto Buyer's conveyance at Seller's warehouse passes to the buyer at
the Seller s loading dock. If upon delivery at job site, there is not present at the job site an employee of the Buyer authorized to accept de [very and
sign a delivery document evidencing delivery of materials as listed on this invoice document, then the Seller reserves the right to deposit the material
at the delivery area prey gus y des gnated by the Buyer without obtaining a signed receipt therefore, and the Buyer agrees to liability for payment of
this invoice as if it were signed by an authorized employee of the Buyer, un,ess the Buyer has previously instructed the Seller not to deposit material
at the designated delivery area without obtaining a signed delivery receipt from an authorized employee of the Buyer.
FINANCE
All bills are payable on the 15th of the month following billing date and are past due after 30 days. Past due accounts are subject to a FINANCE
CHARGE of 1 1/4% PER MONTH on the past due unpaid balance (which is an ANNUAL PERCENTAGE of 15%).
MATERIALS SAFETY DATA SHEETS (MSDS)
The occupational safety and Health Administration Hazard Communication Btandard, the Superfund Amendments and Reauthorization Act of 1986
and many state right-to-know laws require that a material safety data sheet (MSDS) be provided with products containing hazardous chemicals. As
a manufacturer, importer or distributor, you are required by law to ascertain which of your ??ducts require an accompanying MSDS and provide
such. As a condition of this sale, you expressly warrant that you will comply with the prows~ons of the foregoing right-to-know-laws.
HAZARD COMMUNICATION LABEL
Alkaline Copper Quaternary {ACQ) Pressure Treated Wood Hazard warning~ for treated wood are similar to those for untreated wood.
A rborne wood dust can cause respiratory eye, and skin irritation,
Breathing excessive amounts of treated or untreated wood dust pr marily hardwood) has been associated with nasal cancer in some industries.
· Handling may cause splinters.
· High airborne levels of wood dust may burn rapidly in the air when exposed to an ignition source.
· Some forms of components of the liquid preservative used to manufacture this product (arsenic and chromium) have caused lung, skin, and
possibly other cancers in humans occupationally or environmentally overexposed,
SUCH EXPOSURES HAVE NOT OCCURRED WITH TREATED WOOD.
NOTE: Consult the Materiel Safety Data Sheet for additionat information on this product.
This Information is designed to address the label requirements of the OSHA Hazard Communication Standard with respect to treated lumber.
DEL;VERY
All deliveries are priced and understood to be on a first floor/tailboard delivery basis.
FISHERS ISLAND FERRY DISTRICT
VENDOR 019719 STAPLES CREDIT PLAN 12/06/2011 CHECK 202
FUND & ACCOUNT P.O. # INVOICE DESCRIPTION AMOUNT
SM .5711.4.000.000
SM .5711.4.000.000
SM .5711.4.000.000
SM .5711.4.000.000
SM .5711.4.000.000
100911 CREDIT FROM 10/9 30.00-
2687954001 FI OFFICE SUPPLIES 364.24
2903121001 1-UNIDEN PORT PHONE 29.99
2903121002 3 BANK BAGS,KEY TAGS 92.46
2903121003 1-PK STATIONERY 7.99
TOTAL
464.68
Town of Southold, New York - Payment Voucher
Vendor Tax ID Number or Social Security Number Vendor Address
Staples
Vendor Tclephonc Number
Vendor Con~a~
Invoice
Dept 31-0000307779
Vcnaor
I 19719
P.O. Box 989020
Des Moines, IA 50368-9020
Invoice
Net Purchase Order
Check No.
Entered by
Town Clerk
Numar Date
26879540011012112011
2903121002 10/2812011
2903121001 10/20/20tl
2903121003 101281201t
Tot~
Amount Claim~
364.24 364.24
92.46 92.46
29.99
7.99
29.99
7.99
494'68i I 494.68
Payee Certificafion 989.36
The undersigned (Claimant) (Acting on behalf of the above named claimant)
does hereby cerlify that the foregoing claim is true and correct, that no part has
been paid, except as therein stated, that the balance therein stated is actually
due and owi~n~i~/~thatthat taxes from which the To ?sexempt eexcluded.
Number
Description of Goods or Services
FI Office Supplies
Bank Bags, Key Taos
Uniden Port Phone
Statione~ for Notices
SM57tl.4.000.000
Department Certification
I hereby certify that the materials above specified have been received by me
in good condition without substitution, the services properly
performed and that the quantities thereof have been verified with the exceptions
Town of Southold, New York - Pa~
Vendor Tax ID Number or Social Security Number
Staples
Vendor Telephone Number
Vendor Contact
Invoice
'ment Voucher
Vendor Address
Dept 31-0000307779
i Vendor No.
' 19719
P.O. Box 689020
Des Moines, IA 50368-9020
Net Purchase Order
Entered by
Audit Date
Town Clerk
Nuraber
2687954001
290312t 002
2903121001
2903121003
iOCql I
Date
10/21/2011
10/28/2011
t0/2812011
10/2812011
Total i Amotmt Claimed
364.24 : 364.24
92.46 92.46
29.99 29.99
7.99 7.99
0,o
Number
Description of Goods or Services
FI Office Supplies
Bank Ba~ls, Key Ta~ls
/-
Uniden Port Phone
StaUonery for Notices
SM57t 1,4,000.000
//
Payee Certification ~
The undersigned (Claimant) (Acting on behalf of the above named claimant)
does hereby cer;i~ that the foregoing claim is true and correct, that no part has
been paid, except as therein stated, that the balance therein stated is actually
dUesig~i~and owin that taxes from which theTi':~/To is exempt e excluded.
