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AU-02/14/2012 Fishers Island
FISHERS ISLAND FERRY DISTRICT VENDOR 001623 ARROW PAPER EQUIP RNTL & SALES 02/14/2012 CHECK 304 FUND & ACCOUNT P.O.~ INVOICE DESCRIPTION AMOUNT SM .5710.2.000.200 294056-1 (2)MOP HANDLES 33.90 TOTAL 33.90 Town of Southold, New York - Payment Voucher Vendor Tax ID Number or Social Security Number Vendor Address Vendor Name Arrow Equipment Rental & Sales Vendor Telephone Number Vendor Contact 667 Colman Street New London, CT 06320 Number Date Total Discount 294066-1 1/1112012 33.90 33.90 Net Amount Claimec Payee Certification The undersigned (Claimant) (Acting on behalf of thc above named claimant) does hereby cerri fy that the forcgning 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 Company Name Purchase Order Number Vendor No. 1623 Desl:ri~tion of Goods or Services Mo?.2nd,e Check No. 3o't Entered by Audit Date FEB 1 4 2012 Town Clerk General Ledger Fund and Account Number 8M5710.2.000.200 Department Certification I hereby certi~ 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 discrepancies noted, and payment ~s approved. Signature Title Date ARROW EQUIPMENT RENTAL& SALES 567 COLM'AN ST 860-447-1621 phone NEW LONDON, CT 06320 860-437-1080 fax www.ez2rentit.com FISHERS ISLAND FERRY DISTRIC PO BOX DRAWER H FISHERS ISLAND, NY 06390 ~ Customer8 31118 860 442-0t 65 PO #: NONE Status: Closed Invoice #: 294066-1 Invoice Date: 111112012 Date Out: Wed 1/1112012 9:40AM Operator: MATTHEW HUTCHINGS Terms: On Account Qty Key 2 590216 Items Sold Pa~# Status HANDLE, MOP QUICK CHANGE 60" F590216 Pulled Each 1 $16.95 Price $33.90 Picked Up By: JESSE Please pay from this invoice. RENTAL CONTRACT The said properly listed below is to be returned to 567 Colman Street, New London, CT on the date and time listed below under "Agreed Return Date'*. Signed Witness Date This is a contract. Read both sides before signingThe words "Renter", "You" and '~(ours" mean the person who signs this contract (or are obligated under its terms). "We", "Our" and "Us" refers to Arrow Equipment and Sales or Arrow Paper Pady Rental at address listed above. Terms: Cash in advance. Established open accounts are due and payable net 10th of each month. Past due accounts bear late payment penalties at 1 1/2% par month, I accept/decline the damage waiver,if damage waiver declined please initial .as provided on the reverse side and agree to pay above described additionat chaq;es thereof. I, the undersigned renter, specifically acknowledge that I have received and understand the instructions regarding the use and operation of the rented equipment. Renter further acknowledges that he has read and fully understands the within equipment rental contract and agrees to be bound by all of the terms, conditions and provisions hereof. Renter acknowledges that he has received a true and correct copy of this agreement at the time of execution hereo[Notify Arrow Equipment Rental and Sales Promptly if equipment does not function proper~y, or no refund or allowances will be considered SIGNATURE: FISHERS ISLAND FERRY DISTRIC Rental: $0.00~ Damage Waiver: $0.00 Sales: $33.90 Delivery Charge: $0.00 Misc. Charges: $0.00 Subtotal: $33.90 CT Sales Tax: $0.00 TOTAL: $33.90 PAID: $0.00 AMOUNT DUE: $33.90./ Printed on 1/23/2012 9:58:42 am Open Monday-Friday 7am-5pm, Saturday 8am-5pm, Closed Sunday Modification #1 Software by Point-of-Rental Systems WWW. POINT-OF-RENTAL COM Contract-Params. rpt (1) FISHERS ISLAND FERRY DISTRICT VENDOR 019500 AT&T 02/14/2012 CHECK 305 FUND & ACCOUNT P.O.~ INVOICE DESCRIPTION AMOUNT SM .5710.4.000~100 86044201650212 TEL/NL TERM 1/15-2/14/12 281.72 TOTAL 281.72 Town of Southold, New York - Payment Voucher Vendor Tax 1D Number or Social Securiiy Number Vendor Address Vendor Name AT&T Vendor Telephone Number Vendor Contact AT&T P.O. Box 5082 Carol Stream, iL 60t97- Vendor No. 19500 Uheck No. Entered by 4.udit Date FEB 1 4 2012 Fown Clerk Number Total ~1,'~,~ Net Discount Amount Claimee 281,72 Purchase Order Number 8604420165 -; -':;*; ~,; -"$;; I 0~[~ i ~)11~/2012-02/1412012 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 paid, except as therein stated, that the balance therein stated is actually due and owing, and that taxes from which the Towa is exempt are excluded Title Description of Goeds or Services NL Terminal Tel General 12xlser Fund and Account Number 8M5710,4.000.100 Department Certification 1 hereby certif5r 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 Title Date at&t FISHERS ISLAND FERRY DISTRICt Page I of fi PO BOX H Accooot Number 860 442-0165 078 FISHERS ISLE NY 06390-0607 Billing Date Jan 15, 2012 Web Site att,corn Monthly Statement Previous Bill Payment .OO Adjustments 1.29 Past Due - Please Pay Immediately 112.62 Current Charges 280.43 Total Amount Due ~1.''1~ ~ Current Charges Due in Full by Feb 14, 2012 · Thank you for being an ALL DISTANCE® customer. Your ALL DISTANCE® savings includes: Promotions and Discounts Uem l~ Date Oescrimm Adiustmeuts 1, 1-15 Late Payment Charge 1.5% 129 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 · NAME CHANGE NOTICE · APL PRICE CHANGE · NAME CHANGE · AT&T CAPTEL SERVICE * UNIVERSAL SVC FEE See "News You Can Use" for additional iuformation. 280.43 280.43 Promotions and Discounts 2. Save Elite-S Conn-$27 off -12mo term 27.00CR Monthly Service - Jan 15 thru Feb 14 Charges for 860 44Z-0165 3. Monthly Charges 122.60 Charges for 860 4436851 4. Monthly Charges 28.35 Charges for 860 444-0320 5. Monthly Charges 2835 Charges for 860 447-9371 6. Monthly Charges 28.35 Total Monthly Service 207.65 Directory Assistance Instate ?. I Call(s) billed at $1.89 each 1,89 Call CharRes Bus Block of Time 700 II 2Y Summary 1100 Minutes Used 700 Minutes Allowed Instate Long Distance 852 Out of State Long Distance 871 Call Plan Summary Total 17.23 8. Bus Block of Time 700 II 2Y 3000 *BASIC $158.44 NON BASIC ~234.61 Return bottom portion witb your check in the enclosed envelope. Local Services provided by AT&T Connecticut. Sewices beyond Connecticut provided by AT&T Long Distance East, P GO GREEN- Enroll in papede~s billing. R .,i FISHERS ISLAND FERRY DISTRICT Page 2 of 6 Po B0X H Account Number 860 442-0165 078 FISHERS ISLE NY 06390-0~O7 Billing Date Jan 15, 2012 at&t Web Site att.com Call Charges - Continued Chargee for 860 442-0100 Item No. J~TTQ Time Place Number Itemized CaRs 1,12-15 824A FISHERSlS NY 631788-7318 2.12-15 831A FISHERSIS NY 631788-5508 3.12-15 854A FARMINGDL NY 631414-5808 4,12-15 855A FARMINGDL NY 63t694-2300 5.12q5 932A NOIWVALK CT 203003-(~42 6. 12-15 1116A FISHERS IS NY 631 78~-7463 7.12-15 1137A BRIDGEPORT CT 203673-4145 8.12-15 1251P FiSHERSIS NY 631788-7463 9.12-15 212P FISRERSIS NY 631788-7311 10.12-15 249P READING PA 484256-4169 11.12-15 251P CHESHIRE CT 203272-1412 12.12-15 252P CHESHIRE CT 203272-1412 13.12-15 33OP READING PA 484256-4169 14.12-16 831A FISHERSIS NY 631788-7318 15.12-16 943A NORTRAMPTN MA 413387-7128 16.12-16 944A CHESHIRE CT 203272-7730 17,12-16 949A CHESHIRE CT 203272-7730 18.12-16 007A INDIANAPLS IN 312899-4440 19.12-16 1053A MORRISTOWN NJ 973 214-1506 20.12-16 1114A FISHERS iS NY 631 788-7463 21.12-16 1133A FISHERSIS NY 631788-7463 22.12-16 1143A FISHERSIS NY 631788-7444 23.12-16 1148A FISHERSIS NY 631788-7444 24.12-16 1238P SOUTHOED NY 631765-4333 25.12-16 109P LINDENHST NY 631225-3060 26.12-16 218P MOODUS CT 860873-8687 27.12-16 221P SOUTHOLD NY 631765-4333 28.12-16 244P FISHERSIS NY 631788-7463 29.12-16 337P BOSTON MA 617 939-9487 30.12-17 1042A WH PLAINS NY 914 216-2239 31.12-17 1048A WH PLAINS NY 914216-2239 32.12-17 809P FISHERSIS NY 631788-5680 33.12-19 759A NEWRAVEN CT 203393-5862 34.12-19 823A FISHERSIS NY 631788-7225 35.12-19 918A DELVIOERE NJ 908 475-8685 36.12-19 1120A FISHERS IS NY 631 788-7345 37.12-19 246P FISHERSIS NY 001700-5673 38,12-20 823A COLCHESTER CT 860537-2344 39.12-20 849A FISHERSIS NY 631788-7710 40.12-20 918A HARTFORD CT 860916-6867 41.12-20 955A RSHERSIS NY 631788-7311 42.12-20 1000A HAMPTNBAYS NY 631 594-2169 43.12-20 1000A HARTFORD CT 800900-7634 44.12-20 1011A GREENWICH RI 401884-7800 45.12-20 1108A FISHERS IS NY 631 788-7463 46.12-20 1210P RSRERSIS NY 63178~-7463 47.12-20 131P COLCHESTER CT 860537-2344 Code Min 5:58+ 2:33+ 0:30+ 1:45+ O 0:37+ 2:06+ 3:24+ 2:11+ 3:09+ 1:26+ 0:30+ 0:30+ 0:51+ 0:35+ 1:02+ 1:15+ 6:02+ 1:09+ 15:59+ 1:32+ 2:42+ 4:29+ 3:31+ 9:01+ 6:43+ 1:48+ 17:14+ 1:37+ 4:48+ 1:43+ 2:39+ 0:42+ 0:30+ 1:22+ t 1:33+ 0:30+ 0:30+ 0:31+ 1:46+ 27:44* 0:40+ 0:53+ 1:02+ 8:58+ 0:30+ 0:30+ 0:39+ Call Chargee - Continued Item ~l~ Date Time Place Number 48.12-20 224P RSHERSIS NY 631788-7345 49.12-20 232P NEWBRNSWCKNJ 900 227-1515 50.12-20 255P FISHERSIS NY 631788-7463 51.12-21 803A RSHERSIS NY 631788-5515 52,12-21 815A FISHERSIS NY 631788-5515 .00 53. 12-21 838A HAMPTNBAYS NY 631 594-2169 .00 54.12-21 842A FISHERSIS NY 631788-7444 .00 55.12-21 845A OLDSA¥BRK CT 860399-2841 .OD 56.12-21 930A WORTRINGTN OH 614854-8475 .00 57. 