The URL can be used to link to this page

Home My WebLink AboutAU-09/11/2012 Fishers IslandFISHERS ISLAND FERRY DISTRICT VENDOR 019500 AT&T 09/11/2012 CHECK 685 FUND & ACCOUNT SM .5710.4.000.100 P.O.# INVOICE DESCRIPTION 86044201650912 TEL/NL TERM 8/15-9/14 TOTAL gJqOUNT 260.22 260,22 /DISTRICT 9/I1/12 AUDIT CHECK NO. 685 7HE S~FFOLK Ce. NATIONAL B;~N/~ cu'rCHO~UE.N¥ 1~3~ ~ D~ ; ~ AMOUNT ~ , ~ ~0~ 09/11/2012 S260.22 P~¥ ~ AT&T rO~ PO BOX 5082 IORDER OF CAROL STREAM IL 6019~7-5082 Town of Southold, New York - Payment Voucher Vendor Tax ID Number or Social Securi[y Number Vendor Address Vendor Name AT&T Vendor Telephone Number 800.,32t-2000 Vendor Contact hwoice Number 860442016~ Invoice Invoice ~ Date Total 8/t5/2012 $260.22 $260.221 Payee Certification ;Vendor No. 19500 P.O. Box 5082 Carol Stream, IL 60197-5082 Discount Amount Claimec $260.22 I $260.22 Purchase Order NL Terminal Tel Number Description of Goeds or Services 08/15112 - 09114/12 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 es 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 ~ Check No. Entered by .~ Audit Date SEP I 1 2012 General Ledl~er Fund and Account Number 8M8710.4.000.100 Department Certification I hereby certify that the materials above specified have been received by me in good condition without substitution, the services propafly performed and that the quantities thereof have been verified with the exceptions or discrepancies noted, and payment is approved. Signature ~~"~ Tit,e /X/C_ Date at&t I o17 060 442-0165 078 Aug 15. 2012 att.com Monthly Statement Previous Bill 578.49 Payment Received 7-23 292.12CR Adjustments 4.16 Past Due - Please Pay Immediately 290.53 Current Charges 260.22 Total Amount Due $550.75 Current Charges Due in Full by Sop 14, 2012 ·Thauk you for being an ALL DISTANCE® customer. Your ALL DISTANCE® savings includes: Promntions and Discounts 27.00 Item No~ ~q~ OescriDtion Adiustmeuts payments L 7-23 Payment 292.12 2. 8-15 Late Payment Charge 1.5% 4.16 Totals 4.16 292.12 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 * CT RELAY SERVICE · 900 # INFORMATION * DO NOT CALL · AUTOMATIC PAYMENTS · PAPERLESS BILLING See "News You Can Use" for addihonal information. 260.22 260.22 Promotions and Discounts 3. Save Elite-S Corm $27 off -12mo term Monthly Service - Aug 15 thru Sop 14 Charges for 860 442-0165 4. Monthly Charges Charges for 860 443~851 Monthly Charges 5, Charges for 866 444-0320 6. Monthly Charges Cha~ges for 860 447-9371 7. Moufl~ly Charges Total Monthly Service Ca Charges 27,00CR 122.60 28.35 2835 28.35 207.65 Bus Block of Time 700 II 2Y Summary 733 Minutes Used 700 Minutes Allowed Instate Long Distauce .12 Out of State Long Gistance 1.36 Call Plan Summary Total 147 8. Bus Block ot Time 700 II 2Y Charges for ~60 447.-0165 Item [:~ J~ Time Place Number ~ode Min Itemized Calls 9. 7 14 80CA FISHERS IS NY 631 788-7345 2 0:30+ 3000 *BASIC $147,94 NON BASIC $402.81 at&t FISHERS ISLAND FERRY DISTRICT Page PO 80x H Accou~ Number FISHERS iSLE NY 06390-0607 Billing Date Web Site 2of7 860 442-0165 078 Aug 15, 2012 att.com Call CharDes - Continued Item No. Date Time ptace Number 1. 7-14 836A FISHERSIS NY 631788-7528 2. 7-14 1CO2A KEYS FL 305393-5016 3. 7-14 I013A FISHERS IS NY 631 788-7267 4. 7-15 645A GARDENCITY NY 516655-4004 5. 7-15 646A MINEOLA 6. 7-15 647A MINEOLA 7. 7-15 159P FISHERSIS 8, 7-15 205P FISHERSIS 9. 7-15 343P DEDHAM 10. 7-15 344P NEWYORK 11, 7 16 822A FISHERSIS 12, 7-16 COOA FISHERSIS 13. 7-16 935A FISHERSIS NY 516650-4004 NY 516650-4004 NY 631 788-5563 NY 631 788-5563 MA 781 915-4096 NY 917922-4303 NY 631 788-7444 NY 631 788-7444 NY 631 788-7463 14. 7 16 945A NEWHAVEN CT 203641-9494 15. 7-16 951A NEWHAVEN 16. 7-16 959A FISHERSIS 17. 7-t6 1034A FARMINGDL 18. 7-16 1043A SOUTHOLD 19. 7-16 l140A GUILFORD 20. 7-16 1258P GREENWICH 21. 7-16 120P GUILFORD 22. 7-16 144P FISHERSIS 23. 7q6 251P FARMINGDL 24. 7-16 311P FISHERSIS 25. 7-16 328P FARMINGDL 26. 7-16 354P WlLLIMNTIC CT 203777-1750 NY 631 788-5673 NY 631 414-58~ NY 631 765-3140 CT 203458-4128 CT 203 869-5440 CT 203458-4128 NY 631 788-5685 NY 631 414-5844 NY 631 788-7857 NY 631 414-5844 CT 860 234-0023 27. 7-16 402P BRIDGEPORT CT 203650-9~47 28. 7-16 415P CAROLINA 29. 7-16 709P SYOSSET 30. 7-16 715P FARMINGDL 31, 7-16 719P FARMINGDL 32. 7-17 654A FISHERS IS 33. 7-17 759A FISHERSIS 34. 7-17 946A FARMINGDL 35. 7-17 t006A NEWHAVEN 36. 7-17 1034A WlLLIMNTIC 37. 7-17 IOZ!3A FISHERS IS 3& 7-17 1046A FISHERS IS 39, 7-t7 1240P FISHERS IS 40, 7-17 1251P FISHERS IS 41, 7-17 1253P FISHERS IS 42, 7-17 112P FISHEflSIS 43, 7-12 127P MADISON RI 401 364-0474 NY 516857-1707 NY 631 694-2300 NY 63t 694-2300 NY 631 788-7269 NY 631 788-7463 NY 631 694-2300 CT 203777-1750 CT 860 234-0023 NY 631 788-7155 NY 631 788-7599 NY 631 788-7524 NY 631 788-7311 NY 631 788-7628 NY 631 788-7528 CT 203318-5054 44. 7-17 139P PROVIDENCE RI 401862-139~ 45. 7-17 142P PROVIDENCE RI 401862-1398 46. 7-17 237P WlLLIMNTIC CT 860234-0023 47. 7-17 251P MILFORD CT 203876-8666 48. 7-17 253P MILFORD CT 203876-8606 49. 7-17 327P FISHERSIS NY 631788-7858 Call Charqes - Continued Item No. Date T~L~ Place Number 50. 