Department Certification
I hereby certify that the materials above specified have been received by me
in good condition without substitution, the services properly
performed and that the quantities thereof have been verified with the exceptions
that was easy:
Previous BaiGnce $ [, 13~.. 83 Closing Date 11/08/11
Paymer~s -$ ]., 15~.. 83 Next Closing Date 1Z/0cj/11 FISHER ISLAND FERRY DIST
Credits -$ 0.00 Payment Due Date [2/03/11 ~I~OMAS DORARTY OR NINA
Purchases +$ &94.68 PO BOX H
Debits +$ 0.00 Currem Due $ Z S. 00 FISHERS ISLAND, NY 063go-0607
FINANCE CHARGES +$ 0.00 Pasl Due Amount +$ 0.00 Credit Line $ 10,500
Late Fees +$ 0.00 Minimum Payment Due =$ 25.00 Credit Available $ 10,035
New BGlance =$ ~.6~. 68
CURRENTACTIVlTY
View, Manage and Pay online @ http://www.staples.accountonline.com
OCT 21 #9220687954-000-001PUTNAH CT $6q.24
OCT 28 #9220905121-000-002 PUTNAN CT 92.46
OCT 28 #9220905121-000-001NONTGONERY NY 29.99
OCT 28 #9220905121-000-005 PUTNAN CT 7.99
PAYHENTS, CREDITS, FEES, end ADJUSTHENTS
OCT 15 PAYHENT - REF # P919fi00910AIPSH58
OCT 31 PAYHENT - REF # P9194009G09HYSBEN
537.98-
626.85-
FINANCE CHARGE SUMMARY
Current Billing Period Previous Billing Period
Balance Dai;y D~ys in ANNUAL Balance Daly ~in I PERCENTAGE
REGULAR REVOLVE CREDIT PLAN
This Accc~nt Issued by Citibank. NA CUSTOMER SERVICE 1- 800-767 1291 FAX NUMBER 1-1~01-779-7425
Make checks payGble to: STAPLES CREDIT PLAN Payment must be received by 5:00 p.m. local time on Payment Due Date.
12/03/11 $ 464.68 $ 25.00 $
FOR PROPER CREDIT, PLEASE WRITE 6035 5178 2025 5882 ON CHECK AND ENCLOSE WITH THIS STUB.
Mail Payments to:
Dept. 51- 7820255882
STAPLES CREDIT PLAN
PO BOX 689020
DES MOINES IA 50368-9020
tfll'd'm'lfi,'llql ,H"t,,,I,',tfllfl,,,¥t,¥111Ht,dt
Make Address Changes Below
FISHER ISLAND FERRY DIST
THOMAS DOHARTY OR NINA
PO BOX H
FISHERS ISLAND, NY 06390-0607
0003586
6035517820255882004646800000000002500
Information About Your Account
ffeviou$
Notify Us in Case of Errors or Questions About Your Bill
Important Payment Instructions
Payment Options Other Than Reqular Mail:
If you send an eligible check with this ayment coupon you authorize us to
Remit To:
STAPLES CREDIT PLAN
DEPT.51 - 7820255882
PO BO}( 689020
DES MOINES IA 50368-9020
Payment Due Date: 12/03/11
Sill To: page 2 of 2
ACCOUNT: 6035517820255882
FISHER ISLAND FERRY DIST
PO BOX H
Please make checks payable to STAPLES CREDIT PLAN
that was easy:'
CTO0000
INVOICE:
2687954001
AMOUNT DUE: 364.24
INVOICE DATE: 10/21 /11
SHZP TO= INVOICE:
NZNA SCHHZD 2903121002
AMOUNT DUE: 92.46
INVOICE DATE: 10/28/11
INVOICE:
2903121001
AMOUNT DUE: 29.99
INVOICE DATE: 10/28/11
TO:
INVOICE:
2903121003
AMOUNT DUE: 7.99
INVOICE DATE: 10/28/11
PleaseDJrectlnquiriesto: Phone:800-767-1291 Fax: 801-779-7425
InformatiOn About Your Account -Ifaperiodicrateisadailyperiod[crate, we use the fdlowin calcdation
Balance Subject to Finance Charge: We calcdate periodic finance charges
and
(if
balance method
the dali
g period,
· Alternate Balance Subiect to Finance Charee Calculation Method. If the front
dally balance method (includir~g Flew hansac~ions) for purchases and ail ave)age
daily balance method (dl{ILIdiI/LJ new lransactions} for casb advances.
and 0% balances, on
pay
afaove in the Grace Per od for Purchases} or a
a ready billed o~ that balar~ce.
Notify Us in Case of Errors or Questions About Your Bill
Describe lhe errol and explain, if~/oucan, why yo~l believe [here is al error
Important Payment Instructions
Creditinq merits: We must receive
at the form after that time
as of the
address for a dar mail is the address listed on the return
]pon..A payment made in store is not
payment sent by courier or
expless frail is the Express Payments Address shown bdow
Payment Options Other Than Reqular Mail:
If you send an eliqible check with this a,/ment coupon you authorize us to
complete ~our payment by electronic ~blt. If we do thr' :heckinq account Tbi~; Account is I%LJed by Citibank NA
will be detiited m the amount on the check, We may do ti,is as soon as the
day we receive the check. Also, the check will be destroyed. Std)les CR( S604ST00000711 Rev. 07/11
that was easy:
$
STAPLES that was easy
FISHERS ISLA~ND FERRY
NINA~SCHMID
Floor: 1
5 WATERFRONT PARK
NEW LONDON, CT
Contact: (860)
Order Date:
For Customer Service, call
1-800-333-3330, or emai~ at
support@orders.staples.com. Order
'online, by phone or by fax 24
hours a day, 7 days a week.
06320
44210165 - NINA SCHMID
4051825224 10/21~11 9220687954-000001
CA~aI ER ROUTE :MCH/COU /44
TOTAL PACKAGES: 4
10/21/2011
744150
772994.