12-21 1040A BELVIDERE NJ 008475-0085 .00 58.12-21 1044A BELVIDERE NJ 908475-8685 .00 59.12-21 1009A COLCHESTER CT 860537-2344 .00 60.12-21 153P GLASTONBY CT 000633-8770 .00 61.12-22 825A FISHERS IS NY 631 788-7463 .00 62. 12-22 843A FISHERS IS NY 631 788-7463 .00 63.12-22 1010A MERCERVL NJ 609689-3060 .00 64. 12-22 240P BRENTWOOD NY 631 553-5017 .00 65.12-22 414P NEWBRNSWCKNJ 908227-1515 ,DO 66.12-23 844A GLASTONBY CT 000633'-8770 .OO 67.12-23 85OA FISHERS IS NY 631 788-5573 .00 68.12-23 9~A FISRERSIS NY 631788-7463 .OO 69.12-23 914A NEWBRNSWCKNJ 90~227-1515 .00 70.12-23 915A RSHERSIS NY 631 788-7463 .00 71.12-23 918A WARWICK RI 401 773-~943 .00 72.12-23 1042A FISHERS IS NY 631 700-7400 .00 73.12-23 1229P SOUTHGATE MA774282-1999 .~ 74.12-23 104P FISHERSIS NY 631788-7193 .00 75.12-23 104P BABYLON NY 631943-7487 .00 76.12-23 202P FISHERSIS NY 631788-7444 .00 77.12-23 237P HARTFORD CT 860986-7634 ,00 78. 12-26 910A PROVIDENCE RI 401 474-0033 .00 79.12-26 1116A PROVIDENCE RI 401474-0633 .OD 80.12-26 1121A FISHERS IS NY 631 780-7001 .00 81.12-26 248P FISHERSIS NY 631780-7662 .OO 82.12-26 252P FISHERS IS NY 631 788-5570 .80 83.12-26 254P FISHERS iS NY 631 788-7573 .00 84. 12-26 300P FISHERS IS NY 631 780-7463 .00 85.12-27 1159A FISHERS IS NY 631 788-7463 .00 86. 12-27 1239P FISHERS IS NY 631 788-74~3 .00 87.12-27 127P NEWBRNSWCKNJ 908812-3750 .00 88.12-27 133P NWYRCYZN01 NY 04~593-73~3 .00 89. 12-27 157P FISHERS IS NY 631 788-7345 .00 90, 12-27 203P FISHERS IS NY 631 788-7345 .00 91.12-27 224P MERIDEN CT 203 238-6745 .00 92.12-27 315P PROVIDENCE RI 401862-1001 .00 93.12-28 837A DARIEN CT 203 655-2525 .00 94. 12-28 1000A FISHERS IS NY 631 700-7463 .80 95. 12-28 1047A FARMINGDL NY 631 414-5808 .00 96.12-28 1051A SOUTHOLD NY 63t 765-4333 .00 97.12-28 1219P MERIDEN CT 203238-8160 .00 98.12-28 1245P FISHERS IS NY 0031 788-7463 .00 99.12-28 232P HARTFORD CT 860986-7634 100. 12-28 24OP WINDSORLKS CT 860008-0044 0:30+ .00 0:47+ .00 0:30+ ,00 3:01+ .00 2:51+ ,00 0:45+ .00 2:22+ .00 5:30+ .00 1:0~ .00 1:09+ .00 8:50+ .O0 3:02+ 1:00+ .00 6:49+ 7:51+ .00 2:51+ .00 2:48+ ,00 1:19+ .00 1:00+ ,00 0:30+ ,00 4:12+ .00 0:38+ .00 0:30+ .00 0:40+ .00 1:16+ .00 0:34+ .00 0:30+ .00 0:55+ .00 0:31+ .00 0:30+ .00 0:44+ .00 0:59+ .00 0:30+ .00 0:40+ .00 0:30+ .00 0:37+ .00 0:30+ 0:55+ .00 t:22+ ,00 5:45+ ,00 2:40+ .00 0:49+ 0:59+ 4:40+ ,00 3:56+ .00 2:03+ .00 2:49+ .00 1:57+ .00 8:37+ .00 0:55+ 1:07+ .00 0:30+ .00 51:59+ .00 6451.005.05(~61.01.03.0000000 NNNNNNNY 101005.101805 FISHERS ISLAND FERRY DISTRICT Page 3 of 6 PO BOX H Account Number 860 442-0165 078 at&t FISHERS ISLE NY 06390 0607 Billing Date Jan 15, 2012 Call Charges - Continued Item No. Date Time ploc~ 1.12-28 341P FISHERSIS 2.12-29 701A FISHERS IS 3.12-29 73OA FISHERS IS 4.12-29 110DA BRISTOL 5.12-29 1127A FISHERSIS 6A2-29 1144A FISHERSIS 7.12-29 137P FISHERSIS 8.12-29 204P FISHERSIS 9,12-29 216P FISHERSIS Number NY 631 788-7463 NY 631 788-7729 NY 631 788-7345 VT 802 453-5549 NY 631 788-7343 NY 631 788-7343 NY 631 788-7729 NY 631 788-7729 NY 631 788-7463 10.12-29 226P NWYRCYZN01 NY 646593-7363 11.12-29 258P NEWYORK NY 917626-7402 12.12-29 428P RAMPTNBAYS NY 631594-2169 13.12-29 546P BELVlDERE NJ 9(~475-8685 14.12-30 817A FISHERSIS NY 631788-7345 15.12-30 853A FISHERSIS NY 631788-7001 16.12-30 913A FISHERSIS NY 631788-7463 17.1230 925A BOST0N MA617437-3261 18.12-30 926A WARWICK RI 401773-9894 19.12-30 928A HAMPTNBAY8 NY 631594-2169 20.12-30 940A WARWICK RI 401773-9894 21.12-30 1007A STAFFDSPG CT 860458-0074 22,12-30 1021A HARTFORD CT 860528-3860 23. 12-30 1023A FISHERS IS NY 631 788-7345 24.12-30 1028A HARTFORD CT 860493-1534 25.12-3(]1217P NWYRCYZN01 NY 212222-4880 26. 1-02 951A BELVIDERE NJ 90~475-8685 27. 1-02 1047A MORRIST0WN NJ 973214-1506 28. 1-02 1056A FISHERSlS NY 631788-7311 29. 1-02 542P NWYRCYZN01 NY 646384-1205 30. 1-03 838A MERIDEN 31. 1-03 1121A NEWHAVEN 32, 1-03 124P FISHERS IS 33. 1-03 305P NEW HAVEN 34. 1-03 321P FISHERS IS 35. 1-03 402P OLD SAYBRK 36. 1-03 406P OLD SAYBRK 37. 1-03 40BP OLD SAYBRK 38. 1-03 452P BOSTON 39. 1-03 538P BELVIDERE 40. 1-04 963A FISHERS IS 41. 1-04 904A NEWYORK CT 203 238-8160 CT 203468*4503 NY 631 788-7251 CT 203468-4503 NY 631 788-7463 CT 860399-6544 CT 860399-6544 CT 860399-5266 MA 617 478-6545 NJ 908 475-8685 NY 631 788q345 NY 917355-1276 42. 1-04 918A NWYRCYZN01 NY 646593-736.3 43. 1-04 1048A FISHERS IS NY 631 788-7345 44. 1-04 332P NORTRAMPTN MA 413387-7128 45. 1-05 832A MOODUS CT 860873-19~0 46, 1-05 1029A MOODUS CT 860873-8668 47. 1-05 1133A NWYRCYZNOI NY 212222-4880 48. 1-05 1142A NWYRCYZN01 NY 212222-4880 49. 1-05 1238P FISHERS IS NY 631788-7463 Call Charges - Continued ~ Datq Time Place Number 50. 1-05 152P FISHERSIS NY 631788-7444 51. 1-05 216P OLBSAYBRK CT 860227-2335 Code Mien 52. 1-05 233P OLD SAYBRK CT 860227-2335 1:58+ .00 53. 1-05 354P ESSEX CT 860662-4090 0:39+ .00 54. 1-06 828A FISHERS IS NY 631 788-7463 0:30+ .00 55. 1-06 910A WARWICK RI 401773-9864 3:07+ .00 56. 1-06 940A HARTFORD CT 860986-7634 4:55+ .00 57. 1-06 1155A HARTFORD CT 860986-7634 0:41+ .00 58. 1-06 328P HARTFORD CT 8609~6-7634 0:30+ .00 59. 1-06 459P SANANGELO TX 325223-9300 0:33+ .00 60. 1-09 726A BRANFORD CT 203483-7772 5:45+ .00 61. 1-09 841A PROVIDENCE RI 401 286-1767 2:39+ .00 62. 1-09 855A FISHERS IS NY 63l 788-7345 2:24+ .0~ 63. 1-09 933A FISHERS IS NY 631 788-7857 2:06+ .00 64. 1-09 946A FISHERS IS NY 631 788-7463 3:54+ .00 65. 1-09 958A AUBURN MA.,.50~832-5008 2:18+ .00 66. 1-09 1015A AUBURN MA 508832-5008 12:32+ .00 67. 1-09 1019A FISHERS IS NY 631 788-7455 1:38+ .00 68. 1-09 1021A AUBURN MA 508832-5008 0:31+ .00 69. 1-09 1027A FISHERS IS NY 631 788-7528 0:33+ .00 70. 1~09 1113A OLD SAYBRK CT 860 388-4091 11:38+ .00 71. I 09 1142A HARTFORD CT 860521-2455 8:18+ .00 72. 1-09 1158A FISHERS IS NY 631 788-7857 0:47+ .00 73. 1-09 1239P FISHERS IS NY 631 788-7343 1:39+ .00 74. 1-09 1256P FISHERS IS NY 631 788-7345 0:30+ .00 75. 1-09 112P HARTFORD CT 860916-6867 0:58+ .00 76. 1-09 128P NARRAGNSTT RI 401 874-4241 1:35+ .00 77. 1-09 203P HARTFORD CT 8609~6-7634 13:07+ .00 78. 1-09 323P FISHERS IS NY 631 788-7345 0:51+ .00 79. 1-10 815A NARRAGNSTT RI 401 789-1021 0:58+ .00 80. 1-10 834A FARMINGDL NY 631 414-5808 0:33+ .00 81. 1-10 843A PROVIDENCE RI 401 863-8669 1:49+ .00 82. 1-10 846A NEWHAVEN CT 203410-6997 0:50+ .00 83. 1-10 911A FISHERS IS NY 631 788-7463 0:36+ .00 84. 1-10 919A FARMINGOL NY 631 414-5808 7:56+ .00 85. 1-10 958A FARMINGDL NY 631 414-5808 16:05+ .00 86. 1-10 IOOOA HARTFORD CT 860293-0442 0:30+ .00 87. 1-10 1013A HARTFORD CT 860916-6867 1:33+ .00 68. 1-10 1020A FISHERS IS NY 631 788-7463 0:56+ .00 89. 1-10 1035A PROVIDENCE RI 401 785-3780 1M 8:50+ .00 90. 1-10 247P FISHERS IS NY 631 788-7919 2 12:08+ .00 91. 1-10 255P FISHERS IS NY 631 788-7928 1 0:30+ .~ 92. 1-10 344P FISHERS IS NY 631 788-7311 1 1:01+ .00 93. 1-11 1211P HARTFORD CT 860986-7634 1 0:34+ .OO 94. 1-11 257P FISHERSIS NY 631788-7919 1 0:30+ .00 95. 1-11 313P PROVIDENCE RI 401862-166l 1 0:37+ .00 96. 1-11 329P WALLINGFD CT 203741-112l D 1:24+ .00 97. 1-11 5lip BELVIOERE NJ 90~475-8685 D 13:34+ .00 98. 1-11 550P BELVIDERE NJ 908475-8685 1 1:25+ .00 99. 1-12 902A FISHERS IS NY 631 788-7857 1 1:15+ .00 100. 1-12 903A FISHERS IS NY 631 788-7343 I 0:43+ .00 101. 1-12 957A MERIDEN CT 203238-6757 102. 1-12 139P MERIDEN CT 203238-6757 Code Min 1 0:42+ O 0:56+ .00 O 3:59+ .00 O 0:30~ .00 1 0:38+ .00 D 12:37+ .0~ O 34:17+ .00 0 83:53+ .00 1M 36:43+ N 0:35+ ,00 0:30+ .00 0:33+ .00 1:06+ .00 8:54+ .00 8:33+ .00 0:30+ .00 0:30+ .00 1:50+ .0~ 0:30+ 2:12+ .0~ 1:34+ .00 1:13+ .00 0:41+ .00 0:46+ .00 12:40+ .35 2:13+ .10 66:27+ 2.86 0:30+ .02 1:56+ .08 1:39+ .07 1:01+ .04 1:41+ .07 6:3~+ .29 0:36+ .03 1:13+ .05 0:37+ .03 0:41+ .03 1:01+ .04 0:56+ ,04 2:28+ .1 1:02+ .04 22:13+ .96 0:3~+ .03 0:30+ .02 1:48+ .08 0:30+ .02 13:13+ .57 0:30+ .02 1:45+ 3:14+ .14 1:10+ .05 at&t FISHERS ISLAND FERRY DISTRICT Page PO 60X H Account Number FISHERS iSLE NY 06390 0607 Dilling Date I 4of6 860 442-0165 078 Jan 15, 2012 Call Charges - Continued No. Date Time Place P, Jumbef 1. 1-12 143P FISHERSIS NY 631788-2919 2. 1-13 744A FISDERSIS NY 631788-1311 3. 1-13 IOIOA FISHERS iS NY 631 788-7628 4. 1-13 1050A FISHERS IS NY 631 788-7463 5. 1-13 346P FISHERSIS NY 631288-7444 6 i-13 350P FISHERS IS NY 631 788-7345 7. 1-13 352P FISHERS IS NY 631 788-7632 8, 1-13 355P HARTFORD CT 860550-0081 9, 1 13 4O~P FISHERS IS NY 631 788-7842 10, 1-13 403P FISHERS[S NY 631788-7882 11. 1-13 404P FISHERSIS NY 631788-7842 12. 