7-17 348P FISHERSIS NY 631 788-7889 51. 7-18 724A FISHERStS NY 631 788-7463 Code ~! 52. 7-18 756A COOPERSBG PA 610214-COCO 0:36+ .06 53. 7-18 1010A DANBURY CT 203733-7377 5:32+ .CO 54. 7-18 1014A DANBURY CT 203733-7377 1:46+ .00 55, 7-18 1036A FISHERS IS NY 631 788-7857 0:30+ ,CO 56. 7-18 1t07A GREENWICH DT 203629-1862 0:30+ .CO 57. 7-18 14OP QUEENS NY 718392-8910 0:46+ .00 58. 7-18 154P ASHAWAY RI 401377-2837 1:12+ .00 59. 7-18 25OP HARTFORD CT 860289-0267 1:23+ .00 60. 7-18 320P HARTFORD CT 860289-0267 0:30+ .00 61. 7-18 329P HARTFORD CT 860 289-0267 0:34+ .00 62. 7-18 601P NEWYOflK NY 917~86-5554 3:41+ .CO 63. 2-18 601P NEWYORK NY 917586-5554 0:30+ ,00 64. 7-19 704A FISHERS IS NY 631 78~-7463 1:42+ ,CO 65. 7-19 735A FISHERS IS NY 631 788-7345 D 0:30+ .00 66. 7-19 827A FISHERS IS NY 63t 788-7463 D 0:30+ .00 67. 7-19 831A FISHERS IS NY 631 788-7463 1 1:08+ .00 68. 7-19 837A FISHERS IS NY 631 788-5515 I 0:59+ .00 69. 7-19 845A BRIDGEPORT CT 203650-9~47 I 1:21+ .00 70. 7-19 848A BRIDGEPORT CT 203650-9~54 D 3:26+ .00 71. 7-19 855A FISHERS IS NY 631 788-7343 O 0:59+ .CO 72. 7-19 931A WARWICK RI 401737-6662 O 5:45+ .CO 73 7-19 946A FISHERS IS NY 631 78~-7463 1 4:07+ .CO 24, 7-19 950A FISHERS IS NY 631788-7550 1 0:30+ .CO 75. 7-19 1026A WATERBURY CT 203754-5334 I 3:09+ .00 76. 7-19 1032A FISHERS IS NY 631 788-7345 1 0:31+ ,CO 77. 7-19 1036A FISHERS IS NY 631 788-7345 D 4:24+ .CO 78. 7-19 1156A FISHERS IS NY 631 788-7463 D 1:11+ .CO 79. 7-19 1156A FISHERStS NY 631788-7345 I 2:32+ .C~ 80. 7-19 1241P BRENTWOOD NY 631445-9338 2 0:30+ .00 81. 7-19 210P LAKEPARK IA 712432-0111 2 0:43+ .0~ 82. 7-19 503P MOODU$ CT 860873-8488 2 1:20+ .00 83. 7-20 649A FISHERS IS NY 631 788-7255 2 0:55+ .CO 84. 7-20 710A FISHERS IS NY 631788-7255 2M 3:22+ .CO 85. 7-20 920A BRISTOL VT 802 453-5549 I 0:30+ .CO 86. 7-20 920A BRISTOL VT 802 453-5549 D 0:30+ .00 87. 7-20 921A BRISTOL VT 802453-5549 D 3:59+ .00 88. 7-20 930A FISHERSIS NY 631788-7919 I 0:36+ .00 89. 7-20 IOOIA FISHERS IS NY 631 78~-7463 1 0:30+ .00 90. 7-20 1010A MILFORD CT 203876-8606 I 2:46+ .CO 91. 7-20 IOI7A FISHERS IS NY 631 788-5515 1 0:30+ .00 92. 7-20 1027A MILFORD CT 203876-8606 1 0:30+ .00 93. 7-20 1042A FISHERS IS NY 631 788-7463 1 0:33+ ,CO 94. 7-20 1100A FISHERS IS NY 631 788-7225 D 8:44+ ,CO 95. 7-20 1144A FISHERS IS NY 631 788-7744 I 2:54+ .CO 96. 7-20 1258P QUEENS NY 718392-8910 I 4:30+ .00 97. 7-20 900P FISHERS IS NY 631788-7889 D 1:06+ .00 98. 7-21 1013A GARDENCtTY NY 516779-6424 D 1:27+ .00 99. 7-23 858A FISHERS IS NY 631 788-7463 D 1:04+ .00 100. 7-23 915A FISHERS IS NY 631788-7225 I 3:45+ .CO 101. 7-23 917A FISHERSIS NY 631788-7223 102. 7-23 934A FISHERSlS NY 631788-7255 Code 1 2 2M 1:15+ .CO 6:47+ .00 7:11+ .CO 0:56+ ,CO 0:30+ .CO 4:09+ .CO 0:30+ .CO 0:30+ .CO 4:08+ .CO 0:37+ .00 1:43+ .CO 0:45+ .00 0:30+ 0:30+ .CO 5:11+ .(3O 0:30+ .CO 0:30+ ,CO 0:56+ .CO · 0:4~+ ,CO 1:56+ .CO I 5:42+ .00 1:41+ .iX) 1:20+ .CO 1:41, CO 1:00+ .CO 0:57+ .CO 0:30+ .CO 1:48+ .CO 0:30+ .00 0:~+ .00 0:30+ .CO 54:51+ .00 0:30+ .00 2:31+ .CO 1:37+ .CO 0:30+ .CO 0:30+ .CO 1:16+ .CO 2:18+ .CO 1:37+ 2:22+ .CO 0:30+ 0:31+ .CO 0:42+ .00 0:30+ .CO 4:39+ .CO 0:58+ .CO 1:22+ .CO 1:03+ ,CO 2:35+ .CO 1:30+ .CO 1:26+ .CO 0:41+ .CO 6012.CO~.077353.01.04.0000CO0 NNNNNNNY 56721.154849 RSHERS ISLAND FERRY DIS~'RICY Pa~ 3 of 7 PO BOX H Acceum Number 860 442-0165 078 at&t ...,.o. Call Chaqlns - Continuud Item No. Oate Time Place Number I, 7-23 1015A FISHERS IS NY 631 788-7463 2. 7-23 1116A FISHERSIS NY 631788-7919 3. 7-23 1191A FISHERS IS NY 631 788-7463 4. 7-23 115P FISHERSIS NY 631788-7463 5. 7-23 124P PROVIDENCE RI 401DO2*1398 6. 7-23 448P FISHERSIS NY 631786.7345 7. 7-24 813A FISHERSIS NY 631788-5515 8. 7-24 840A HARTFORD CT 860883-4845 9. 7-24 847A OLDSAYBRK CT 860227-2335 10. 7-24 851A BRISTOL VT 802453-5549 11. 7-24 920A OLDSAYBRK CT 860227-2335 12. 7-24 949A FISHERS IS NY 631 788-7463 13. 7-24 955A FISHERS IS NY 631 788-7919 14. 7-24 1027A BURLINGTON VT 802363-3816 15. 7-24 1058A FISHERS IS 16. 7-24 It07A MILFORD 17. 7-24 Ilt3A MILFORD 18. 7-24 133P FISHERSIS 19. 7-24 223P FISHERSIS 20. 7-24 224P FISHERSIS 21. 7-24 306P SEATTLE 22. 7-25 812A FISHERSIS 23. 7-25 827A FISHERSIS 24. 7-25 833A FtSHERStS 25. 7-25 1129A RSHERSIS 26. 7-25 1133A PLAINFIELD 27. 7-25 1IDEA FISHERS IS 28. 7-26 658A FISHERSIS 29. 7-26 DO1A DANBURY 30. 7-26 11DNA HARTFORO 31. 7-26 llDOA HARTFORD NY 631 788-7223 CT 203876-8606 CT 203876-8606 NY 631 788-7345 NY 631 788*7463 NY 631 786.7463 WA 206 356-0486 NY 631 788-7839 NY 631 78~-7839 NY 631 788-7839 NY 631 78~-7345 CT 860 2DO-01DO NY 631 788-7255 NY 631 788-7677 CT 203 733-7377 CT 860 278-2670 CT 860 278-2670 92. 7-27 1038A NOTHOMPSONCT 860935-0390 33. 7*27 1057A HADDAM 34. 7-27 1057A HARTFORD 35, 7-27 1058A FISHERS IS 36. 7-27 1204P FISHERS IS 37. 7-27 12OEP FISHERSIS 38. 7-27 1247P FISHERSIS 39. 7-27 102P FISHERSIS 40. 7-27 119P FISHERSIS 41. 7-27 134P FISHEHSIS 42. 7-27 137P FISHERSIS 43. 7-27 143P FISHERSIS 44. 7-27 526P FISHERSIS 45. 7-27 536P PROVIDENCE CT 860 345-85','~ CT 860841-2256 NY 631 788-7311 NY 631 788-7919 NY 631 788-7619 NY 631 788-5673 NY 631 788-7345 NY 631 788-7345 NY 631 788-7463 NY 631 788-7426 NY 631 788-7255 NY 831 788-7734 RI 401 347-5259 46. 