775313
~77824
'782185
GREEN MTN FRC~ RST DECAF KCUP
'k-~UF-BREAJ<~AST BLEND 18/BX
BATTERY AA ALKALINE I~PK
Submit rebat~ offer 11-65~29 @ w~rw.staplese, asyrebates.com
/0694
/C~07~N#140
{C~995~N#140
/~554/0~0
Ch~ck your order
Ne~d to return· something? Please
'a return. ' '
online b~ going to ~www. Sta~leq.com and cl~cking "Order
2 2
: 1 f'
tatus" .
28.79 57[58
i ~OTAL ' V~LUE 2
OF ORDER:' ~64 . 24
- -, , '."Fhahk You Foe Your.Ord,er! Staples,.lne. ,THIS. IS ,~T AN INVOICE,
that was easy:
For Customer Service, call
1-800 333-3330, or email at
support@orders.staples.com. Order
online, by phone or by fax 24
hours a day, 7 days a week.
STAPLES that was easy
FISHERS ISLAND FERRY
NINA SC}AMID
Floor: 1
5 WATERFRONT PARK
NEW LONDON, CT 06320
Contact: (860) 442-0165 - NINA SCHMID
_ · REFER TO THIS ORDER NO. FOR ALL INQUIRIE~
4051825224 110/21/11 I 9220687954 -000001
~HIPPINa LOCATION: Putnam, CT FC
CARRIER ROUTE:MCH/COU /44
TOTAL PACKAGES: . 4
PAGE: 1
Order Date:
lO/2i/~Oll
Cgupons an~ other
1'16657
Please tell ~s how
TO partic'~pate
tm~ts are deducted a~ter the- Merchandise Total
're doing for a chance ~o win $2~0!
go to WWW<SURVE~4STAPLES.~OM
~nd en~e'r Survey Code 9220687954 -.
· FO~ rules vis
************************
194506
~09882 '
344887
4~8~06 '
DI%PENSER-TE~E DZX ~/~ B~ ?t40~B~ ·
PHONE MESSAGE BK 2~K /SCl[54-2D
AVY iX2 ~/8 LSR LBL 100SH /05160
MINIMOOS i/2 A~ i/2 CkFJ~4E~' ~!0071~
CUP HOT PERFECT TOUCH 80Z ~5338CD '
TAPE REFILL NL~GIC 1X1296 ' /810-11296
STAPLES 25IN 2 DRA~ER - PUTTY /15286 ~ '
· P~ND SPRNGS WATER OF~IC~ BX 24/1D12~2
CT 1
· Pk- };
'CT 1.
1
1
6.59. 6.59
9.29 9.29'
26.99 26.99
.~17.99 17t9~
5.99 5.99
149.9~ 14~.99
Continued...
Thank. you...For Your' Order,! -S .aples, Inc.
that was easy:
For Customer Service~ call
1-800-333-3330, or email at
support@orders.staples.com, Order
online, by phone or by fax 24
hours a day, 7 days a week.
STAPLES that was easy
REFER TO THIS ORDER NO. FQR ALL INOUIRIES
I I I
SHIPPIN~ LOCATION:Putnam, CT FC
CARRIER ROUTE :MCH/COU /44
NINA SCHMID TOTAL PACI%A~ES:
Floor: 1
5 WATERFRONT PARK
NEW LONDON, CT 06320
Contact: (860) 442-0165 - NINA SCHMID
Order Date: 10/28/2011
Coupons and other adjustments are deducted after the Merchandise Total.
513457 CASH BAG NYLON LOCK 11X8.5 BLE/2330981W08 EA 3 3 28.49 85.47
Awarded 2011 ENE5SY STAR Partner of the Year
Leading the Way in Sustainability Excellence
619446 OVAL KEY TAGS /2018009W47 PK 1 1 6.99 6.99
N =-rc] ~andise Total ....... 92.46
E ~li~ 'ery ................ 00
Check your order statu~ online by going to www. Staples.com and clicking on "Order tatus".
~' Need to return something? Please
call Customer Service to process TOTAL VALUE
oo~ Thank You For Your Order! Staples, Inc. THIS IS NOT zlN INVOICE
that was easy:
For Customer Service, call
1-800-333-3330, or email at
support@orders.staples.com. Order
online, by phone or by fax 24
hours a day, 7 days a week.
STAPLES that was easy
FISHERS ISLAND FERRY
NINA SCHMID
Floor: 1
5 WATERFRONT PARK
NEW LONDON, CT 06320
Contact: (860) 442-0165 - NINA SCHY4ID
REFER TO THIS (RDEE NO. FOR ~LL INOUIRIES
4051825224 10/28 '11 9220903121-000001
SHIPPING LOCATION:Montgomery, ~Y FC
CARRIER ROUTE:MCH/COU
/44
Order Date:
10/28/2011
Check your order
D
online by going to www. Staples.com and clicking
"Order atus".
29.99
.00
.00
Need to return something? Please
call Customer Service to process
· a return.
TOTAL VALUE
OF OF. DER: 29. 99
00~ Thank You For Your Order! Staples, Inc. THIS IS NOT AN INVOICE
that was easy:
For Customer Service, call
1-800-333-3330, or email at
support@orders.staples.com. Order
online, by phone or by fax 24
hours a day, 7 days a week.
STAPLES that was easy
FISHERS ISLAND FERRY
NINA SCHMID
Floor: 1
5 WATERFRONT PA=RK
NEW LONDON, CT 06320
Contact: (860) 442-0165 - NINA SCHMID
REFER ~'0 THIS ORD! ~ NO. FOR ALL INOUIRIES
4051825224 110/28 '11 I 9220903121-000001
SHIPPINa LOCATION:Montgomery, NY FC
CARRIER ROUTE:MCH/COU
/44
Order Date: 10/28/2011
Coupons and other
513457
tments are deducted after the Merchandise Total.
CASH BAG NYLON LOCK 11X8.5 BLE/2330981W08
Awarded 2011
Leading the Way
STAR Partner of the Year
Sustainability Excellence
619446 OVAL KEY TAGS /2018009W47
If QTY. SHIPPED equals zero, the charges for those items will appear on
an additional packing lip within a separate box.