1-13 726P SPRINGVLY NY 914906-8056 Total Itemized Calls Directory Assistance Summary 1 Instate Directu~/Assistance Call(s) Total Cbarges for 860 442-0165 Charges for 860 4434851 &temized Calls 13.12 15 1014A FISHERS IS NY 631 788-5522 1412-15 250P FISHERSIS NY 631788-5522 15.12-16 959A FISHERSIS NY 631788-5522 16.12-19 13lA FISHERS IS NY 631 788-5523 17.12-19 944A EISHERSIS NY 631788-5522 18.12-19 257P FISHERS IS NY 631788-5522 19.12-20 1020A FISHERS IS NY 631 788-5522 20 12 20 1127A FISHERS IS NY 631 788-5522 21.12-20 256P FISRERSIS NY 631768-5522 2Z 12 21 I I00A FISHERS IS NY 631 288-5522 23 12-21 259P FISHERS IS NY 631788-5522 24.12-22 956A FISHERS IS NY 631 288-5522 25,12-12 324P FISHERS IS NY 631 288-5522 26, 12 23 618A FISHERS IS NY 631 786-5523 22. 12-23 1OO1A FISHERS IS NY 631 188-5522 28.12-23 249P FISHERS IS NY 631 788-5522 29, 12-24 626A FISHERS IS NY 631 188-5522 30.12-26 256P FISHERSIS NY 6317885523 31, 12-27 938A FISHERS IS NY 631 788-5522 32.12-28 100lA FISHERS IS NY 631 788-5522 33. 12-28 IOIOA FISHERS IS NY 631 788-5522 34. 12-28 1013A FISHERS IS NY 631 788-5522 35.12-28 1014A FISHERSIS NY 631788-5522 36,12-28 304P RSHERSIS NY 631788-5522 37.12-29 954A FISHERS iS NY 631 788-5522 38.12-29 1216P FISHERS IS NY 631 788-5600 39. 12-29 1218P EISRERS IS NY 631 788-5600 40.12-29 250P FISHERSIS NY 631788-5522 41.12-30 941A EiSHERSIS NY 631188-5522 42 12-30 1051A SMITRTOWN NY 631 382-8175 Cod~ Mi~ 0:30+ 0:42+ 1:12+ 7:49+ 3:57+ 1:01+ 0:54+ 0:30+ 0:48+ 0:30+ 1:28+ 0:31+ 1:03+ 0:30+ 0:39+ 0:30+ 0:59+ 0:33+ 0:57+ 0:30+ 0:32+ 1:03+ 0:32+ 0:59+ 0:32+ 0:30+ 0:58+ 0:32+ 8:34+ 0:32+ 0:32+ 0:40+ 0:34+ 0:34+ 0:35+ 0:33+ 0:36+ 0:30+ 0:30+ 0:34+ 0:36+ 0:39+ Call Charqes - Continued Item No~ Date T~ P!aFe Number 43.12-31 130P FISHERS IS NY 631 788-5522 44, 1-02 253P FISHERS IS NY 631 788-5522 45, 1-03 937A FISHERS IS NY 631 788-5522 .02 46. 1-04 1005A FISHERS IS NY 63t 788-5522 .03 47. 1-05 951A FISHERS IS NY 631 788-5522 .05 48. 1~05 125P FISHERSiS NY 631788-5522 .34 49. 1-06 1000A FISHERS iS NY 631 788 5522 ,17 50. 1 06 1004A FISHERS iS NY 631 788-5522 .04 51. 1 07 130P FISHERS iS NY 631 788-5522 .04 52. 1-09 1051A FISHERS iS NY 631788-5522 .02 53. 1-09 314P FISHERS IS NY 631788-5522 .03 54. 1-09 335P FISHERS IS NY 631 788-5522 .02 55. 1-10 1067A FISHERS IS NY 631 788-5522 .06 56 1-11 956A FiSHERSIS NY 631 788-5522 ,03 57. 1-11 251P FISHERSIS NY 631 788-5522 7.57 58. 1-12 1010A FISHERS IS NY 631 788-5522 59. 1-13 1036A FISHERS IS NY 631 788-5522 Total Itemized Calls Total Charses for 860 443-6851 7,57 Charges for 860 444-0326 itemized Calls 60,12-15 115P ROWLEY MA978948-2294 ,05 61.12 20 1000A FISHERS IS NY 631 788 5523 ,02 62.12-20 303P LINDENHST NY 631225-7911 ,03 63. 12-21 1049A ST PAUL MN 651 628-6199 .02 64,12-21 1219P SANANGEL0 TX 325223-9104 .04 65 12-21 1223P FISHERS IS NY 631 788-5523 .02 66.12-22 1129A BOSTON MA 617 223-3034 ,04 67 12-22 1133A FISHERS IS NY 631 788-5523 .02 68 12-23 953A FISHERS IS NY 631 788-5523 ,02 69.12-28 1222P MERIDEN CT 203630-4415 .05 70.12-29 738A MERIDEN CT 203630-4415 .02 7112-29 743A MERIDEN CT 203630-4415 .04 72.12-29 762A MERIDEN CT 203630-4415 .O2 73.12-30 921A PLYMOUTH NH 603536-3338 .02 74 1-02 203P FISHERS IS NY 631 788-5523 .04 75. 1-05 704A FISHERSIS NY 631 788-5523 .02 76. 1-05 124P SANANGELO TX 325223-9104 ,02 77. I 06 537P SANANGECO TX 3252239104 ,02 78 1-06 539P SANANGELO TX 325223-9104 .02 79. 1-09 1228P FISHERS IS NY 631 788-5523 .03 80. 1-09 1241P FISHERS IS NY 631 788-5523 .02 81. 1-09 333P FISHERS IS NY 631 788-5523 .02 82. 1-09 3,37P FISHERS IS NY 631 788 5523 .03 83. 1-11 1243P FISHERS IS NY 631 788-5523 .02 84. 1-12 222P MERIDEN CT 203630-4415 .03 85. 1-13 1045A NEWHAVEN CT 203468-4445 ,02 Total Itemized Calls .02 Total Charges for 860 444-0320 ,02 ,03 Cha~Jes far 860 447-9371 .03 Itemized CaBs 86.12-15 808A LEBANON CT 860642-4317 Cod~e Mi~ 0:30+ .02 0:32+ .02 0:36+ .03 0:41+ .03 0:38+ .03 0:30+ .02 0:37+ .03 0:38+ .03 0:32+ .02 0:36+ .03 0:30+ .02 0:37+ .03 0:36+ .03 0:35+ ,03 0:31+ .02 0:51+ .04 0:34+ .02 1 25 1.25 0:50+ .04 0:30+ ,02 0:52+ 04 0:31+ .02 0:34+ .02 0:32+ .02 0:40+ .03 0:32+ .02 0:30+ 02 2:00+ .09 3:42+ .16 5:36+ 24 2:49+ .12 2:44+ 32 0:30+ .02 1:03+ .05 0:36+ ,03 0:44+ .03 1:07+ .05 0:30+ .02 0:30+ ,02 0:30+ .02 0:30+ .02 0:30+ .02 1:14+ 05 0:33+ ,02 1.31 1,31 D 1:47+ .08 6451.005,050861.02.03.0000000 NNNNNNNY 85603.85603 at&t FISHERS tSLAND FERRY DISTRICT Page PO BOX H Account Number FISHERS ISLE NY 06390-0607 Billing Data 5of6 860 442-0t65 078 Jan 15, 2012 Call Charges - Continued Item No. Date Time Place Nulqll~F Code Mi~fl 1.12-15 1141A DANIELSON CT 860774-9621 O 0:44+ .03 2.12-15 132P FISHERSIS NY 631788-5673 1 1:36+ .07 3.12-16 838A FISHERSIS NY 631788-5508 1 0:32+ .02 4.12-16 906A READING PA 484256-4169 1 3:21+ .14 5. 12-16 1250P FISHERS IS NY 631 78e-7463 I 9:41+ .42 6.12-16 234P MOODUS CT 860873-8687 D 0:30+ .02 7.12-19 907A FISHERS IS NY 631 788-7318 1 0:30+ .02 8.12-19 928A FISHERS IS NY 631 788-7463 I 0:30+ .02 9.12-20 848A COLCHESTER CT 860537-2344 D 0:30+ .02 10.12-20 853A WINDSORLKS CT 860668-0044 D 1:25+ .06 11.12-20 855A HARTFORD CT 860916-8867 0 15:53+ 12.12-20 124P FISHERS IS NY 631788-5515 1 0:30+ .02 13.12-21 1050A COLCHESTER CT 860537-2344 O 3:31+ .15 14.12-21 149P MANHATTAN NY 646839-8582 I 2:14+ .10 15.12-23 842A NORTHAMPTN MA 413387-7128 1 0:55+ .04 16.12-23 909A FtSHERSIS NY 631788-7345 I 1:12+ .05 17.12-23 918A FISRERSlS NY 631788-7463 1 0:48+ .03 18. 12-23 947A FISHERS IS NY 631 788-74&3 1 0:59+ .04 19.12-23 157P FISHERS IS NY 631788-7345 1 0:53+ .04 20 12-23 259P FISHERSIS NY 631788-7345 1 1:10+ .05 21.12-26 238P FISHERSIS NY 631788-7463 I 2:56+ .13 22.12-27 155P HARTFORD CT 860916-6867 D 24:42+ 1.06 23.12-27 242P HARTFORD CT 860986-7634 D 0:38+ .03 24.12-27 243P WlNDSORLKS CT 880668-0044 D 0:53+ .04 25.12-28 1010A WARWICK HI 401773-9943 1 1:36+ .07 26. 12-28 1029A WARWICK RI 401 773-9943 1 6:02+ .26 27.12-28 1105A BOSTON MA 617 478-6545 1 13:45+ .59 28.12-28 233P WtNDSORLKS CT 860668-(3044 D 3:13+ .14 29.12-30 946A RSHERSIS NY 631788-7463 I 0:48+ 30. 12-30 I009A FISHERS IS NY 631 788-7463 I 0:36+ .03 31. 1-02 1250P FISHERSIS NY 631788-5515 1 0:38+ .03 32. 1-03 215P BRIDGEPORT CT 203650-0327 D 0:33+ .02 33. 1-O4 947A FISHERS IS NY 631 788-5515 1 1:43+ .07 34, 1-05 828A FISHERS IS NY 631788-7345 1 0:35+ .03 35. 1-05 919A FISHERS IS NY 631 788-7345 1 0:380+ .02 36. 1-05 920A FISHERS IS NY 631788-7345 1 0:59+ .04 37. 1-05 931A ROANOKE VA 540387-5731 1 0:30+ .02 38. 1-05 931A MOODUS CT 860873-8668 D 0:30+ .02 39. 1-05 1023A FISHERS IS NY 631788-7345 I 2:13+ .10 40. 1-05 1201P FISHERSIS NY 631788-7919 I 0:57+ .04 41. 1-06 100lA SIMSBURY CT 860325-2238 O 0:38+ .02 42. 1-06 IO01A SANANGELO TX 325223-93(]0 1 6:42+ 29 43. 1-06 1014A HARTFORD CT 8609~6-7634 D 4:22+ .IS 44. 1-06 1041A HARTFORD CT 860986-7634 D 1:20+ .06 45. 1-06 1103A GARDENCITY NY 516790-5381 I 0:30+ ,02 46. 1-06 124OP HARTFORO CT 860986-7634 D 0:41+ .03 47. 1-06 335P RRIDGEPORT CT 203913-2013 D 1:19+ .06 48. 1-06 347P NWYRCYZN01 NY 646593-7363 1 4:56+ 21 49. 1-06 402P MORRIST0WN NJ 973214-3307 1 0:49+ .04 Call Cherges - Continued Item ~ Date Tirade Pla~g Number 50. 1-09 1055A HARTFORD CT 860521*2455 51. 1-09 1132A FISHERS IS NY 631 788-7224 52. 1-09 216P FISHERSIS NY 631 788-7345 53. 1-09 258P FISHERS IS NY 631 788-7345 54. 1-09 305P MORRISTOWN NJ 973214-1566 55. 1-10 803A NEWBEDFORD MA 50~969-4449 56. 1-10 833A EARM[NGDL NY 631414-5808 57. 1-10 837A NWYRCYZN01 NY 646593-7363 58. 1-10 838A NWYRCYZN01 NY 646593-7363 59. 1-10 917A OLDSAYBRK CT 860388-5035 60. 1-10 100~A FISHERS IS NY 531 788-7345 61. 1-10 1103A FISHERS IS NY 631 788-7345 62. 1-10 209P FISHERS IS NY 6:31788-7345 63. 1-12 8O~A FISHERS IS NY 631788-7345 64. 1-12 816A WATERBURY CT 203754-5334 65, 1-12 917A ALLENTOWN NJ 609259-8900 66. 1-12 1037A FISHERSIS NY 631 788-7463 67. 1-12 1107A PROVIDENCE RI 401339-1419 68. 1-12 313P FISHERS IS NY 631 788-7463 69. 1 13 949A NEWBEDFORD MA 50e938-4449 70. 1-13 1105A TRENTON 71. 1-13 311P FISHERSIS 72. 1-13 355P FISHERS IS 73. 1-13 358P FISHERS IS 74. 