7-27 DO7P FRAMINBHAM MA 5DODOS*2166 47. 7-20 744.A FISHERS IS NY 631 788-5515 48. 7-28 147P HARTFORD CT DO03DO-8276 49. 7-30 903A FISHERS IS NY 631 788-5673 Code Min 1:27+ 2:22+ 0:55+ 121+ 0:39+ 0:30+ 5:56+ D 1:54+ D 1:13+ I 1:03+ D I:DO+ 1 0:30+ 1 1:10+ 1 0:30+ 1 0:34+ D 2:22+ D 0:30+ 0:34+ 0:45+ 0:30+ 0:30+ 9:13+ 1:36+ 1:18+ 0:30+ 0:59+ 0:30+ 0:47+ 0:30+ 0:30+ 3:03+ 0:30+ 0:30+ 0:30+ 0:41+ 0:30+ 2:52+ 0:30+ 0:30+ 0:3O+ 0:30+ 0:30+ 2:25+ 0:30+ 0:30+ 0:41+ 0:51+ 0:3,% 2:10+ Call Cbe~s - Continuud Item No. Date Tim~ 50. 7-30 1014A FISHERS IS 51. 7-30 1026A MILFORD 52. 7-30 12O5P OLD SAYBRK .00 53. 7-30 12O3P FISHERS IS .DO 54. 7-30 1258P NEWYORK ,DO 55. 7-30 131P FISHERS IS ,DO 56. 7-31 916A FISHERS IS .00 57. 7-31 1021A FISHERS IS .00 58. 7-31 1041A WlNDSORLKS .00 59. 7-31 1121A FISHERSlS .00 60, 7-31 1IDEA FISHERSIS .DO 61. 8-01 807A FISHEflStS .DO 62. 8-01 1DO4A FISHERSIS .DO 63. 6.01 1DO7A FISHERSIS .DO 64. 8-01 1110A FISHERSIS .DO 66. 8-01 1232P BROOKLYN .(30 66. 8-01 324P FISHERS IS .DO 67. 8-02 841A NEWHAVEN .DO 68. 8-02 90~A FISHERS IS .DO 69. 8-02 922A WINOSORLKS .DO 70. 8-02 925A FISHERS IS .DO 71. 8-02 1012A HARTFORD .DO 72. 8-02 1029A WATERBURY ,DO 73. 6.02 1035A FISHERS IS .DO 74. 8-02 1112A FISHERS IS .~ 75. 8-02 1133A FISHERS IS .~ 76. 8-02 114OA RICHMOND .eO 77. 6.02 317P FISHERSIS .DO 78. 8-02 323P FISHERS IS .DO 79. 8-02 330P FISHERS IS .00 80. 8-02 349P FISHERS IS .DO 81. 6.02 353P FISHEHSlS .00 82, 6.02 405P OARIEN .DO 83, 8-02 DO8P FISHERS IS .DO 84. 8-03 651A FISHERS tS ,DO 85. 8-03 748A FISHERS .DO 86. 8-03 749A FISHERS IS ,DO 87. 8-03 829A FISHERS IS .DO 88. 6.03 834A FISHERS IS .DO 89. 6.DO 839A DARIEN .DO 90. 8-03 019A DARIEN .DO 91. 8-03 932A FISHERS IS .DO 92. 6.DO 966A FISHERS IS .DO 93. 8-03 1037A HARTFORD .DO 94. 8-03 IDOSA FISHERS IS .DO 95. 8-03 1051A FISHERS IS .DO 96. 8-03 1126A FISHERS IS .DO 97. 8-03 116P FISHERS IS .DO 98. 8-03 256P FISHERS IS .DO 99. 8-03 321P FISHERS IS .DO 100. 8-03 331P FISHERS IS .DO 101. 6.03 607P FISHERS IS 102. 8-03 IDO~P FISHERS IS Number NY 631 788-7255 CT 203876-8606 CT 860399-5266 NY 631 788-7463 NY 212 558-3881 NY 631 788-7286 NY 631 788-5550 NY 631 788-7444 CT 860 663-0044 NY 631 78~-7463 NY 631 788-7463 NY 631 78~-7463 NY 631 788-5550 NY 631 788-7585 NY 631 788-7345 NY 917 685-DO82 NY 631 788-74(k3 CT 203 795-4945 NY 631 788-7345 CT 8DO 668-DO44 NY 631 788-7463 CT 86O 490-2O77 CT 2DO 754-5,3~4 NY 631 788-7345 NY 631 788-7345 NY 691 788-7323 VA 804371-4660 NY 691 786.5673 NY 631 786.74~3 NY 631 788-7463 NY 631 78~-7887 NY 631 788*7323 CT 203655-0112 NY 631 78~-7412 NY 631 788-7255 NY 631 788-7345 NY 631 788-7345 NY 631 7DO-7463 NY 631 786.5515 CT 2DO 655-0112 CT 203655-0112 NY 631 788-7463 NY 631 788-7345 CT 8DO 539-2942 NY 631 788-7137 NY 631 786.7463 NY 631 786.7141 NY 631 788-5673 NY 691 788*7345 NY 691 788*7345 NY 691 786.7463 NY 631 788-7523 NY 691 788-7625 Code Min 2:34+ .DO 1:05+ .DO 1:25+ .DO 1:24+ .DO 0:49+ .DO 1:28+ .DO 1:03+ .DO 0:30+ .DO 23:10+ .DO 0:43+ ,DO 6:14+ .DO 13:49+ .DO 0:30+ .DO 0:30+ .DO 0:35+ .DO 1:44+ .DO 0:32+ .DO 1:13+ .DO 0:30+ .DO 1:44+ .DO 0:30+ .DO 0:53+ .DO 1:01+ .DO 0:30+ .DO 0:30+ ,DO I:00+ .DO 1:06+ .DO 0:30+ .DO 3:01+ .DO 0:30+ .DO 0:30+ 0:30+ .DO t:25+ .DO 0:30+ .DO 0:30+ .DO 0:33+ .DO 1:12+ 4:28+ ,DO 3:50+ .DO 0:30+ .DO 0:42+ .DO 1:14+ .DO 0:30+ .DO 0:41+ .DO 2:59+ .DO 1:55+ .DO 3:21+ .DO 0:30+ .DO 6:30+ .DO 0:30+ .DO 1:49+ .DO 1:48+ .DO 0:39+ .DO FISHERS ISLAND FERRY DISTRICl' Page 4of7 att ,OT0X, Account Number 860442-0165078 FISHERS ISLE NY 06390-0607 Billing Date Aug 15, 2012 Call Charges - Continued Item No. Date Tim Place Number 1. 8-04 1009A FISHERS IS NY 631 788-7255 2. 8-04 1056A FISHERS IS NY 631 78~-7463 3. 8-06 741A FISHERS IS NY 631 788-7463 4. 8-06 841A FISHERS IS NY 631 788-7463 5. 8-06 912A ESSEX CT 860767-9917 6. 8-06 1047A FISHERS IS NY 631 788-7255 7. 8-06 1126A SYOSSET NY 516921-9005 8. 8-06 1204P NEWYORK NY 212418-6902 9. 8-06 1221P SYOSSET NY 516921-9006 10. 8-06 190P FISHERSIS NY 631788-7463 11. 8-06 112P FISRERSIS NY 631788-7345 12. 8-06 24OP FISRERSIS NY 631788-7463 13. 8-06 305P STAMFORD CT 203321-0553 14. 8-06 308P FISHERSIS NY 631788-5655 15. 8-06 909P FISHERS IS NY 631 788-7632 16. 8-06 332P BOSTON MA 617 720-4526 17. 8-90 347P FISHERS IS NY 631 788-7975 18. 8-07 827A FISHERS IS NY 631 788-7463 19. 8-07 941A HARTFORD CT 860760-3942 20, 8-07 9~6A OLDSAYBRK CT 860395-,~131 21. 8-07 1055A FISHERS iS NY 631 788-7345 22. 8-07 1156A COCOA FL 321 482-3786 23. 8-07 1241P FISHERS IS NY 631 788-7463 24. 8-07 132P ALBANY NY 518701-2721 25. 8-07 151P FISHERS IS NY 631788-7522 26. 8-07 256P FISHERS IS NY 631 788-5662 27. 8-07 258P FISHERS IS NY 631 788-7731 28. 8-90 890A FISHERS IS NY 631 788-7345 29. 8-90 959A FISHERS IS NY 631 788-7463 30. 8-08 1901A FISHERS 18 NY 631 788-7224 31. 8-08 1047A FISHERS IS NY 631 788-7463 32. 8-08 114~A FISHERS IS NY 631 788-5673 33. 8-08 1148A FISHERS IS NY 631 788-~673 34. 8-08 1203P FISHERS IS NY 631 788-7463 35. 8-08 1241P FISHERS IS NY 631 788-7463 36. 8-08 312P FISHERS IS NY 631 788-7345 37. 8-08 322P FISHERS IS NY 631 788-5673 3~. 8-08 324P FISHERS IS NY 631 78~-7887 39. 