924489 UNIDEN DECT CID EXP CDLSS /D1660
Material Safety Data eets (MSDS) may be found by visiting
The following custom i~ ems are shipped individually as soon as
and should arrive by 1/07/11
828203 FALL FOLIAGE STATIONERY 100CT /970055
3 0 28.49
1 0 6.99
1 1 29.99
1 0 7.!
.0O
.00
29.99
.00
Continued...
Thank You For Your Order! Staples, Inc.
FISHERS ISLAND FERRY DISTRICT
VENDOR 019741 STATE INSURANCE FUND 12/06/2011 CHECK 203
FUND & ACCOUNT P.O.# INVOICE DESCRIPTION AMOUNT
SM ,1910.4.000.300 I5203005-11/11 INSTALLMENT 4 OF 9 769.08
TOTAL 769,08
Town of Southold, New York - Payment Voucher
Vendor Tl~x ID Number or Social Security Number
Vendor Name
State Insurance Fund
Vendor Telephone Number
Vendor Contact
Invoice
Date
1111/2011
Total
769.08
:Vendor No.
19741
Vendor Address
Workers' Compensation
P.O. Box 5262
Binghamton, NY t3902-5262
Net
Discount Amount Claime~
769.08
Payee Certification
The undersigned (Claimant) (Acting on behalf of the above named claimant)
does herebybycg~c ' that the foregoing claim is t~ae and correct, that no part h~s
been paid~'~t as therein stated, that the balance therein stated is actually
due and~ nd that taxes from which the Town is exempt are excluded.
Purchase Order
Number
Cheek No.
Entered
by
Audit Date
Description of Goods or Services General Ledger Fund and Account Number
V4 of 9 Installments
~11111-9/30111
NY Workers Comp
I-fi20 300-5
Plus Payment Towards
8M1910.4.000.300
2010-2011-Est. Audit Balance
Department Certification
I hereby certify that the materials above specified have been received by me
in good condition without substitution, the services properly
performed and at the quantities thereof have been verified with the exceptions
discre cies n , and payment is approved.
Signamrc ~ ~
Title
Town of Southold, New York - Payment Voucher
Vendor T~x ID Number or Social Securit~ Number
Vendor Name
State Insurance Fund
Vendor Telephone Number
Vendor Contact
17983124
Invoice
Date
111112011
Invoice
Total Discount
769.081
!9e~aor No.
19741
v'endor Add~s
~o~rke~m' Compensation_
P.O. Box 5262
inghamton, NY 13902-~262
769.08
Payee Certification
The undersigned (Claimant) (Acting on behalf of the above named claimant)
does hereby c~y that the foregoing claim is trae and correct, that no part has
due and ~v~ing~ ~nd that taxes from which the Term is exempt are ~xcluded.
Purchase Order
Number
Check No.
Entered by
Town Clerk
Description of Goeds or Services ~eral Ledger Fund ~d Account Number
tt4 of 9 Installments SM1910.4.000.300
911/t 1-9130/tt
IY Workers Comp
520 300-5
Plus Payment Towards
2010-2011-Est Audit Balance
Department Certification
1 hereby certify that the materials above specified have been received by me
in good condition without substitution, the services properly
performed and tllat the quantities thereof have been verified with the exceptions
discre cies n , and payment is approved
New York State Insurance Fund
WORKERS' COMPENSATION
520 300-5
8 CORPORATE CENTER DR, 3RD FLR, MELVILLE, NEW YORK 11747-3129
Any questions, Carl t-888-875-5790
811117
iS 1R 7] 2
FISHERS ISLAND FERRY DISTRICT
PO BOX H
FISHERS ISLAND NY 06390
GENCURP INSURANCE GROUP
16 MAIN STREET
EAST GREENWICH RI 02810
Minimum Amount Due 1
$1.515.13
Previous Balance Payments Received Other Credits New Charges Other Debits Current Balance
,$3. 137.93 $416.87CR $0,00 $439.91 $0,00 $2 i60;97
Workers' Compensation Activity Period - 10/04/2011 to 11/01/2011
Transaction Date Reference ¢~ Payment/Credit Status Charges Credits
October 3, 2011 Previous Balance $3,137.93
October 18, 2011 005262 Payment Received - Thank You $416.87-
New Charges
November 1,2011 !586486 Interest $23.04
November 1,2011 2167887 Installment 4 el 9 ( 08/01/2011 ) $406.87
November 1,2011 !590525 Service Charge $10.00
New Charges $439.91
Your current 'Total Account Balance' is $5,195.34. Payment of this amount is required to avoid service charges and/or
future interest charges. See reverse side (Page 2) for details.
Page 1 of 2
To ensure proper credit, please mail payment & remittance slip 7 days prior to the due date to the address below.
inciuOe policy number off your check.
REMITTANCE SLIP
Policv No.
Current Balance:
Minimum Amount Due:
Date Due:
I 520 300-5 Insured:
$3.160.97 FISHERS ISLAND FERRY DISTRICT
PO BOX H
$746 05 FISHERS IS. LAND NY 06390
11/30/2011
Payment Enclosed:
CHECK SOX FOR CHANGE OR CORRECTION OF NAME OR ADDRESS
ENTER CHANGE ON REVERSE SIDE
Pay your bill at nysif.com or call 1-877-309-6028
eCHECK - no service fee
Credit card - 2.5% convenience fee by Official Payments
Return to:
New York State Insurance Fund
Workers' Compensation
PO Box 5262
Binghamton, NY 13902-5262
05203005110111179831240000004399100000316097
Policy Number: I 520 300-5 *** Bill Number:. 17983124
Failure to make payment by the date(s) indicated will result in the cancellation of this policy and
notification to the Worker's Compensation Board as required by law and to holders of certificates
of insurance, if any. If your policy is cancelled, any unpaid balance is subject to the provisions of
section 18, paragraph 5 of the New York State Finance Law. If notice of nonpayment cancellation
is issued, all outstanding premium, regardless of due date must be paid in full by the cancellation
date in order for the policy to be reinstated. This is the only notice you will receive before the
cancellation.