1-13 401P FISHERSIS Total Itemized Calls Total Charges for 860 447-9371 + - Optional Calling Plan Key to Calling Codes I Peak M Multiple Rate Periods Total 0all Charges NJ 609 462-3870 NY 631 788-7345 NY 631 788-5685 NY 631 788-7251 NY 631 78~-7255 2 Off Peak N Night~Neekend Surcharges and Other Fees C~d~ Mi~ D 0:30+ .02 1 0:58+ .04 1 0:38+ .02 1 0:30+ .02 1 0:46+ .03 1 1:51+ .08 t 0:30+ .02 I 0:30+ .02 I 3:35+ .15 D 0:30+ .02 I 1:52+ .0~ 1 0:30+ .02 1 0:38+ .03 1 0:40+ .03 D 0:43+ .03 1:39+ .07 t:33+ .07 3:43+ ,16 0:57+ .04 4:04+ .17 0:38+ .02 0:30+ .02 0:30+ .02 1:23+ .06 1:38+ .07 7,10 7,10 D Day 47.23 AT&T Connecticot 75. ConnecticutEg-I-1 Surcharge- 4Lines 76. Connec0cut Service Fund - 4 Lines 77. Universal Service Fund - Local(4 @ $1.38) 78. Federal Subscriber Line Charge - 4 Unes Total AT&T Connecticut AT&T LD East 79. FederaJ Regulatory Fee 80. Universal Service Fund - Interstate Total AT&T Long Distance East Total Surcharges and Other Fens 1.20 .20 5.44 23.08 29.92 .33 4.03 4.36 34.28 81. Federal 3.50 82. State Sales Tax 12,88 Total Taxes 16.38 Total Plans and Services 280.43 at&t FISHERS 18LAND FERRY DISTRICT Page 6 of 6 PO g0X H Accom~t Numbe¢ 860 442-016§ 078 FISHERS ISLE NY 06390 0607 Billing Date Jan rs, 2012 PREVENT DISCONNECT If your bill shows a past due amount, BOTH tim Past Due amount and Current Charges are due IMMEDIATELY. All of your bill charges must be paid each month to keep your account currelrt and avoid collection activities (See Terms and Conditions for lurther information). However, to avoid disconnection of Inca[ service, Basic Charges MUST be paid, For ntis account that amount is: $158.44 for Current Basic Charges $0.00 for Past Doe Basic Charges CARRIER INF0 Our records indicate that AT&T Connecticm is your carrier for instate calls. AT&T Long Distance Fast is your carrier for interstate and international calls. KEEP YOUR DISCOUNT You receive any discounts, reduced rates, or promotional credits de- scribed in tire AT&T Benefits section ol the bill because you subscribe to certain required services, for example, because you are an ALL DISTANCE® customer. If you remove any of file services required for a particular discount reduced rate, or promotional credit your effective rate for file associated remaining service will chauge. Please call your AF&T service representative if you have any questions. NAME CHANGE NOTICE Effective January 31, 2012, AT&T Business Intornational Calling (SM) will be renamed AT&T Business International Calling (SM) Standard. Your calling plan rates will .lot chaDge as a result of this name change. For more information please cail the toll-free Dumber on your bill. APL PRICE CHANGE Effective February 15, 2012, tile Analog Private Une month-to-month prices in Connecticut will increase approximatoly 20%. The amount of file increase will depend oil fire specific circuit type, If you have any questions, please contact an AT&T Service Representabve at the toll free number on your bill. Thank you for choosing AT&T Connecticut, NAME CHANGE Effective January 31. 2012, AT&T Business intornatim~al Calling (SM) will be renamed AT&T Business International Calling (SM) Basic. Your calling plan rates will not clrange as a result of this name change. For more intormation please call the toll-free number on your bill. AT&T CAPTEL SERVICE Do you or someone you know have difficulty hearing on the telephone? AT&T now offers a service that allows you to listen and read the captions of what is being said. With AT&T CapTel Service, tile captions are displayed on a special telephone or on your computer screen, similar to bow captions are displayed on your television. Don't miss auother word of your telephone conversations. For more inlormatiou, please visit captaLattcom or call 1.877,401.8668. UNIVERSAL SVC FEE Effective 1/I/2012, the Federa[ Universal Service Fee has increased. This fee supports telecommunication needs of Iow-income households, consumers living in Itigb-cost areas, schools, libraries, and rural hospitals. Your current bill reflects tire change. For more information, please cmrtact all AT&T Service Representative at the phone number listed on the front of your biib BASIC CHARGES Basic Charges are charges for Basic Services. Basic Services iDctude local service and in-state toll if you are an AT&T Connecticut local service customer. Basic Charges include: Monthly Charges tot your local line and other services, such as Totalphone and Smarflink; in-stato Calling Charges; m-state Directory Assistance Charges; tim Connecticut E-951 Surcharge; the Connecticut Service Fund fee; the Eederai Subscriber Line Cllarge; and tile Universal Service Fund - Local lee. NONBASIC CHARGES Non-Basic Charges are charges for Non-Basic Services. These charges include: Call Charges for out of state calls, 900 calls and calls placed through 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 Intomet Wireless, AT&T I DISH Network, AT&T I DIRECTV, Advertising in the white page directories or other media; anti the Universal Service Fund - Interstate fee. CHARGES THAT MAY BE BASIC OR NON-BASIC Certain charges may be either Basic or Non-Basic, depending on the associated service. These include taxes, Late Payment Charges, Collection Charges, end Additions and Changes to your service. BILL PAYMENT, LATE PAYMENT CHARGES AND OTHER FEES Failure to pay any portion of your bill may result in additional collectimr action. Any pardal payment made will first be applied to Basic Charges, then to Non-Basic Charges. Failure to pay your Basic Charges will result in iDtarruptiml of your local service. If you fail to pay your Non-Basic Charges, your AT&T Conuecticut local service will not be interruptod, but all of your Non-Basic services will be terminateti. AT&T Connecticut may apply a late payment charge per month on any unpaid balance, excluding tire previously assessed late payment charges. To avoid a late charge, we must receive payment for ~e total amount due no later than the date specified on your bill statament. AT&T Comrecticut will apply a S20.00 Collection Charge on an account where a termination notice bas been senL An explanation of these charges may be obtained by calling AT&T Connecticut at the number shown on your bill or accessing our website: http~/www.atLcom/cthdlglossary AT&T SERVICES Local and in state long distance services, inside wire, rental sets, and voice mail services (except where shown as provided by AT&T Messaging) are provided by AT&T Commcticut Out of state long distance is provided by AT&T Long Distance East. Intemet services are provideti by AT&T Intemet Services. Wireless services are provided by AT&T Mobility. 6451,005.0.50861.03,03,00000(]~ NNNNNNNY 85605,85605 FISHERS ISLAND FERRY DISTRICT VENDOR 004442 THOMAS F. DOEERTY JR. 02/14/2012 CHECK 306 FUND & ACCOUNT P.O.# INVOICE DESCRIPTION AMOUNT SM .5710.4.000.000 010711-REIS REIMB.PVA CONF.REG 550.00 TOTAL 550.00 Town of Southold, New York - Payment Voucher Vendor T~x ID Nmnber or SeciM Security Number Vendm- Address P.O. Box 102 Fishers Island, NY 06390 Thomas Doherty ~nvoice Invoice Invoice DmCOarrt Payee Certification The undersigned (CIaiman0 (Acting on behalfof&e above named claimant) doe~ hct~by crt tify fl~at the foregoing claim is tree and correcl, that no pnrt has been paid, except as t~rein stated, that the [~lance thelein stated is ~ctunlly _~cription ofGoo~s ~ Services PVA Conference R~I Feb 5-8; N/att Re~/StLou Check No. Audi~ Shtb'710.4.°°°,oo0 Department Certification I he.by ce~Afy thru the n'mtrdnls above specified have been received by me Title ACCOUNTING & FINANCE DEPT. John A. Cushman, Town Comptroller Telephone (631) 765-4333 Fax (631 ) 765-1366 E-mail: accounting@town.southold.ny.us TOWN HALL ANNEX 54375 Main Road P.O. Box 1179 Southold, NY l 1971-0959 http://southoldtown.northfork.neff Thomas F. Doherty Jr. PO Box 102 Fishers Island, NY 06390 TOWN OF SOUTHOLD OFFICE OF THE SUPERVISOR February 1, 2012 Dear Tom: Our records indicate that on February 1,2011, we issued you a check in the amount of $550.00 to reimburse a PVA conference registration fee. To date, this check appears outstanding on our records. Please check your records to see if you have received this check and negotiated it, or if it appears unpaid. If this amount is still due you, please verify this fact by signing this letter as confirmation and returning it to our office. If some other circumstance exists regarding this item, please contact this office immediately. In the event that we do not hear from you by February 15, 2012, we will consider this matter closed, Your attention to this matter is appreciated. Very truly yours, man ptroller stop payment on ~.~..eck and ...,~,~_ _ ~ew one~../. / ,~ ¸'2 FISHERS ISLAND FERRY DISTRICT VENDOR 005029 MARK EASTER 02/14/2012 CHECK 307 FUND & ACCOUNT P.O.# INVOICE DESCRIPTION AMOUNT SM .5710.4.000.000 011212 REIM 217.3MI@.51/MI 112.91 TOTAL 112.91 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 152 Gager Road Bozrah, CT 06334 Vendor No. 5029 Check No. Entered by ~ FEB 1 4 2012 Town Clerk Invoice invoice Invoice Net Number Date Total Discount Amc Purchase Order Number Description of Goods or Services Traval/Expenee Reimb. xmas trees, AirGas, Benn RIn~ls End, Girard Ford, Home Depot Transfer Station, lan Elec,Staples, Ali-Time Manufacturln~l General Ledger Fund ancl Account Number SM5710.4.000.gEO" Payee Certification The undersigned (Claimant) (Acting on behalf of the above named claimant) does hereby ccrti~ '~hat 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 Toum is exempt arc excluded Signature ~.~ Company Name Department Certification l 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 Title Date Mileage Reimbursement Form Name: /W~rk- ~_ct~-~-v Date Miles Destination Purpose Total miles oL).