8-08 330P FISRERSIS NY 631788-7463 40. 8-09 652A HARTFORD CT 860604-2135 41. 8-09 914A FISHERS IS NY 631 788-7455 42. 8-G9 938A FISHERS IS NY 631 788-7463 43. 8-09 1903A ALEXANDRIA VA 703474-2599 44. 8-09 1907A FISHERS IS NY 631 78~-5515 45. 8-09 1019A FISHERS IS NY 631 788-7790 46. 8-09 1046A FISHERS IS NY 631 788-7744 47. 8-09 1153A HARTFORD CT 860278-2670 48. 8-09 1154A HARTFORD CT 860278-2670 49. 8-09 124P FISHERS IS NY 631 788-7463 Code Call Charges - Continued Item No. Date Tim~ Pla~ Number 50. 8-09 146P FISHERS IS NY 631 788-7463 51. 8-09 209P ESSEX MA 978768-7918 ~ 52. 8-09 241P FISHERS IS NY 631 788-7345 t:31+ .06 53. 8-09 339P FISHERS IS NY 631 788-7463 8:22+ .90 54. 8-14 945A HARTFORD CT 860289~0267 1:19+ .90 55. 8-14 1147A OLD SAYBRK CT 860227-2335 1:01+ .90 56. 8-14 223P HARTFORD CT 860278-7293 2:15+ .90 57. 8-14 235P HARTFORD CT 900982-4063 1:55+ .90 Tota~ Itemized Calls 8:13+ .90 Total Charges for 860 442-0165 2:51+ .00 11:55+ .90 Charges for 866 443-6~51 Itemized Calls 4:15+ .90 58. 7-14 928A FISHERS IS NY 631 788-5522 5:36+ ,90 59. 7-14 131P FISHERS IS NY 631 788-5522 1:14+ ,90 60. 7-16 1054A FISHERS IS NY 631 788-5522 0:30+ .00 61. 7-16 307P FISHERS IS NY 631 788-5522 0:30+ .90 62. 7-16 316P FISHERS IS NY 631 788-5522 1:03+ .90 63. 7-17 1116A FISHERSIS NY 631788-5522 3:28+ .90 64. 7-17 207P FISHERS IS NY 631788-5523 0:30+ .90 65. 7-17 310P FISHERS IS NY 631 788-5522 2:57+ .90 66. 7-18 1212P FISHERS IS NY 631 788-5522 0:30+ .90 67. 7-18 313P FISHERS IS NY 631 788-5522 2:34+ .90 68. 7-19 1105A FISHERS IS NY 631 788-5522 0:30+ .90 69. 7-19 1156A FISHERS IS NY 631 788-5523 4:24+ .90 70. 7-19 131P FISHERSIS NY 631788-5523 4:0~ 71. 7-19 140P WARWICK RI 401738-2597 1:07+ .90 72. 7-19 141P WARWICK RI 401738-2597 10:20+ .90 73. 7-19 311P RSHERSIS NY 631788-5522 0:30+ .90 74. 7-20 957A FISHERS IS NY 631 188-5523 1:25+ .90 75. 7-20 1028A MILFORD CT 256876-8616 0:30+ .90 76. 7-20 1119A FISHERS iS NY 631 788-5522 0:30+ .90 77. 7-20 1130A FISHERS IS NY 631 788-.~22 0:30+ .00 78. 7-20 309P RSHERSIS NY 631788-5522 0:42+ .90 79. 7-21 228P FISRERSIS NY 631788-5522 0:42+ .00 80. 7 23 I I01A FISHERS IS NY 631 788-5522 0:55+ .90 81. 7-23 tl4P FISHERSIS NY 631788-5523 0:30+ .00 82. 7-23 320P FISHERS IS NY 631788-5522 0:42+ .00 83. 7-24 653A DEEPRIVER CT 860526-2647 0:43+ .90 84. 7-24 1039A FISHERS IS NY 631 788-5522 0:51+ .00 85. 7-24 23OP FISHERS IS NY 631788-5522 0:30+ .90 86. 7-25 954A FISHERS IS NY 631788-5522 0:34+ .90 87. 7-25 1033A FISHERS IS NY 631 788-5522 0:30+ .90 88. 7-25 301P FISHERS IS NY 631788-5522 0:30+ .00 89. 7-26 1156A FISHERS IS NY 631 788-5522 0:32+ .90 90. 7-26 252P FISHERS IS NY 631 788-5522 0:30+ 91. 7-26 351P FISHERS IS NY 631 788-5522 0:47+ .G~ 92. 7-27 1013A FISHERS IS NY 631 788-5522 0:56+ .90 93. 7-27 1036A FISHERS IS NY 631 788-5522 0:41+ .90 94. 7-27 1118A FISHERS IS NY 631 788-5523 0:30+ .90 95. 7-27 311P FISHERS IS NY 631 788-5522 2:05+ .90 96. 7-28 249P FISHERS IS NY 631 788-5522 0:30+ .90 97. 7-30 1018A FISHERS IS NY 631 788-5522 Code Mi~ 1 0:30+ .00 I 0:41+ .90 1 1:27+ .90 1 0:34+ .90 D 1:01+ .90 D 1:01+ .OD D 1:35+ .90 D 0:30+ .90 ,00 .90 0:31+ .90 0:31+ .90 1:56+ .90 0:30+ .90 0:32+ 2:08+ .90 0:34+ 0:33+ .90 2:38+ .90 0:32+ .90 1:17+ 0:48+ .90 0:47+ .90 0:30+ ,00 0:30+ .00 0:31+ .00 0:34+ .90 0 0:30+ .00 1:45+ .90 1:46+ .90 0:32+ 0:31+ 1:30+ .90 0:35+ .90 0:33+ .00 N 0:30+ .90 2:08+ .00 0:34+ .90 0:35+ 2:18+ 0:34+ .90 1:46+ .90 0:33+ .90 0:30+ .90 0:35+ .lB 1:21+ .90 0:30+ 0:31+ 0:33+ .90 1:41+ .90 6012.908.077353.02.04.0090000 NNNNNNNY 61023.161565 at&t FISHERS ISLANR FERRY DISTRICT Page PO BOX H Account Number FISHERS ISLE NY 06390-0607 Billiag Date 5of7 860 442-0165 078 Aug 15, 2012 Call Cbeqle$ - Continued Item ~ ~ ~.~ PI~¢~ Number 1. 7-30 1027A FISHERS IS NY 631 788-5522 2. 7-30 314P FISHERS IS NY 631788-6522 3. 7-31 940A WEBSTRGRVS MO 314918-258~ 4. 7-31 1012A FISHERSIS 5. 7-31 1021A FISHERSIS 6. 7-31 1234P FISHERS IS 7, 7-31 244P FISHERSIS 8, 7-31 308P FISHERSIS 9. 8-01 IO14A FISHERS I$ 10. 6.01 1015A FISHERS IS 11. 8-01 1017A FISHERS IS 12. 8-01 31:3P FISHERSIS 13. 8-02 1112A FISHERS IS 14. 8-02 30&° FISHERS IS 15. 0-03. 9~3A FISHERS IS I& 8-03 952A FISHERSIS 17. 8-03 953A FISHERSIS 18. 8-03 1024A FISHERS IS 19. 8-03 1058A FISHERS IS 20. 8-03 318P FISHERS IS 21, 8-04 2§5P FISHERS IS 22. 6.0~ 9S&A FISHEHS IS 29. 8-06 958A FISHEHS IS 24. 6.06 119P FISHERSIS 25. 6.06 122P FISHERSIS 26. 8-06 330P FISHERS tS 27. 6.07 1005A FISHERS IS 28. 8-07 1049A FISHERS iS 29. 8-07 301P FISHERStS 30. 6.0~ 1021A FISHERSIS 31. 8-0~ 309P FISHERSIS 32. 8-G~ 407P FISHERSIS 33. 8-09 1036A FISHERS IS 34. 8-O9 312P FISHERS IS Total Itemized Calls Total Charges for 860 443-6851 Cha~ge$ for 860 44443Z0 Remized Calls 35. 7-30 331P FISHERS IS Charges for 860 447-0371 Itemized Calls 36. 7-14 632P FISHERSIS 37. 7-14 re33P NEWYORK 38. 7-10 836A NEWHAVEN 39. 7-16 924A FISHERS IS 40. 7-16 959A FISHERS IS 41, 7-16 1010A NEWHAVEN 42. 