Minimum Amount Due Calculation
a) Deposit/Rebill
b) Installments
c) Audit Balance
d) Miscellaneous Charges
e) Minimum Current Charge (Due By 11/30/2011)
I) Past Due
Minimum Amount Due
Account Remaining Minimum
Balance Installments Payment Due
$ 2,848.12 6
$ 2,304.18 6
$ 43.04
$ 406.87
$ 329.17
$ 33.04
$ 769.08
$ 746.05
$ 1,515.13
g) Remaining Audit Balance $ 1,645.84 5
Current Balance $ 3,160.97
Any unpaid audit balances will be charged interest at a rate of 1% per month. To avoid future interest charges, please
pay the entire $ 3,160.97 by 11/30/2011.
h) Future Installments $ 2,034.37 5
Total Account Balance $ 5,195.34
For policy periods effective 1/1/99 and later, to avoid future service charges you must pay $ 5.195.34 by 11/30/2011
To insure timely posting to your account, payment must be mailed 7 days prior to the due date.
You also have the option of paying audit premium in installments. Please refer to the information page which gives
details of your audit, and how the minimum payment will be calculated.
IF YOU HAVE CHECKED THE BOX ON THE REVERSE SIDE, PLEASE ENTER NEW INFORMATION BELOW.
FISHERS ISLAND FERRy DISTRICT '. Credit card . 2.5% COnvenience lee by official Payments
,a., ., .... ~. ~ PO BOX H
~' Lq~-~'; ' ~. F~SHERS ISLAND NY 06390
CHECK BOX FOR CHANGE OR CORRECT[ON OF
ENTER CHANGE ON REVERSE SIDE NAME OR ADDRESs
~ Return to:
Ii,,/"lhhh'lh',,,hhhh,,hhlh,,,hhll,,,,hJ,,hll
New York State Insoranc
Workers' ,, ........ e Fond
,/ PO Bo -
x ~262
Binghamton, NY 13902-5262
052030051003111788684700000272106000003137936
FISHERS ISLAND FERRY DISTRICT
VENDOR 019823 SULLY'S MOBIL MART 12/06/2011 CHECK 204
FUND & ACCOUNT P.O.# INVOICE DESCRIPTION AMOUNT
SM .5710.4.000.000 513436 GASOLINE/PVA-20.786 GALS 76.89
SM .5710.4.000.000 514512 GASOLINE/PYA-16.7 GALS 60.80
TOTAL 137.69
Town of Southold, New York - Payment Voucher
Vendor Tax ID Number or Social Security Number
Vendor Name
Sull¥'s Mobil
Vendor Telephone Number
Vendor Contact
Vendor Address
382 Vauxhall Street
New London, CT 06320
Nendor No.
; 19823
Check No.
Entered b~ .-~
Audit Date '
Invoice
Number
Net
Discount Amount Claimed
Purchase Order
Number
Invoice Invoice
Date Total
1 I101201 t 60.80
1 It 012011 76.89
137.69
Payee Certification
Description of Goods or Services
/~. ? ~z,_.c
Gas-Ford Truck to PVA
514512 60.80
Conf
513436 76.89 ~,D, ,7~:~_~ ~_~<~ /t
137.69
The undersigned (Claimant) (Acting on behalf of the above named claimant)
does hereby certify that the foregoing claim is true and correct, that no pert has
been paid, except as therein stated, that the balance therein stated is actually
due and { ~re excluded
Date
General Ledger Fund and Account Number
$M6710.4.000.000
Department Certification
I hereby certify that the materials above specified have been received by me
in good condition without substitution, the services properly
performed and that the quantities thereof have been verified with the exceptions
Signature i
/
Town, of Southold, New York - Pa,
~:~or Tax ID Number or Social Security Number
'ment Voucher
Vendor Address
382 Vauxhall Street
Vendor No.
Vendor Name
Sully's Mobil
Vendor Telephone Number
Vendor Contact
514512
513436
Invoice
Date
t111012011
1111012011
Invoice
Total Discount
60.80
76.89
137.69
New London, CT 06320
Net
Amount Claime~
19823
60.80
Check No.
Entered by
Fown Clerk
76.89
l~mhaseOrder
Number
Description of Goods or Services
Gas-Ford Truck to PYA
Conf
General Ledger Fund and Account Number
SM5710.4.000.000
137.69
Payee Certification
T~e undersigned (Claimant) (Acting on behalf of the above named claimant)
does hereby certify that the foregoing claim is true and correct, that no part has
been paid, except as therein stated, that the balance therein stated is actually
duei/~and , d that taxes from which the~e~!To is excrap[aare excluded.
a,e ,a
Department Certification
I hereby certify that the materials above spacified have b~n received by me
in good condition without substitution, the services properly
performed and that the quantities thereof have been verified with the exceptions
or screpanci not d payment is approved.
I
382 .'~uxh~}!i gt~-eet
N6~- Lc. qdoi, CT 06320
(860) 44~9~8
SOLD
DATE
NAME
ADDRESS
CASH I C.O.D I CHARGE I ON ACCT.
P.O, #
Stock #
All claims and returned goods MUST be accompanied by this bill
513b, 36 Cyou
o
All claims and returned goods MUST be accompanied by this bill.
5'~ ~,512
FISHERS ISLAND FERRY DISTRICT
VENDOR 019216 THE GRANITE GROUP 12/06/2011 CHECK 205
FUND & ACCOUNT P.O.# INVOICE DESCRIPTION AMOUNT
SM .5710.2.000.100 5782320-00 1-PRESSURE SWITCH 15.41
TOTAL 15.41
Town of Southold, New York - Payment Voucher
Vendor Tax ID Number or Social Sccuri~ Number Vendor Address
Vendor Name
The Gmnita Group
Vendor Telephone Number
Vendor Contact
Invoice Invoice
Number Date
/
I/I/~//I
57823204)0; ;; i ;' iii
Vendor No.