\,% X -%1 signature per mile date www. BusinessFormTemplate.com FISHERS ISLAND FERRY DISTRICT VENDOR 005440 EMPIRE HEALTHCHOICE, INC. 02/14/2012 CHECK 308 FUND & ACCOUNT P.O. # INVOICE DESCRIPTION AMOUNT SM .9060.8.000.000 SM .9060.8.000.000 598599-D2-0212 -2/12 HEALTH INS PREMIUM 11,369.44 598599H15-0212 HEALTH SAV ACCT-2/12 911.94 TOTAL 12,281.38 Town of Southold, New York - Payment Voucher Vondor Tax ID Number or Social Security Number Empire HealthChoice, Inc. Vendor Telephone Number Vendor Contact P.O. Box 11744 Newark, NJ 07101-4744 vendor No. 5q 0, , Check No. ,: qos Entered by ~ Audit Date FEB 1 4 2012 Town Clerk Net Discount Amount Claime~ Invoice Invoice Date Total 1/14/2012 11,369.44 11,369.44 Payee Certification Number 598699 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 paid, except as therein stated, that the balance therein stated is actually due and owing, and that taxes from which the lown is exempt are excluded. Signature <~'~.~ Company Name Title Purchase Order Number Description of Goods or Services General Ledger Fund and Account Number t Feb 1Health Ins Premium $M9080.8.000.000 /O2-Emoire Prism EPO 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 Title Date COMMUNZTY RATED 3ROUP NUMBER SUB GRP. 598599 I)2 ~ILLINO TYPE REGULAR B/LL EMLLING FREQUENCY MONTHLY BENEFITS CONSULTANT SUZANNE COOLS- LART1~GUE IDATE BILLED 01/14/12 BILLED PERIOD PAYMENT DUE DATE 02/01/12 NINA SCHMID FISHERS ISLAND FERRY DISTRICT PO BOX H FISHERS ISLE, NY 06390 PAGE: 1 THE PREMIUM BILLED IS SUBJECT TO I CHANGE UNDER APPL CABLE LAW I I FOR BILLING INFORMATION: (86~) 422-2583 PRIOR BILLING PERIOD PRIOR AMOUNT BILLED PAYMENTS I RECEIVED DATE STATUS 01/01/12 - 02/01/12 11,369.q& 0.00 UNPAXD CURRENT BILLING PERIOD CURRENT AMOUNT BILLED NET ADJUSTMENTS I CURRENT DUE ~ ~ 02/01/12 - 03/01/12 11,369.44 0.00 11,369.44 THXS XNVOXCE REFLECTS ALL PAYMENTS AND ADJUSTMENTS PROCESSED THROUGH 01/14/12. ANY ADJUSTMENTS PROCESSED AFTER THXS DATE NXLL BE REFLECTED ON A SUBSEQUENT XNVOXCE. # URGENT: PRZOR AMOUNT BZLLED ZS PAST DUE AND YOUR GRACE PERXOD ZS ABOUT TO m EXPXRE. REMXT XHMEDXATELY OR YOUR CONTRACT ~XLL BE TERMXNATED. PLEASE SEE THE REVERSE SXDE OF THXS PAGE FOR MORE XMPORTANT NOTXCES. To rece;ve proper cr~hL please return tl~e BOTTOM PORTION of ti)ts page wttt} your payment. NOTICE: As reqmred by Labor Law, Secben 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 coverecl members, subscribers and their covored dependents shall be afforded the ~Ollowing rights under the terminating policy: 1. Any claims ibourred during the effective date5 of the group contract will be processed and adjt)dicated in accordance with the terms, condlhol~s and provisions of said group contract. 2. Addibonal 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 provisions of the terminabng group contract. 3. Rights to convert to a direct pay contract between Empire HealthChoice Assurance, Inc. and the covered member, subscriber or certificate ho~ier, providing for coverage which ~s currently offered a direct pay basis, may be available provided (e.g. by including the notice in the certificate holder's pay envelope) at least nine days prior to intended date ot termination; or: b) mailed by the policyholder to each certihcate holder at the certihcefo holder's last known residential address at feast nine days prior to the intended date of terminahon. 3. The policyholder must also post a copy of this notice of intent to terminate and the required covering letter m conspicuous locations chosen as most hkely to give notice to the certdicate holders. The notice shall be posted at least nine days prior to the of Labor Law, Section 217 (4), the provisions of the Codes, Rules to apply ~f, at least 10 days prior to the date of the intended D~rector of Labor Standards-Department of Labor-Agency Building 12, State Office Budding Campus-Albany, New York, 12240. York State Insurance Department-Agency Building l-Albany, New York 12223. IMPORTANT NOTICES Full payment of this invoice is required in order to avoid termination of your coverage. If you have may 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 renUnder notice will be sent. If paymenl is not received within the 30-day grace period, your coverage will AUTOMATICAI.I.Y BE CANCEl.LED as of the date to which premiums have been paid. Empire is not financially responsible for clanns incurred beyond the premium paid to date. In order to ensure proper crediting of your payment, you must mail your remittance to the address appeanng on the face of this invoice. Sending payments to any other address may delay processing and cause your coverage to be termmated. Group Number: 598599 D2 Group Name: FISHERS ISLAND FERRY INDIVIDUAL DETAIL Bill Period: 02/01112 To 03/01/12 Payment Due Date: 02/01112 ADD EXPLANATION OF CHANGE TYPE CODES: SUB INDIVIDUAL'S :ON1 CHANGE INDIVIDUAVS NAME GRP IDENTIFICATION NO'KG ~PE TYPE ADJUSTMENT PERIOD AMOUNT DUE Empire HeelthChoice Assurance, Znc BARRETT FREBERZCK 88886607 0011 12 568.82 BRO#N DONALD 85377836 OOl BURKE STEPHEN G 8SS15734 001 12 568.82 DOHERTY THOHAS 882&0378 001 15 DUHOUCHEL ROBERT N 8S78S679 001 15 EASTER HARK B 889S5198 001 12 568.82 HZLLER JONATHAN Z 8&8386&& 001 12 568.82 HOCH RZCNARD 88742559 001 2a 568.82 LEPEVRE RAYNONB 86638861 001 12 568.82 NARSNALL JESSE 89420041 001 1S 1,136.48 #ORGAN JOH# E 87023977 001 14 1,704.14 RZCKER KENHETH H 88006302 001 12 568.82 SCHNZD NZNA 89633561 001 12 S68.82 TRAUB JAHES G 82S171&4 001 12 S68.82 PAGE TOTAL: 11,369.44 TOTAL CURRENT ANOUNT PLUS CHANGES: 11,369.44 BALANCE DUE FROR PRZOR BZLL(S): 0.00 TOTAL AHOUNT DUE: 11,369.44 PAGE: 2 Gro~]p Number: 598599 D2 Group Name: FISHERS ISLAND FERRY Bill Period: 02/01112 To 03/01112 Payment Due Date: 02/01112 Prepared Date: 01114/12 PAGE: CONTRACT / RATES / COUNTS SUMMARY GROUP / PACKAGE CONTRACT TYPE RATE COUNT 598S99 D2 / 001 12 568.82 8 l& ~,704.1q IS 1,136.48 22 S68.82 PACKAGE SUB TOTAL 14 GROUP TOTAL PLEASE SEE REVERSE OF THZS PAGE FOR A SUMMARY OF COVERAGE DESCRZPTZONS CONTRACT TYPE TOTALS CONTRACT TYPE SINGLE THO PERSON FAMZLY GRANO TOTAL NO. OF CONTRACTS 9 4 I 14 3 GROUP / PACKAGE DESCRZPTZON OF COVERAGE 598599 D2 / OOX EHPXRE PRZSH £PO CARVEOUT EHPZRE PRZSH EPO HAHAGED CARE DRUG AND VZSZON Town of Southold, New York - Payment Voucher Vendor Tax ID Number or Social Security Number Empire HealthCholce Assurance, Inc. Vendor Telephone Number Vendor Contact Vend0;No. P.O. Box 11744 Newark, NJ 07101-4744 Check No. Entered by Audit Date FEB 1 4 2012 Town Clerk Invoice Invoice Invoice Number Date Total Discount 598599 t/14/2012 91t.94 911.94 Net Purchase Order Number General Ledger Fund and Account Number Payee Certification The undersigned (Claimant) (Acting on behalf of thc above named claimant) does hereby certi~ that the foregoing claim is true and correct, that no par~ 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 //J-~¢~- ~r- ( /~ Company Name ~",~' t~) Date Health Savln~ls Accounts Feb/201~. Premium Hsl SM9060.8.000.000 Department Certification I hereby certi~, that the materials above specified have been received by me in good condition w~thout substitution, the services properly performed and that the quantities thereo£have been verified with the exceptions or discrepancies noted, and payment is approved Signature Title Date COMMUNZTY RATED 2ROUP NUMBER SUB ORP. 598S99 HXS BILLING TYPE REGULAR BXLL BILLING FREQUENCY ROHTHLY BENEFITS CONSULTANT SUZANNE COOLS- LARTTGUE IDATE BILLED I BILLED PERIOD PAYMENT DUE DATE 02/01/12 NINA SCHMID FISHERS ISLAND FERRY DISTRICT PO BOX H FISHERS ISLE, NY 06390 PAGE: 1 THE PREMIUM BILLED I$ SUBJECT TO CHANGE UNDER APPL CABLE LAW FOR BILl. lNG INFORMATION: (866) 422-2583 PRIOR BILLING PERIOD PRIOR AMOUNT BILLED PAYMENTS I RECEIVED DATE STATUS 01/01/12 - 02/01/12 911.94 0.00 UNPAZD CURRENT BILLING PERIOD CURRENT AMOUNT BILLED NET ADJUSTMENTS CURRENTDUE I ~ ~ 02/01/12 - 03/01/12 911.94 0.00 911.94 THZS ZNVOZCE REFLECTS ALL PAYHENTS AND ADJUSTRENTS PROCESSED THROUGH 01/14/12. ANY ADJUSTHENTS PROCESSED AFTER THZS DATE #ZLL BE REFLECTED ON A SUBSEGUENT ZNVOZCE. DATES ZNCLUDE AN EHPZRE TOTAL BLUE(SH) ADHZNZSTRATZON FEE FOR ALTERNATE FUNDZNG ARRANGEHENTS (HRA/HSA). ! URGENT= PRZOR AHOUNT BZLLED ZS PAST DUE AND YOUR GRACE PERZOD ZS ABOUT TO i N EXPZRE. REHZT ZHHEGZATELY OR YOUR CONTRACT MZLL BE TERHZNATED. . M M PLEASE SEE THE REVERSE SZDE OF THZS PAGE FOR RORE ZRPORTANT HOTZCES. NOTICE: As required by Labor 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, subscribers and their covered dependents shall be afforded the following rights under the terminating policy: 1. Any claims incurred during the effective dates bt the group contract will be processed and adjudicated in accordance with the terms, conditions and provisions of said group contract. 