7 16 1153A FISHERSIS NY 631 788-5522 NY 631 788-5522 NY 631 788-~22 NY 631 786.6522 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 631 788-5523 NY 631 788-5522 NY 631 788-5523 NY 631 788-5522 NY 631 788*5522 NY 631 788-5522 NY 631 788-5522 NY 631 78~-5522 NY 631 788-5522 NY 631 78&5522 NY 631 788-5522 NY 631 788-5522 NY 631 788-5522 NY 631 78~-5522 NY 631 788-5522 NY 631 78&5522 NY 631 788-5522 NY 631 788-5522 NY 631 788-5522 NY 631 788 5522 NY 631 788-5523 NY 631 788-7227 NY 917692-1440 CT 203 641-9494 NY 631 788-7463 NY 631 788-5545 CT 203 468-4506 NY 631 786.5673 (:all Cberges - Continued item No. kate Time Place Number 43. 7-16 1154A FISHERS IS NY 631 788-7225 44. 7-16 1156A FISHERS IS NY 631 788-7463 Code Min 45. 7-16 1237P GREENWICH CT 203869-5440 0:34+ .00 46. 7-16 1253P GREENWICH CT 203869-5440 0:32+ .00 47. 7-16 103P FISHERS IS NY 631 788-5515 0:43+ .OD 48. 7-16 20DP FARMINGDL NY 631 694-2300 1:40+ .OD 49. 7-16 241P FISHERS IS NY 631 788-7463 0:31+ .00 50. 7-16 830P NEWHAVEN CT 203468-4506 0:36+ .00 51. 7-17 850A FARMINGDL NY 631 694-2300 0:30+ .00 52. 7-17 909A FISHERS IS NY 631 788-7370 0:32+ .00 53. 7-17 107P MORRISTOWN NJ 973214-1506 0:36+ .00 54. 7-t7 232P MILFORD CT 203876-8606 0:38+ .00 55. 7-17 303P FISHERSIS NY 631786.7858 1:31+ .00 56. 7-17 304P QUEENS NY 718392-8910 0:32+ .OD 57. 7-18 803A COOPERSBG PA 610214~0000 2:44+ .00 58. 7-18 824A FISHERStS NY 631788-7919 0:32+ .OO 59. 7-19 159P FISHERS IS NY 631 788-7463 0:30+ .00 60. 7-19 345P NEWHAVEN CT 203468-4506 0:33+ .00 61. 7-20 746A FISHERS IS NY 631 786.7345 0:36+ .00 62. 7-20 95OA FISHERSIS NY 631 788-7919 0:34+ .00 63. 7~20 1224P FISHERS IS NY 631 788-7225 1:12+ .00 64. 7-20 328P FARMINGDL NY 631414-5825 0:33+ .00 65. 7-20 550P FARMINGDL NY 631 414-580~ 0:31+ .00 66. 7-21 141P HARTFORQ CT 860986.7634 0:35+ .00 67. 7-22 1059A FISHERS IS NY 631 786.7463 1:19+ .00 68. 7-23 1232P FISHERS IS NY 631 788-7223 1:24+ .00 69. 7-23 1235P FISHERS IS NY 631 788-7463 1:25+ .00 70. 7-24 816A FISHERS IS NY 631 788-734S 0:36+ .00 71. 7-24 953A BRISTOL VT 802453-5549 0:38+ .00 72. 7-24 1019A FISHERS IS NY 631 788-7496 1:39+ .00 73. 7-24 1058A NEWHAVEN CT 203710-4410 0:32+ .00 74. 7-24 305P SEATTLE WA 206 355-0286 1:39+ .00 75. 7-25 934A FISHERS IS NY 631 788-7463 0:33+ .00 76. 7-25 937A FISHERS IS NY 631 788-5673 0:32+ .00 77. 7-26 255P HARTFORD CT 860841-2256 1:49+ .00 78. 7-26 256P RADDAM CT 860345-8554 O:35+ .00 79. 7-27 321P MILFORD CT 2038768606 .00 80. 7-30 1121A OLD SAYBRK CT 860396.5266 .00 81. 7-30 1217P FISHERS IS NY 631 786.7463 82. 7-31 1136A MILFORD CT 203876-8606 83. 8-01 251P FISHERS IS NY 631 786.7585 84. 8-02 916A FISHERS IS NY 631 788-7345 0:45+ .OD 85. 6.02 917A FISHERS 19 NY 631 788-7323 86. 8-02 14OP FISHERS IS NY 631 788-7463 87. 6.02 34&P FISHERS IS NY 631 788-5673 2 0:30+ ,00 88. 6.03 1006A FISHERS IS NY 631 788-7463 2 0:49+ .00 B~, 8-03 1016A MERIDEN CT 203238-6751 D 0:35+ .00 90. 8-03 1032A FISHERS IS NY 631 788-7463 1 2:33+ .00 91. 8-03 118P FISHERSIS NY 631788-7741 I 1:01+ .00 92. 6.03 224P COCOA FL 321482-3786 D 10:10+ .00 93. 6.03 320P FISHERS IS NY 631 788-7463 1 0:49+ .00 ~. 6.03 321P FISHERS IS NY 631 788-7345 95. 8-03 333P BROOKLYN NY 917685-0~82 Code I 0:57+ I 0:30+ D 7:49+ D 1:00+ t 1:0~- 1 1:35+ I 6:32+ E 1:31+ I 0:39+ 1 0:30+ 1 0:30+ D 2:51+ 1 0:30+ I 0:30+ I 0:47+ I 6:12+ I 0:50+ O 1:11+ 0:30+ h01+ 1:13+ 28:15+ 1:37+ 0:59+ 5:14+ 2:50+ 0:40+ 0:30+ 0:37+ 0:30+ D 0:31+ 1 0:30+ 1 0:31+ 1 1:52+ D 0:30+ D 0:30+ D 3:32+ D 2:52+ I 4:32+ D 2:07+ I 1:10+ 1 0:30+ 1 2:17+ 1 1:24+ 1 1:14+ 1 0:30+ O 0:25+ 0:38+ 15:50+ 2:01+ 0:30+ 0:30+ 4:22+ .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .57 .09 .02 .02 .19 at&t FISHERS ISLAND FERRY DISTRICT Page 6 of 7 PO BOX H Accouut Number 860 442-0165 078 FISHERS ISLE NY 06390-C~07 Billi#g Date Aug 15, 2012 Call Charges - Continued Item No. Date Time Place Number I. 8-03 339P FISHERS IS NY 631 788-7463 2. 8-05 922A FISHERS IS NY 631 788-7463 3. 8-06 1131A FISHERS IS NY 631 788-7560 4. 8-06 116P FISHERS IS NY 631 78~-7463 5. 8-06 334P FISHERS IS NY 631 788-7345 6. 8-0~ 808A FISHERS IS NY 631 788-7345 7. 8-08 836A FISHERS IS NY 631 788-7447 8. 8-08 945A ESSEX CT 860662-3013 9. 8-0~ 316P FISHERS IS NY 631 788-7255 10. 8-0~ 324P FISHERSIS NY 631 788-7255 11. 8-09 1209P FISHERS IS NY 631 788-7701 12. 8-09 1210P FISHERS IS NY 631 788-7323 Total Itemized Calls Total Charges for 860 447-9371 + - Optional Calling Ran Key to Calling Codes I Peak E Evening Total Call Charges Code Surcharges and Other Fees 1:26+ 3:24+ 0:43+ 0:54+ 0:34+ 0:30+ 0:38+ 2:48+ 0:31+ 0:42+ 0:30+ 0:55+ 2 Off Peak D Day M Multiple Rata Periods N Night/Weekend AT&T Connecticut 13. Coonecticut E9-1-1Surcharge-4Unes 14. Connecticut Service Fund - 4 Unes 15. Universal Service Fund - Eocal(4 @ $1.28) 16. Federal Subscriber Line Charge- 4 Unes Total AT&T Connecticut AT&T LD East 17. Federal Regulatory Fee 18. Universal Service Fund - Intarstata Total AT&T Long Distance East Total Surcharges and Other Fees Taxes 19. Federal 20. State Sales Tax Total Taxes Total Plans and Services .06 .15 .03 ,04 .02 .02 .03 ,12 ,02 .03 .02 .04 1.47 1.47 31.47 1.20 .20 5.12 23.84 30.36 .22 2.37 2.59 32~5 3.47 11.68 15.15 260.22 PREVENT DISCONNECT If your bill shows a past due amount, DOTH the Past Due amount and Current Charges are due IMMEDIATELY. All of your bill charges