Invoic~ I
Total Discoun~
P. O. Box 2004
Concord, NY 03302-2004
15.41 , 15.41
15'41i I 15.41
19216
T~e undersigned (Claimant) (Acting on bebalf of the above named claimant)
does hereby certify that thc foregoing claim is true and correct, that no part has
been paid,.~cept as therein skated, that thc balance therein stated is actually
due and , mad that t~xes from which the To erupt excluded
MU Fwd Sanitary Prop Sw
Check No.
Entered b~
Audit Date/~//
8M5710.2.000.100
Department Certification
l hereby certify that the materials above specified have been received by me
in good condition without substitation, the services properly
performed and thatt~c quantities thereof have been verified with thc exceptions
or di~icrepanciets noted, at~yment is appmvnd.
Signature
/vw '
(860)442-4348
CUSTOMER #: 27698
INVOICE
matinence
306
FISHERS ISLAND FERRY DISTRICT
POBOXH
FISHERS iSLAND NY 06390
THE GRANITE GROUP
PO BOX 2004
CONCORD NH 03302-2004
II1,,,,,11,,,11,11,,,,,I,1,,I,II1,,,11,,,,I,,111,,,,I,,I,,I,II
SHIP TO:
FISHERS ISLAND FERRY DISTRICT
POBOXH
FISHERS ISLAND, NY 06390
ONLY STEVE TO CHRG
I CAMFSG2A3050
FSG2-A 30/50 PRESSURE SWITCH
I I 0 each
15.40830 15.41
Total
15.41
Page 1 of 1
$15.41
INTERNAL USE ONLY: Page I of 1
FISHERS ISLAND FERRY DISTRICT
VENDOR 021506 UNITED PARCEL SERVICE 12/06/2011 CHECK 206
FUND & ACCOUNT P.O. # INVOICE DESCRIPTION AMOUNT
SM .5710.4.000.700
SM .5710.4.000.700
026639461 W/E ll/ll/ll-(1)PKG 67.87
026639471 W/E ll/18/ll-(1)PKG 39.91
TOTAL 107.78
Town of Southold, New York - Payment Voucher
United Parcel Service
Vendor No.
P.O. Box 7247-0244
Philadelphia, PA 19170-0001
21506
Cheek No.
Entered by C~h
Audit Date --
DEC0 6 2011
Invoice
Date
Total Discount
026639461 11112/2011 $67.86
026639471 111t9/2011 39.91
Net I Purchase Order
~nount Clairol Number
S07.8
39.91I
Description of Goods or Services
w,. 11,11,11
Fund and Account Number
$M$?~0.4.000.?00
$107.78
Payee Certification
The underslg~ed ~hamam) (Acting on behalf of the above named claimant)
dees hereby ceai~ tl~t the foregoing claim is true and eorceet, that no pail has
6~b~en peid, excq~t a~t h c r eineSst a,£r oedn~ twha, tkt~;Fl~e i~oCe therein state~ is actu~lI
Company Nam?~ : ~:e,?
Department Certification
hereby ceni fy that the materials above specified have been received by me
in ood condition without substitution, the services properly
~e~ ~U,r e~!i thc quantities ther e° f haVpaeymhaee~nt ;.~e~pfiep~dovWeidth the cxcepti°ns
Shipped from:
FISHERS ISLAND FERRY
0 STATE ST
NEW LONDON, CT 06320
Delivery Service Invoice
Invoice date November 12, 2011
Invoice number 0000026639461
Shipper number 026639
Control ID 738X
Page 1 of 3
0720A00000266392 77366200012396
AT 01 028605 90111[ 76 B**3DGT
~ FISHER ISLAND FERRY
~ PO BOX H
m'-' FZSHER ISLAND, NY 06590-0607
ISign up for electronic billing today!
Visit ups.corn/billing
For questions about your invoice, call:
(800) 811-1648
Monday - Friday
8:00 a.m. - 6:00 p.m.E.T.
or write: UPS
P.O. Box 650580
Dallas, TX 75265-0580
Account Status Summary
Weekly Payment Plan
Amount Due This Pariod $ 67.87
Amount Outstanding (prior invoices) $ 519.29
Total Amount Outstanding $ 587.16
Please include the Return Portion of each outstanding invoice with
your payment. See Account Status for details.
Go green - and save
Choose a UPS electronic billing solution as an alternative to
receiving a paper bill You will be able to view, manage and
pay your UPS bills. Choose the electronic bill format that best
suits your company's needs. Learn more at
www.ups.com/billing
Thank you for using UPS.
Summary of Charges
Page Charge
Outbound
3 UPS WoddShip $ 45.87
3 Adjustments & Other Charges $ 2.00
Service Charge~ $ 20.00
Amount due this period
$ 67.87
UPS payment terms require payment of this invoice by November
23, 2011.
Note: This invoice may contain a fuel surcharge aa described at
ups. com. The published fuel surcharge is 8.5% for UPS Ground
Services and 14.0% for UPS Air Services, UPS 3 Day Select, and
International services. For more information, visit upa.com.
Delivery Service Invoice
Invoice date November 12, 2011
Invoice number 0000026639461
Shipper number 026639
Page 2 of 3
Account Status
Weekly Payment Plan
Amount Outstandin~l (prior invoices):
Please include the Return Portion of each outstanding invoice
with your payment~
Balance
invoice Number Invoice Date Due
0000026639421 10/15/2011 $ 40.01
0000026639431 10/22/2011 $ 97.18
0000026639441 10/29/2011 $170.57
0000026639451 11/~5/2011 $ 211.53
Total $ 519.29
Outstanding balances reflect any payments received an of
11/11/2011. Please ignore thiu message if a recent payment has
been made for any outstanding invoices.