2. Additional benefits beyond the termination date bt the contract may be available under the termination contract tot cond~tions which result in a total d~sability, pursuant to the terms, conchtions and prows~ons bt 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 aveilable prowded the group does not obtain replacement coverage. B. Further, as required by the prowslons cited above, you, as the policyholder, may be requirect to meet the 1ollowing obligations: 1. The policyholder, must give written notice of the intended termination to each certificate holder resident in New York State insured under this group pOlicy by hand-delivering o1 mailing to the certificate holder a copy Of the notice bt termination and covering letter advising the certificate holders of the intended termination. 2. The pOlicyholder's notice to the certd~cate holder sllall be either: a) hand~elivered 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 nine days prior to intended date bt termination; or: b) mailed by the policyholder to eacl~ 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 POSt a copy or this notice of intent to terminate and the required covering letter in conspicuous locations chosen as most likely to give notice to the certificate holders. The notice shall be pOsted at least nine days prior to the intended date of termination. 4. In accordance with the prows~ons of Labor Law, Section 217 (4), the provisions bt the Codes, Rules and Regulations of the State ol New York, Title 11, Insurance Section 55.2 and Labor Law, Section 217 (3) shall not be deemed to apply it, at least 10 days prior to the date of the intended termination, as specified in the notice of intent to terminate, the policyholder has: a) taken necessary steps whereby the intended termination ~s rendered null and void: or: b) contracted with another insurer to replace the existing ~nsurer for the providing of similar coverage for t~qe same certificate holders, and liled an affidavit with the Commissioner of Labor and Superintendent bt insurance to that effect. Affidavits filed w~th the Commissioner of Labor shall refer to LabOr Law, Section 217, and be addressed to: Director of Labor Standards-Department of Labor-Agency Building 12, 5tare Off, ce Building Campus-Albany, New York, 12240. Aff~lavits filed with the Superintendent of Insurance shall refer to Labor Law, Section 217 and the Cobbies, Rules an(t Regulations bt the State of New York, Title 11, Insurance, Section 55.2 Part, and shall be addressed to: Chief, Health and Life Poltcy Bureau New York State insurance Department-Agency Building l-Albany, New York 12223. IMPORTANT NOTICES Full 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 AUTOMATlCAI,I.Y BE CANCELLED as of the date to which premiums have been paid. Empire is not financially responsible for clmms incurred beyond the premium paid to date. In order to ensure proper crediting of your payment, you must mail your remittance to the address appeanng on the face of this invoice. Sending payments to any other address may delay processing and cause your coverage to be terrmnated. Group Number: 599599 HIS G/ioup Name: FISHERS ISLAND FERRY INDIVIDUAL DETAIL Bill Period: 02/01/12 To 03/01/12 Payment Due Date: 02/01112 EXPLANATION OF CHANGE TYPE CODES: Prepared Date: 01114112 TER. - T,rmlnatlon CPIGGUT - Contract Change Out PAGE: SUB INDIVIDUALS ~ON1 CHANGE INDIVIDUAL'S NAME GRP IDENTIFICATION#C'KG ~PE TYPE ADJUSTMENT PERIOD AMOUNT DUE Empire HealthCholce Assurance, Znc FZORA HZCHAEL 83054186 001 12 455.97 LYNCH HATTHEN B 88138034 001 12 455.97 PAGE TOTAL: 911.94 TOTAL CURRENT ANOUNT PLUS CHANGES: 911.94 BALANCE DUE FRON PRXOR BXLL(S): 0.00 TOTAL ANOUNT DUE: 911.94 2 Group Number: 598599 HIS G~oup Name: FISHERS ISLAND FERRY Bill Period: 02/01112 To 03101112 Payment Duo Date: 02/01112 Prepared Date: 0111~J12 PAGE: CONTRACT ! RATES ! COUNTS SUMMARY GROUP / PACKAGE CONTRACT TYPE RATE COUNT 598599 HXS / OOZ 12 455.97 2 PACKAGE SU~ TOTAL 2 GROUP TOTAL Z PLEASE SEE REVERSE OF THXS PAGE FOR A SUNKARY OF COVERAGE DESCR[PTZONS CONTRACT TYPE TOTALS CONTRACT TYPE SZNGLE GRAND TOTAL NO. OF CONTRACTS 2 2 3 ALL PACKAGES CONTAXN HSA PARTXCZPATZON GROUP / PACKAGE DESCRZPTZON OF COVERAGE 598599 H1S / 00! CDHP PPO SG CARVEOUT CDHP PPO SG HARAGED CARE DRUG AND VZSZON FISHERS ISLAND FERRY DISTRICT VENDOR 009682 GOOSE ISLAND CORP 02/14/2012 CHECK 309 FUND & ACCOUNT P.O. # INVOICE DESCRIPTION AMOUNT SM .5710.4.000.200 SM .5710.4.000.200 25261 153.4 GAL #2 HTG OIL 707.17 25261A FUEL OIL TREATMENT 20.00 TOTAL 727.17 c Olg Town of Southold, New York - Payment Voucher · Vendor Tax ID Number or Social Securiiy Number Vendor Address P.O. Box 49 Vendor No. 9682 Check No. Entered by ~ Audit Date FEB 1 4 2012 town Clerk Vendor Name (~ 00,Se Island Service Vendor Telephone Number Vendor Contact Number Invoice Date Total Fishers Island, NY 063~0 Discount 25261 1/1812012 707.17 707.17 28261, 20.00 Net Amount Claimec 20.00 727.17 Payee Certification 727.17 1/1812012 Purchase Order Number General Ledser Fund and Account Number 8M5710.4.000.200 Thc undersigned (Claimant) (Acting on behalf of the above named claimant) does hereby certi~ that the foregoing claim is true and correct, that no par~ has been paid, except as therein stated, that the balance therein stated is actually due and owing, and that taxes from which thc Town is exempt are excluded Description of Goods or Services HeatinfJ Fu61 - FI Term $ 4.61 ~lal Fuel Oil Treatment 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 or discrepancies noted, and payment is approved. Signature ~/ Company Name Title Date Island Service Station Fishers l. sland, NY06390 P.O. Box 49 Invoice Date Invoice # 1/18/2012 25261 Bill To Fl Ferry District P.O. Box H Fishers Island, NY 06390 Description Qty Rate Amount #2 Fuel Oil 153.4 4.61 707.17T Sales Tax (0.0%) $o.oo Total $7o?.17 Balance Due $707.17 Island Service Station Fishers I. sland, NY06390 P.O. Box 49 Invoice Date Invoice # 1/18/2012 25261a Bill To FI Ferry District P.O. Box H Fishers Island, NY 06390 Description Qty Rate Amount Fuel oil treatment will Help totally dispense water, clean fuel 20.00 20.00T systems, Pumps, nozzles and help keep filters clean, this will extend burner life and improve fuel efficiency, and with its powerful anti-gel properties and anti-waxing agents will control the waxing and gelling of fuel in cold weather. Sales Tax (0.0%) $o.oo Total $20.00 Balance Due $20.00 P.O. [] Dyed unmarked Heating Oil: Not for u.e in highww/or nol~highway, Iocomolive or marine erw~ine~. 25261 TAX TOTAL FISHERS ISLAND FERRY DISTRICT VENDOR 008021 HAROLD'S, LLC 02/14/2012 CHECK 310 FUND & ACCOUNT P.O. ~ INVOICE DESCRIPTION AMOUNT SM .5709.2.000.200 SM .5709.2.000.200 SM .5709.2.000.200 SM .5709.2.000.200 7077 7078 7079 7105 REMOVE GUTTERS ON A~rNEX 40.00 LIGHT BULBS INSTALLED 125.63 REPR.GD~P3kGE DOOR-WHT BLD 135.00 NEW LCKS-MGR BLDG/KEYS 818.00 TOTAL 1,118.63 Town of Southold, New York - Payment Voucher Vendor To.x ID Number or Social Securiiy Number Vendor Address Harold's LLC Vendor Telephone Number Invoice Invoice Number Date 707~ 11612012 707~ 11612012 7077 116/2012 7105 1125/2012 Total i $135.00 $125.63~ $40.00 $818.00 Discount Vendor No. P.O. Box 661 Fishe~i$1and~ NY 0638~ Net Purchase Order Amount Claimed Number 135.00 125.63 $40.00 $818.00 8021 Descdption of Goods or Services Repr. Gara[le door-w bid Li[Iht bulbs installed Remove [lutters on Annex New Locks on Mana[lers Buildin[I, Additional Keys Check No. Entered by Audit Date FEB 1 4 2012 Town Clerk General Led[er Fund and Accomat Number SM~7't074 $1,1t8.63 $1,118.63 Payee Certification Thc undersigned (Claimant) (Acting on behalf of thc above named claimant) docs hereby certi~ 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 owing, and that taxes from which the Town is exempt are excluded. Signature ~ ~'~Title Company Name ~"~F ~i~ Date Z Department Certification I hereby certify that the mater/als 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 discrepancies noted, and peyment is approved Signature Title Date HAROLD'8~~ P. O. BOX 661 FISHERS ISLAND, NY 06390 DATE I INVOICE# 1/6/2012 7079 BILL TO FISHERS ISLAND FERRY DISTRICT P.O. BOX H FISHERS ISLAND, NY 06390 DESCRIPTION QTY RATE AMOUNT REPAIR TO GARAGE DOOR ON WHITE 135.00 135.00 BUILDING Total $135.00 ~AROL~ P. O. BOX 661 FISHERS ISLAND, NY 06390 .Tntto/ce 1/6/2012 7078 BILL TO FISHERS ISLAND FERRY DISTRICT i P.O. BOX H FISHERS ISLAND, NY 06390 DESCRIPTION QTY RATE AMOUNT PURCHASE AND INSTALL NEWLIGHT 125.63 125.63 BULBS Total $1~5.63 HAROLD'So~~~ P. O. BOX 661 FISHERS ISLAND, NY 06390 1/6/2012 7077 BILL TO FISHERS ISLAND FERRY DISTRICT P.O. BOX H FISHERS ISLAND, NY 06390 DESCRIPTION QTY RATE AMOUNT REMOVAL OF THE ANNEX GUTTER 40.00 40.00 Total $40.00 ~AROLD'~~ P. O. BOX 661 FISHERS ISLAND, NY 06390 DATE I INVOICE# /25/2012 7105 BILL TO FISHERS ISLAND FERRY DISTRICT P.O. BOX H FISHERS ISLAND, NY 06390 DESCRIPTION QTY RATE AMOUNT NEW LOCKS AS PER CONTRACT 755.00 755.00 ADDITIONAL KEYS AS PER NINA'S 63.00 63.00 REQUEST Total $818.oo HAROLD'S, LLC. Statement 1/6/2012 Bill To J FISHERS ISLAND FERRY DISTRICT P.O. BOX H FISHERS ISLAND, NY 06390 Amount Due Amount Enc. $1,256.86 Date Description Amount Balance 12/06/201 ] Balance forward ~ ANNEX GUTI~ER REMOVE- 01/06/2012 INV #7077. ANNEX GU 1'1 ER REMOVAL 40.00 996.23 FLOURESCENT LIGHT BULBS- 01/06/2012 1NV #7078. LIGHT BULBS 125.63 1,121.86 GARGE DOOR REPAIR ON WHITE BUILDING- 01/06/2012 1NV #7079. REPAIR TO GARAGE DOOR 135.00 1,256.86 Amount Due $1,256.86 FISHERS ISLAND FERRY DISTRICT VENDOR 014115 NEW YORK AVIATION MGT ASSOC 02/14/2012 CHECK 311 FUND & ACCOUNT P.O.