must be paid each month 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: $147.64 for Current Basic Charges $~.60 for Past Due Basic Charges CARRIER INFO Our records indicate that AT&T Connechcut is your carrier for instate calls. AT&T Long Distance East is your carrier for interstate and international calls. KEEP YOUR DISCOUNT You receive any discounts, reduced rates, or promotional credits de- scribed in the AT&T Benefits section of the bill because you subscribe to certain required services, for example, because you are 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 remaining service will change. Please call your AT&T service representative if you have any questions, CT RELAY SERVICE Dial 711 is a Telecommunications Relay Service for customers with hearing and speech disabilities. AT&T offers products and services for customers with visual, hearing, speech or physical disabilities. For more information, please go to att. com or refer to the customer guide section in your AT&T talephone directory. 600 # INFORMATION 900 Number information services are provided over telephone numbers beginning with the prefix gOO. If you fail to pay legitimate charges for calls to 900 numbers, your access to 900 numbers may be involuntarily blocked. To protect customers from unexpected 900 charges, AT&T offers 900 Cog Blocking at no cost. For further details on 900 Ca~l Blocking, call your AT&T Service Representative, Note that 900 charges incurred from purchasing products and services from dqe Intarnet cannot be blocked. You may withhold payment for 900 charges if you dispute die charges within 60 days. Action to collect disputed amounts will be suspended pending investigation of the dispute. Your local and long-distance telephone service cannot be suspended or disconnected for nonpayment of 900 charges. However, the company that provides the 900 service may take other actions to collect charges you have not paid and have not disputed. You are not to be billed for pay-per-call services that do not comply with federal laws and regulations. DO NOT CALL if your business makes outbound telephone solicitations, you must comply with National Do-Not-Call laws and regulations (47 C.F.R 64.1200 and 16 C.F.R. 310) and any applicable state laws. 6012.008.077363.03.04.0000(X~ NNNNNNNY 61025.161937 at&t FISHERS ISLAND FERRY DISTRICT Page 7of7 PO BOX H Accomlt Number 860 442-0165 078 FISHERS ISLE NY 06390-0607 Billiag Date Aug 15,2012 AUTOMATIC PAYMENTS Sfifi payiflg bills the old fashioeed way - writing checks, staffing envelopes, and licking stamps? You're not only losing precious bme, you're spending extra money your business can use. Enroll in AT&T Account Management AutoPsy and experience ease, convenience, and security of knowing your bill is paid on time. You can also set up a bill threshold and be notified when your tilreshold has been exceeded. Enrofi today at attcom/MyBusiness. PAPERLESS BILLING The benefits of Paperless Billing are Convenience, Control, and Clutter reduction. Convenience - view your bill anywhere there's internet access; Control - schedule payments or pay online anytime; Clutter - no more stacks of bills to file. We stere 36 months of bill history online for you. You can view, save or download your bill anytime you need it tom anywhere. Learn more about AT&T Account Management Papedess Billing at att. c om/billsonline or enroll today at attcom/mybusiness. BILL PAYMENT, LATE PAYMENT CHARGES AND OTHER FEES Failure to pay any porfion of your bill may result in additional collecfien 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 interrupbon of your local service. If you fail te pay your Non-Basic Charges, your AT&T Connecticut local service will not be interrupted, but all of your Non*Basic services will be terminated. AT&T Connecticut may apply a late payment charge per month on any unpaid balance, excluding the previously assessed late payment charges. To avoid a late charge, we must receive payment for the total amount due no later than the date specified on your bill ststemenL AT&T Connecticut wdl 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 websita: http://wvvw.atLcom/ctbillglossary 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 Connecticut. Out of state long distance is provided by AT&T Long Distance East. Intarnet services are provided by AT&T Internet Services. Wireless services are provided by AT&T Mobility. BASIC CHARGES Basic Charges are charges for Basic Services. Basic Services include local service and in*state toll if you are an AT&T Connecticut local service customer. Basic Charges include: Monthly Charges for your local line and other services, such as Totalphone and Smartlink; in-state Calling Charges; in*state Directory Assistance Charges; the Connecticut E-911 Surcharge; the Connecticut Service Fund fee; the Federal Subscriber Line Charge; and the Universat Service Fund - Local fee. NON*BASIC CHARGES Non-Basic Charges are charges lot 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 Internet, Wireless, AT&T I DISH Network, AT&T I BIRECtV, Advertising in the white page directories or other media; and 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, and Additions and Changes to your service. 