Outbound
UPS WorldShip
Delivery Service Invoice
invoice date November 12, 2011
Invoice number 0000026639461
Shipper number 026639
Page 3 of 3
Numberof
Pickup Pickup
Date Record
11/07 6744200341
Message Codes Packages
1
Charge
45.8/
Total UPS WorldShip
45.8/
Total Outbound
1 package(s)
45.8/
Adjustments & Other Charges
Miscellaneous
Explanation
Cha.~ge
2.0u
WEEKLY PRINTER SERVICE FEE
FOR 1 PRINTERS AT $2.00 EACH
FOR 11-NOV-2011
2.(~
Total Miscellaneous
Total Adjustments & Other Charges
Invoice Messaging
Code Message
r Dimensional weight applied
Shipped from:
FISHERS ISLAND FERRY
0 STATE ST
NEW LONDON, CT 06320
Delivery Service Invoice
invoice date November 19, 2011
invoice number 0000026639471
Shipper number 026639
Control ID 408T
Page 1 of 3
~ 0720A00000266392 77366300013017
---- AB 01 068639 931771194 B**3DGT
~ FISHER ISLAND FERRY
~ PO BOX H
~ FISHER ISLAND, NY 06590-0&07
Sign up for electronic billing today!
Visit ups.com/billing
For questions about your invoice, call:
(800) 811-1648
Monday - Friday
8:00 a.m. - 9:00 p.m.E.T.
or write: UPS
P.O. Box 650580
Dallas, TX 75265-0580
Account Status Summary
Weekly Payment Plan
Amount Due This Period $ 39.91
Amount Outstanding (prior invoices) $ 587.16
Total Amount Outstanding $ 627.07
Please include the Return Porlion of each outstanding invoice with
your payment. See Account Status for details.
Go §men - and save
Choose a UPS electronic billing solution as an a~ternative to
receiving a paper bill. You will be able to view, manage and
pay your UPS bills. Choose the electronic bill format that best
suits your company's needs. Learn more at
www.ups.com/billing
Thank you for using UPS.
Summary of Charges
Page Charge
Outbound
3 UPS WorldShip $17.91
3 Adjustments & Other Charges $ 2.00
Service Charges $ 20.00
Amount due this period $ 39.91
UPS payment terms require payment o! this invoice by November
30, 2011.
Note: This invoice may contain a fuel surcharge as described et
ups.com. The published fuel surcharge is 8.5% for UPS Ground
Services and 14,0% for UPS Air Services, UPS 3 Day Select, and
International services. For more information, visit ups.com.
Delivery Service Invoice
Invoice date November 19, 2011
Invoice number 0000026639471
Shipper number 026639
Page 2of3
Account Status
Weekly Payment Plan
Amount Outstandin~l (prior invoices):
Please include the Return Portion of each outstanding invoice
with your payment.
Invoice Number Invoice Date Due
0000026639421 10/15/2011 $ 40.01
0000026639431 10/22/2011 $ 97.18
0000026639441 10/29/2011 $170.57
0000026639451 11/05/2011 $ 211.53
0000026639461 11/12/2011 $ 67,87
Total $ 587.16
Outstanding balances reflect any payments received as of
11/18/2011. Please ignore this message if a recent payment has
been mede for any outatanding invoice~.
Outbound
uPS WorldShip
Delivery Service Invoice
Invoice date November 19, 2011
Invoice number 0000026639471
Shipper number 026639
Page 3 of 3
Pickup Pickup Number of Billed
Date Record Message Codes Packages Charge
11/15 6744200352 1 17.91
Total UPS WorldShip 1 Package(s) 17.91
Total Outbound 1 Package(s) 17.91
Adjustments & Other Charges
Miscellaneous
Billed
Explanation Charge
WEEKLY PRINTER SERVICE FEE 2.00
FOR 1 PRINTERS AT $2.00 EACH
FOR 18-NOV-2011
Total Miscellaneous 2.00
Total Adjustments & Other Charges 2.00
068639 212
FISHERS ISL,4ND FERRY DISTRICT
VENDOR 024539 W.B. MASON CO.,INC. 12/06/2011 CHECK 207
FUND & ACCOUNT P.O.# INVOICE DESCRIPTION AMOUNT
SM .5711.4.000.000 I02689604 STENO BKS,LGL PD.D,TAPE 84.63
TOT3-L 84.63
Town of Southold, New York - Payment Voucher
Vendor Tax ID Number or S~cial Se, curiE/Number
P.O. Box 981101
Boston, MA 02298-110t
W.B. MasonCo., inc.
Vendor Telephone Number
Vendor Contact
Vendor No.
Invoice
Number
Date
Invoice Net
Total Discount Amount Claimed
102689604 1111612011 84.63 84.63
Comply
84'63i I 84.63
Payee Certification
on behalf of the above named claimant)
that the foregoing claim is true and correct, that no part has
that the balance therein stated is actually
which the Town is exempt are excluded.
Purchase Order
Number
Description of Goods or Services
Office Supplies-NI.
Date
Check No.
Entered by~
~uditDat~ / . ~
$M6711.4.000.000
Department Certification
I hereby certify that the materials above specified have been received by me
in good condition without substitution, the services properly
performed and that the quantities thereof have been verified with the exceptions
STii~ature ~Z~a D~tlnt is a ]ilril~! / !
Town of Southold, New York - Payment Voucher
Vendor Tax ID Number or Social Security Number
W.B. MasonCo., Inc.
Vendor Telephone Number
Vendor Conlaet
Vendor N~
P.O. Box 981101
ggst~n~ 0~8-~ I Ol ......
Check No.