# INVOICE DESCRIPTION AMOUNT SM .5610.4.000.000 012712 2012 MEMBERSHIP FEE 250.00 TOTAL 250.00 Town of Southold, New York - Payment Voucher Vendor Tax ID Number or Social Security Number Vendor Address NY Aviation Manafjement Association Vendor Telephone Number Vendor Contact Invoice Invoice Number Total Payee Certification Vendor bio. 14115 119 Washington Avenue, Suite 100 Albany; NY '1~'10 The 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 owing, and that taxes from which thc Iowa is exempt are excluded Net Amount Claimed 250.00 Purchase Order Number Description of Goods or Services Membership Fee-1 Yr 2012 CheckNo. Entered by ~ Audit Date FEB 1 4 2012 Town Clerk General Led[er Fund and Account Number SM5610.4.000.000 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 that the quantities thereof have been verified with the exceptions or discrepancies noted, and payment ~s approved. Title ~./~/~ Signature Date ~ 7 ~/~ ~ ~-~ litle Date ANEW YORK viation Management Ass oci,¢Aa i on 136 Everett Road · Albany, New York 12205 · 518/432-9973 · Fax: 518/432-1712 info@nyarna.com · www.nyama.com Board of Directors Ch~d Nixon - President NYAMA Staff 2012 Membership Dues Invoice Please review the contact information found below, revise the listing as needed, and return this form with your dues payment to: NYAMA 136 Everett Road Albany, NY 12205 Please direct any questions to Michael Thompson, (518) 432-9973 or info@nyama.com. Contact InformatiOn Contact Title Affiliation Address Tom Doherty Manager, Fishers Island Ferry District Elizabeth Field Airport PO Box H, Fishers Island, NY 6390 631-788-7463 mgr fiferry~qishersisland.net Phone Email Web Membership Dues The membership category and dues listed below is based on the size of your Organization. Please review the chart below to confirm the category selected i~ correct. Dues:General Aviation (Small) .............................................................................................. $250 Voluntary PAC Contribution: ........................................................................ Total Amount Enclosed: .................................................................................. NYAMAMe berShipc teg i m a or es Commercial Service (Large) (Over 750,000 enplanements) .................................................................................. $5,000 Commercial Seroice (Medium) (50,000 to 750,000 enplanements) ......................................................................... $750 Commercial Se~;ice (Small) (Less than 50,000 enplanements) ............................................................................... $250 GA (Large) (Over 150 based aircraft) .......................................................................................................................... $750 GA (Medium) (100 to 150 based aircraft) .................................................................................................................... $500 GA (Small) (Less than 100 based aircraft) .................................................................................................................. $250 Business Partner (Professional consultants and vendors) ..................................................................................... $1,250 FBO (Largo (Over 100 employees) ............................................................................................................................. $750 FBO (Medium) (50 to I00 employees) ........................................................................................................................ $500 FBO (Small) (Less than 50 employees) ....................................................................................................................... $250 Aviation Partner (Educational facilities, flying clubs, and non-profits) ................................................................ $250 Association Partner (Government, students, and honorary members) ................................................................. Free Thank you,for your support for New York State's aviation industry! FISHERS ISLAND FERRY DISTRICT VENDOR 016659 PRINCIPAL LIFE GROUP 02/14/2012 CHECK 312 FUND & ACCOUNT P.O.# INVOICE DESCRIPTION AMOUNT SM .9060.8.000.000 H19730-1-02/12 LIFE PREM-2/12 108.06 TOTAL 108.06 Town of Southold, New York - Payment Voucher Vendor Tax ID Number or Social Security Number Vendor Address P.O. Box 14813 Des Moines, IA 50306-3513 Vendor No. 16659 Check No. Entered by Audit Date FEB 1 4 2012 Principal Life Group Vendor Telephone Number Vendor Contact invoice Invoice Invoice Net Number Date Total Discount Amount Claimed 2/11201; $108.061 i $108.06 108.06 108.06 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 part has been paid, except as therein stated, that the balance therein staled is actually due and owing, and that taxes from which the Town is exempt are excluded Title ~ L~-- Purchase Order Number Description of Goods or Services Life Prem-2/2012 Town Clerk General Leper Fund and Account Nmnber SMg060.8.000.O00 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 or discrepancies noted, and payment is approved Signature Title Date Financial Group Principal Financial Group Des Moines, IA 50392-0001 Principal Life Insurance Company PREMIUM STATEMENT This statement in no way changes the contract or weaves any overdue payment Account Number 002231 FISHERS ISLAND FER~¥ ATTN NINA SCHMID PO BOX H FISHERS ISLAND NY 06390 PLEASE REVIEW ALL MESSAGES BELOW. H19730-1 Lb, No. 0819730 00001 93 DueDa~ 02/01/12 ~mtDa~ 01/17/12 BillingPerlod 02/01/12 - 02/29/12 IPlease Pay Balance Due Ibg,o( THEY CONTAIN INFORMATION RELATED TO YOUR PREMIUM PAYMENTS AND THE ADMINISTRATION OF YOUR PLAN. IF YOU HAVE QUESTIONS REGARDING ANY OF THESE MESSAGES, PLEASE CONTACT US AT THE NUMBER LISTED BELOW. IT IS IMPORTANT TD 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 01/31/12. IF YOU HAVE PAID, PLEASE DISREGARD THIS NOT[CE. PROVIDING YOU WITH GOOD SERVICE IS IMPORTANT. PLEASE REVIEW YOUR STATEMENT EACH MONTH TO ENSURE PROMPT AND ACCURATE CLAIM PAYMENT. THIS IS YOUR COPY. Principal Financial Group Des Moines, IA 50392-0002 IPrincipal Life Insurance Company PLEASE KEEP FOR YOUR RECORDS. PREHZUH STATEHENT This statement in no way changes the contract or waives any overdue payment ACCOUNT NO. H19730-1 NAME FISHERS ISLAND FERRY LIFE/AD&D BNFT PREM LB. NO. 0819730 00001 93 DUE DATE: 02/01/12 STMT DATE: 01/17/12 CHARGE/ CREDIT 6.49 6.49 6.49 6.49 4.22 929355154 SCHMID NiN 920098292 TRAUB dAME ;UMMARY TOTALS - TOTAL COVERED 17 s.d9 6.49 IFE $108.0B CHARGES THIS STMT TOTAL AMT DUE 216.12 'FOR ASSISTANCE, PLEASE CALL TOLL FREE: 1-800-843-i371 F396GP-4 ACCOUNT NO. H19730-1 02/01/2012 00o OOODO0 000000 CGS631820171190582D01002 0005655 002 OF 002 FISHERS ISLAND FERRY DISTRICT VENDOR 017991 RACE ROCK GARDEN CO. 02/14/2012 CHECK 313 FUND & ACCOUNT P.O.# INVOICE DESCRIPTION AMOUNT SM .5709.2.000.200 14287 ATTCH SNOW BLWR, LUBE,TST 75.00 TOTAL 75~00 Town of Southold, New York - Payment Voucher Vendor Tax ID Number or Social Security Number Vendor Address P.O. Box 517 Vendor No. 17991 Check No. Entered by AuditD t [ 1 4 2012 Vendor Name Race Rock Garden Co. Vendor Telephone Number Vendor Contact Fishers Island, NY 06390 Invoice Invoice Net Number Total Discount Amount Claimed Purchase Order Number 75.00 i 75.00 14287 tractor, lube & test run 15.00 75.00 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 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 Description of Goods or Services Attach snow blower to 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 exceptmns or discrepancies noted, and payment is approved Signature Title Town Clerk Date Signature J~/ Title /~o'/ Company N;me //'~ .'