6012.008.0773~3.04.04.0000000 NNNNNNNY 61027,1§193§ FISHERS ISLAND FERRY DISTRICT VENDOR 002433 WILLIA24 BLOETHE 09/11/2012 CHECK 686 FUND & ACCOUNT P.O.~ INVOICE DESCRIPTION AMOUNT SM .5713.4.000.000 093012 MAIL TRANSPORT-3RD QTR 2,250.00 TOTAL 2,250.00 PO BO) CHECK NO. 686 A~OUN~ Town of Southold, New York - Payment Voucher P.O. Box 446 William Bloethe Vendor No. 2433 Fishers Island, NY 06390 Invoice Invoice Net Number Date Tota~ Discount I $2,250.00 Payee Certification $2,250.00 $2,250.00 t r/ Check No. Entered by ~)~ Audit Da~e SEP 1 1 2012 Mail Transport SM$713.4.000.000 3r~ Quarter 2012 Town Clerk . · Department Certification I hereby ceni fy ~hat the materials above specif~d have been received by me in good cvndition without substitution, the services properly performed and that the quantities there, of have been vc, rlJlgd ,,,~ th the exceptions Signature Town of Southold, New York - Payment Voucher Vendor Tax ID Number or Social S~curity Number Vendor Contact Vendor No. 2433 Vendor Address P.O. Box 446 ~ishera Island, NY 06390 Check No, Entered by Audit Date SEP 1 1 2012 Town Clerk Invoice Invoice Number Date Total 9/3012012 , $2,500.00 Mail Transport 3rd Quarter 2012 Tiae undersigned (Claima.~d{.Acnng on behaIf of the above named claimant) does hereby certify t~at~ ¢ foregoing claim is true and correct, that no part has been paid,, ex~ thc eincx as therein stated, that the balance therein stated is actually Title~ Company Date I hereby certify that the materials above: ~ received by mc m good condition without substitution, me serv~ces~rly performed and that the quantities thereof have been verified with the tions or discrepancies noted, and payment is approVed. ```. FISHERS 1SLAND FERRY DISTRICT VENDOR 002776 CHARLES BURGESS 09/11/2012 CHECK 687 FUND & ACCOUNT P,O.# INVOICE DESCRIPTION AMOUNT SM .9060.8.000.000 SM .9060.8.000.000 SM .9060.8.000.000 SM .9060.8.000.000 SM .9060.8.000.000 SM .9060.8.000.000 SM .9060.8.000.000 SM .9060.8.000.000 010112 020112 030112 040112 050112 060112 5207103885 S216301250 PRESCRIPT ARREARS-i/12 94.41 PRESCRIPT ARREARS-2/12 94.41 PRESCRIPT ARREARS-3/12 94.41 PRESCRIPT ARREARS-4/12 94.41 PRESCRIPT ARREARS-5/12 94.41 PRESCRIPT ARREARS-6/12 94.41 2ND QTR 2012 REIMB. 416.15 3RD QTR 2012 REIMB. 416.15 TOTAL 1,398.76 9/11/12 AUDIT C~ECK NO. 687 $1,398.76 ~Y THE ORDER OF WATERFOR~ C~0~388 Vendor No. Town of Southold, New York - Payment Voucher i 2776 Vendor Tax ID Number or Social Security Number Vendor Address Hamel Court Waterford, CT 06385 Charles W. Burgess Vendor Telephone Number Vendor Contact Check No. Entered by Audit Date SEP 1 1 2012 rown Clerk Invoice Invoice Invoice : Net Purchase Order Number Date Total i Discount Number 6 11112012 $94.41 $94.41 21112012 $94.41 $94.41 31112012 $94.4t 4/112012 5/112012 61112012 $94.41 $94.41 $94.41 $94.41 $94.41 $94.41 $94.41 Description of Goods or Services nthem ~;et ree -- Prescription Plan ~/I 90% Relmbumement 3I 104.90 less 10% Charles Burgess Ck"8's 3083, 3068,3068,3078, 3084, and 3092 For Months January-June 2012 year General Ledger Fund and Account Number 8M9060.8.000.000 $566.46 $566.46 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 been paid, except as therein stated, that the balance therein stated is actually due and owing, and that taxes from which the Tovm is exempt are excluded Company Name / ?~ Dar: I 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 I II llllt lilt II!1111 II III I[I I I iii tilt tlll111111 mil Iii iii iii Ill il Ill Blue Medimdtx'(PDP) 271437726 G0230329901 IIl.,.Ih.,,ll,l,.I,,I,l,,.hlll,,,ll.,h,l,ll,,.,I.,I,l-II CHARLES W BURGESS 4 HAMEL CT WATERFORD CT 06385-20(0 Balance Due 02/01/2012 $104.90 ' Please return the top portion of this form with your payme,~ See reverse side for payment options. Retain the bottom portion of th~s form for your records Per your Evidence of Coverage booklet, if you and your spouse are both enrolled in tim plan, your momhly premium payments must be paid separately. W9 r_~?fire one r~m~anee advice and one _ _paym~t ~ aeeotmt. The remittance advice is located on the reverse side of this statemeni. This will ensure ~aeh member account is credited appropriately and timely to prevent disearollment from the plan, which will result in a lapse of coverage. If you are disenrolled from the plan, you may only re-enroll durin8 a valid election i~riod. Participant ID: G0230329901 Date: 01/06/2012 Transaction Date Description Promium 01/01/2012 January 2012 Balance Due Amount 104.90 104.90 271437726 G0230329901 111..11,,.11,1,,I.1,1.,I,II1,,,11.,6,1,11..I.1,1-11 CHARLES W BURGESS 4 HAMEL CT WATERFORD CT 06385-2008 Balance Due 03/01/2012 $104.90 D Please return the top_portion of this form w#th your paymem. See reverse side for payment opaons. Retain the bottom 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 re~_ lire one rem~ane~- advice and one payment per account. The remittance advice is located on the reverse side of this statement. This will ensm'e each member account is credited appropriately and timely