Entered by
Invoice
Number
1026896
Invoice
Date
11/16/2011
Total
84.63
Net
84.63
84.63 84.63
Payee Certification
Tile und.~gned (Claimant) (Acting on behalf of the above named claimant)
does bet .~,y c)~i fy that the foregoing claim is t~ue and correct that no part has
been p/al~o, ~x0~pt as therein stated, that the balance therein stated is actually
~ ' ~' ~due,7, o~:i'~..~J ~-- ~c'xand that ~taxes, from which theTitlL~.~ ~-~'~T°wn~is exempt
C°mpany lmtm t ~6~ ~.~ _Date
Purchase Order
Number
Description of Goods or Services General 1 ~g~- Fund and Account Number
Office Supplies-NL
8M5711.4.000.000
Department Certification
1 bereb~ certify that the materials above specified have been received by me
m good condition without substitution, the services properly
performed and that the quantities thereof have been verified with the exceptions
or discre ties not , and payment is approved
'W.B. MASON CO., INC.
PO Box 111 - Brockton, MA 02303-0111
Address Service Requested
888-WB-MASON www.wbmason.com
9265007368 PRESORT 3DG P1 C31 <B>
7368 i AT 0-365
FISHERS iSLAND FERRY DISTRICT
~ PO BOX H
FISHERS ISLE NY 06390-0607
Delivery Address
Fishers Island Ferry Distnct
5 Watedront Park
New London, CT 06320
PM
Invoice Number: 102689604
Customer Number: C2024302
Reference Number: 102689604
Invoice Date: 11/16/2011
Due Date: 12/16/2011
PO Number: ray
Order Date: 11/15/2011
Order Number: S002913066
Order Method: PHONE
Important Messages
J.Solomon Incorporated and W.B. Mason have joined forces!!
The new J.Solomon IncorporatedNV.B. Mason team looks forward to continuing to provide
the outstanding products and service you have become accustomed to
over the years with J.Solomon Incorporated.
All future payments should be sent to the remittance address noted above.
Thank you for your support of the new J.Solomon Incorporated/VV.B. Mason partnership.
QTY QTY
ITEM NUMBER DESCRIPTION ORDERED SHIPPED UNIT PRICE EXT PRICE
UNV86920 BOOK,STENO,GREGG,GN,80SH 8 8 1.92/EA 15.3~
UNV46300 PAD,LGL,RULED,PERF,5X8,WE (67300) 1 6.19/DZ 6.1~
MMM3750 TAPE,BOX SEAL2X54.6YDS,RL(3760-6) 6 6 7.49/RL 44.9,
UNV55520 PENCIL,WOOD,#2,ME D,DZ[DiX 14402] 2 2 2.05/DZ 4.1~
FSK0t 005086 SClSSOR.STRAIGHT,8",2/PK,BK 1 8.99/PK 8.9!
m
W.B. MASON CO., lNG.
PO Box 111 - Brockton. MA 02303-0111
79.58
SALES TAX TOTAL*:
ORDER TOTAL:
5.05
84.63
*May include boltle deposits
P/ease detach and return below porhon with your ¢ayment
Remittance Section
Customer Number: C2024302
Invoice Number: 102689604
Reference Number: 102689604
Invoice Date: 11/16/2011
Terms: Net 30
Total Due: 84.63
Amount Enclosed $
FISHERS ISLAND FERRY DISTRICT
P O BOX H
Fishers Isle, NY 06390
W.B. MASON CO., INC.
PO BOX 981101
BOSTON, MA 02298-1101
IIl,,,,,hh,hlhl,,h,h,,,ll,,,llll ...... IIIh,,,,,Ihhhl
C20243021026896041026896040000000084633
page I of 2
How to Reach WB Mason Customer Service
· By Phone: 1-888-WB-MASON
· For inquiries by mail: PO Box 111 Brockton MA 02303-0111
· For payments by check: PO Box 98110t Boston MA 02298-1101
HOW TO READ YOUR INVOICE
C200000710000001010000001000~00012506~
Customer Number - Your account number. It
will be helpful to reference this number when
calling customer service or in any other
correspondence.
Terms - Invoice must be paid within the terms
period before becoming past due.
Amount Enclosed - Please indicate the
payment amount included with your remittance.
Important Messages - Special notes from
W. B. Mason about your account.
Invoice Detail - Information pertaining to your
order.
Invoice Date - Date your invoice was printed.
Total Due - Amount of this order to be remitted
for payment.
Remittance Address - Send your payment to
this address with your remittance slip for
proper credit to your account.
wbm-103717
Have you moved or changed your phone number?.
Please provide your new address or telephone number and return this portion with your payment. Your records will be updated on request.
Effective Date:
Account Name:
New Address: .City: State: __.Zip:
Contact Name:
Phone Number:
Work Number: Signature:
page 2 of 2
Packing Slip
W.B. Mason
PO Box 111
59 CENTRE ST
BROCKTON, MA 02303
1-888-WBMASON
www.wbmason.com
Page: 1
Route ........ : 00t40
Warehouse: ..... : NLO-CT
Packing Slip~ ...: 02689449ARPACK
Customer # ...... : C2024302
Sales Rep ....... : Russell Sheik~witz
ill To:
SHERS ISLAND FERRY DISTRICT
O BOX H
shers Isle, NY 06390
;hip Date 11/16/2011
LO. Number ray
lpecial Instructions:
Sales Order# S002913068
Ship To:
Fishers Island FemJ District
5 Waterfront Park
New London, CT 06320
Delivery InstnJctions:
FEM NUMBER Qty Order Qty Ship Bk Ord U/M Description Facilit7
~MM3750 6 6 RL TAPE,BOX SEAL,ZX54.6YDS,RL(3760-6) SOS-MA
2 2 DZ PENClL,WOOD,#2,MED,DZ[DIX 14402] UNTD- WOB
;BC66620 -,,,' , :"':': "';~
VBMS069G 8 8 EA BOOK,STENO,GREGG,GN,80SH UNTO -WOB