_~ 2"¢~ Date General Ledger Fund and Account Number 8M5709.2.000.200 Race Rock Garden Company, Inc. PO Box 517 Fishers Island, NY 06390 Invoice Date Invoice # 12/31/2011 14287 Bill To FI Ferry District Dra'~er H Fishers Island. NY 06390 Project Terms Account # Net 30 23 Quantity Serviced Description Rate Amount I 12/21/2011 Mechanic - attach snow blower to tractor, lube, test run 75.00 75.00 Phone # Fax # E-mail Total s75.oo 631-788-7632 631-788-7634 rrgarden 5g~ fisher sisland.net FISHERS ISLAND FERRY DISTRICT VENDOR 018458 ROBERT HALF MANAGEMENT 02/14/2012 CHECK 314 FUND & ACCOUNT P.O. # INVOICE DESCRIPTION AMOUNT SM .1310.4.000.000 SM .1310.4.000.000 34713157 R.WYROFSKY-W/E 1/6/12 3,175.80 34756551 R.WYROFSKY-W/E 1/13/12 2,532.60 TOTAL 5,708.40 Town of Southold, New York - Payment Voucher Vendor Tax ID Number or Social Security Number Robert Half Management Resources Vendor Telephone Number Vendor Contact W~dor No. Invoice Number 34713157 34756551 Invoice Invoice Date Total 1110/2012 3,175.80 1117/2012 2,532.60 , 5,708.40 i Payee Certification 12400 Collections Center Drive Chicago, IL 60693 Net Discount Amount Claimer 3,175.80 2,532.60 I 5,708.40 The undersigned (Claimant) (Acting on behalf of tbe above named claimant) does hereby certify that the foregoing claim is frae 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 Toum is exempt are excluded Purchase Order Number Description of Goods or Services Rwyrofsky-w/e 0t/06/12 w/e 0t113112 Check No. ,siq Entered by 2~ Audit Date FEB 1 4 ?.O1Z Town Cl~rk General Ledger Fund and Account Number SM1310.4.000.000 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 that the quantities thereof have been verified with the exceptions or discrepancies noted, and payment is approved Signature Title Date Robert Half International A Global Leader in Professional Services Since 1948 Page: Invoice Date: 01/10/2012 Invoice Number: 34713157 Customer Number: 00700-101844000 Fed Tax ID: 94-1648752 Personal & Confidential Chds Rafferty FISHERS iSLAND FERRY PO DRAWER H FISHERS iSLAND NY 06390 Labor Invoice- DUE UPON RECEIPT Please Remit To: Robert Half Management Resources 12400 COLLECTIONS CENTER DRIVE CHICAGO IL 60693 Line Employee Name Wk End Dt "Report-To" Supervisor Qty UOM Bill Rate Amount 1 Wyrofsky,Randy 01/06/2012 Brooks,Bob 39.50 HRS REG $ 80.40 $ 3,175.80 Subtotal for Week-Ended: 01/06/2012 39.50 HRS $ 3,175.80 Invoice Subtotal: $ 3,175.80 TOTAL AMOUNT DUE: $ 3~175.80 (800) 533~8435 (888) 400-7474 Please detach and return this remittance stub with your payment. Robert Half® Management Resources Week Ending Date: 1/6/12 Online Timesheet "~mployee ID 0500160010 Name (Last, First Middle) Wyrofsky, Randy ~ob Order Number Report To 00700-113382 IClient Company Name Fishers Island Ferry Brooks, Bob Time worked for one week only, starting with Saturday and ending on F~day midnight. Day Date In Out In Out In Out Total Sat 12/31/11 10:00 AM 12:00 PM J 2.00 Sun 111/12 Mon 1/2/12 8:30 AM 5:30 PM 9.00 Tue 1/3/12 1:30 PM 6:30 PM 5.00 Wed 1/4/12 8:30 AM 4:45 PM 7:00 PM 8:30 PM 9.75 Thu 1/5/12 11:00 AM 4:45 PM 5.75 Fri 1/6/12 9:00 AM 5:00 PM 8.00 Please note: Worked Hours have been entered on a Holiday TotaIWeekly Hours: 39.50 Employee Authorization ours entered by employee were submitted electronically. lectronically Submitted on 1/8/12 8:12:31 AM PST y Randy V~rofsky Client Approval he Total Hours as shown on this timesheet were approved electronically. lectronicallyApproved on 1/9/12 6:58:31 AM PST y Bob Brooks An Equal Opportunity Employer © Robert Half International Inc. 2010, All Rights Reserved. OPO2V3 Robert Half International A Global Leader in Professlonal Services Since 1948 Page: 1 Invoice Date: 01/17/2012 Invoice Number: 34756551 Customer Number: 00700-101844000 Fed Tax ID: 94-1648752 Personal & Confidential Chds Raffedy FISHERS ISLAND FERRY PO DRAWER H FISHERS ISLAND NY 06390 Labor Invoice - DUE UPON RECEIPT Please Remit To: Robert Half Management Resources 12400 COLLECTIONS CENTER DRIVE CHICAGO IL 60693 Line Employee Name Wk End Dt "Repod-To" Supervisor Qty UOM Bill Rate Amount 1 Wyrofsky,Randy 01/13/2012 Brooks,Bob 31.50 HRS REG $ 80.40 $ 2,532,60 Subtotal for Week-Ended: 01/13/2012 31.50 HRS $ 2,532.60 Invoice Subtotal: $_. 2~532.60 TOTAL AMOUNT DUE: $ 2,532.60 we prov!de more timely and accurate information to the business community ~¥.~h~¢in8 our accounts receivable infom~ation with National Credit Reportin9 Asencies. Any questions ~garding this invoice please call: For senior accounting and finance project professionals please call: (800) 533-8435 (888) 400-7474 Please detach and return this remittance stub with your payment. Robert Half' Management Resources Week Ending Date: 1/13/12 Online Timesheet /'Employee ID 0500160010 Name (Last, First Middle) VVyrofsky, Randy /~ob Order Number 00700-113382 Client Company Name Fishers Island Ferry Report To Brooks, Bob · Time worked for one week only, staCcing with Saturday and ending on F~day midnight Day Date In Out I In Out In Out I Total Sat 1/7/12 [ I Mon 1/9/12 1:00 PM 5:30 PM I -- 4.50 Tue 1/10/12 8:15 AM 7:15 PM 11.00 Wed 1/11/12 2:00 PM 6:00 PM 4.00 Thu 1/12/12 8:30 AM 12:00 PM 3.50 Fri ] 1/13/12 8:30 AM 5:00 PMi 8.50 Total Weekly Hours: 31.50 Employee Authorization ours entered by employee were submitted electronically. lectronically Submitted on 1/15/12 5:10:51 AM PST y Randy VWrofsky Client Approval he Total Hours as shown on this timesheet were approved electronically. lectronica/lyApproved on 1/16/12628:17 AM PST An Equal Opportunity Employer © Robert Half International Inc. 201 O, All Rights Reserved. OPO2V3 FISHERS ISLAND FERRY DISTRICT VENDOR 019794 JOHN STANFORD 02/14/2012 CHECK 315 FUND & ACCOUNT P.O.# INVOICE DESCRIPTION AMOUNT SM .5709.2.000.200 2-1/22/12 NL PLOWING/SAND-I/21/12 500.00 TOTAL 500.00 Town of Southold, New York - Payment Voucher Vendor Tax ID Number or Social Security Number Vendor Name John S. Stanford Vendor Telephone Number Vendor Contact Vendor Address 8 Burdick Road Preston, CT 06365 Vendor No. 19794 I ~Check No. Entered by ~) Audit Date FEB 1 4 2012 Town Clerk Invoice Number 2 Date 1/22/2012 Invoice I Net Total [ Discount Amount Claimed 500.00 i 500.00 500.00 500.00 Payee Certification The undersigned (Claimant) (Acting on behalf oftbe above named claimant) does hereby certify that the foregoing claim is trae 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 Company N f'~'~;} Date Purchase Order Number Description of Goods or Services PIowin[l/¢lean up NL 112112012 General Led[er Fund ~d Account Number SM5709.2.000.200 Department Certification I bereb~r 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 Title Date 3ohn Stanford Snow Plowim 8 Burdick Rd Preston Phone: 860 908 2194 Fax: 860 859 1777 Email: js32ryder@sbcglobal.net Ct 06365 Date: Invoice Number: PO Number: Due Date: Shipping Method: 1/22/2012 2 2/21/2012 Billing Address Fishers Island Ferry District 5 Waterfront Park New London, Ct 06320 Shipping Address Fishers Island Ferry District 5 Waterfront Park New London, Ct 06320 Sanding of lot Sanding of Lot on 1/20/12 at the request of Capt. Burke due to lot being iced over 1 200 200.00 Snow Removal Snow Plowing of lot on 1/21/12 of 5" 1 300 300.00 Customer Note: Please make checks payable to John S Stanford SubTotal: Tax: Total: 500.00 0.00 500.00 FISHERS ISLAND FERRY DISTRICT VENDOR 024539 W.B. MASON CO.INC 02/14/2012 CHECK 316 FUND & ACCOUNT P.O.~ INVOICE DESCRIPTION AMOUNT SM .5711.4.000.000 I03338698 (1)CT COPY PAPER 39.34 TOTAL 39.34 Town of Southold, New York - Payment Voucher Vendor Tax ID Number or Social Security Number W.B. Mason Vendor Telephone Number Vendor Contact Vendor No. PlO. BOx i~i Brockton, MA 02303-0111 Check No. Entered by ~ Audit Date FEB 1 4 2012 Town Clerk invoice Invoice Invoice Net Purchase Order Number Date lotal : Discount Amount Claimer Number scri tion of Goods or Services ~3338698 1/101201~ 39.34 39.34 er 39.34 39.34 Payee Certification The undersigned (Claimant) (Acting on behalf of tbe above named claimant) does hereby certi~, that the foregoing claim is tree 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 Toum is exempt are excluded Signature ~~ Title ~.~L ~'~' h~ Signature General Ledger Fund and Account Number 8M571 t .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. Date W.B. MASON CO., INC. PO Box 111 - Brockton, MA 02303-0111 Address Service Requested 888-WB-MASON www,wbmason.com Delivery Address PM Invoice Number: 103338698 Fishers Island Ferry Distdct Customer Number: C2024302 Attn: jim Reference Number: 103338698 5 Watedront Park invoice Date: 01/10/2012 New London, CT 06320 Due Date: 02/09/2012 Order Date: 01/09/2012 Order Number: S003577234 Order Method: PHONE 6572016558 PRESORT AADC P1 £69 <B> 1655& i AB 0-368 FISHERS ISLAND FERRY DISTRICT ~.. PO BOX H FISHERS ISLE NY 06390-0607 Important Messages J.Solomon Incorporated and W.B. Mason have joined forces!! The new J.Solomon IncorporatedRV.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/W.B. Mason partnership. ITEM NUMBER WBM21200 DESCRIPTION PAPER,XERO/DUP,WE,LTR,20# QTY QTY ORDERED 1 SHIPPED UNIT PRICE 1 36.99/CT EXT PRICE SALES TAX TOTAL*: ORDER TOTAL: 36.99 -- 36.99 2.35 39.34 *May include bottle deposits Please detach and return below podion with Your payment 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 981101 Boston MA 02298-1101 HOW TO READ YOUR INVOICE Customer Number - Your account number. It will be helpful to reference this number when carling 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