to p~t diaanrollmant from the plan, which will r~ult in a lapse of coverage. If you are disanrolled from the plan, you may only ~uroll during a valid ele~tiun period. Participant ID: G0230329901 Date: 02/06/2012 Transaction Date I)esexiption Premium 02J01/2012 Febmm7 2012 9Z~ Balance Due I Blue MedicamRx~(PDP) Amount 104.90 104.90 ~P~ c 6u~eEss 3058 CHARLES Lo/FJURGESS 1004.01.0(~0020018-0001-(]0207~ Paa-e 1 Of l Anthem . I IIlllllllllllllllll lllllfl 271437726 IIl..ll,,.ll,l,,h,l,l.,hllh.ll.,I.l,ll..hd,l. II CHARLES W BURGESS 4 HAMEL CT WATERFORD CT O6,385-2OO8 Balance Due 04/01/2012 $104.90 please return the top portion of this form with your txtyment. Retain the bottom portion of this form for your records. Per you~ Evidence of Coverage booklet, if you and your spouse are both enrolled in the plan, your monthly premium payments must be paid sepm'ately. W~ r~ ~ire one l'erniff~ne~e advice alld one pa.vme~lt per account. The remittance advice is located on the reverse side of this statement. This will ensure each member account is credited appropriately and timely to prevent disearollment from the plan, which will result in a lapse of coverage. If you are disenrolled from the plan. you may only re-enroll during a valid election period. Anthem Participant ID: G-0230329901 Date: 03/07/2012 rpm~ction Date Description Amount ~remium 03/01/2012 March 2012 104.90 Balanee Due 104.90 · Anthem I rllllRilllll llrllRlI!llllllBiIiIl lgllrll Blue MedicBreRx'(PDp) IIl,,,,ll,,,,ll,l,,I,,I,l.,I,IIl,,Jl.,I,,I,Ih,,,I,,I,l,,ll CHARLES W BURGESS 4 HNMEL CT WATERFORD CT 06385-2008 271437726 G0230329901 Balance Due 05/01/2012 $104.90 Please return the top portion of this form with yoar payment. See reuerse side.for payment options. Retain the bottom 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 re(mire one remlffRnt'~ advice alld one Daymem Der acc~.nt The remittance advice is located on the reverse side of this statement. This will ensure each member account is credited appropriately and timely to prevent disenrollment from the plan, which will result in a lapse of coverage. If you are disenrolled from the plan, you may only re-enroll during a valid election period. Anthem Transaetion Premium Balance Due Participant ID: G0230329901 Date: 04/04/2012 Date Description 04/01/2012 April 2012 Amount 104.90 104.90 V~AREN C BURGESS CHARLES W~URGESS w~FORDCT06~5 3075 For. o~°f6~~'''~'cc~c~'~*-~ ~'" ~o/7 Citizens Circle Account Connecticut 30?5 IIl,,,.ll,,,,ll,l,,I,,I,l,,,I,IIl,,,Ih,,I,,I,II,,,,I,,I,l,,ll CHARLES W BURGESS 4 HAMEL CT WATERFORD CT 06385-2008 271437726 G0230329901 Balance Due 06/01/2012 $104.90 Please return the top portion of this form with y(mr payment. See reverse side for payment options. Retain the bottom 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 one remittance advice and one pa_vment per account. The remittance advice is located on the reverse side of this statement. This will ensure each member account is credited appropriately and timely to prevent disem'ollmen! from the plan, which will result in a lapse of coverage. If you are disenrolled from the plan, you may only re-enroll during a valid election period. Anthem , Participant ID: G0230329901 Date: 05/08/2012 Transaction Date Description Premium 05/01/2012 May 2012 Ba!~_~ce Due J Blue Yedicareiix'(PDP) Amount 104.90 104.90 KAREN C BURGESS CHARLES W BURGESS 4 HAMEL CT WATERFORD CT 06385 3084 order of~z ~_ Citizens Bank Connecticut For_ ,: ;~ ~ i, ~ ?0 i, I, hi: '---- I D '" DoLLars Citizens Circle Account Page 1 of I --..~--..,-.---.--.- ~..= --~.~=.--.~=".2 · -" i IIIII IIIll Ill IIIII Irlll IIIII IIIII IIIII IIIII IIIF IIII e,d,l.phtlll.,tt;..,Hh;Itl,t,.,;.,I,ulll,,,I;Hlll,,I, CHARLES W BURGESS 4 HAMEL CT WATERFORD CT 06385-2008 271437726 G0230329901 Balance Due 07/01/2012 $104.90 P/ease return the top portion of this form with your payment. See reverse side for payment options. Retain the bottom portion of this form for your records Per your Evidence of Coverage booklet, if you and your spouse areboth enrolled in the plan, your monthly premium payments must be paid separately. We reouire one remittance advice and one payment per account. The remittance advice is located on the reverse side of this statement. This will ensure each member account is credited appropriately and timely to prevent disenroilment from the plan, which will result in a lapse of coverage. If you are disenrolled fi`om the plan, you may only re-enroll during a valid election period. Anthem~ Participant ID: G0230329901 Date: 06/06/2012 Transaction Date Premium 06/01/2012 Balance Due June 2012 Amount 104.90 ~ Citizens Bank Connecticut For t: ~ 2. I, 3. ?0 2. ]. hi: KAREN C BURGESS 3092 CHARLES W BURGESS 4 HAMEL C1- ~ --c~ / --/,~ 51-7011/2111 WATERFORD CT 06385 ~ Date Citizens Circle Account B BO i, tO?05t"" tOq2 Town of Southold, New York - Payment Voucher Vendor Tax ID Numbex or Social Security Number Vendor Address Charles Burgess Vendor Telephone Number Vendor Contata Number Date Total Discount Hamel Court Waterford, CT 06385 Net Purchase Order Amount Claimed Number Vendor No. 2776 Eheck No. ;Entered by Audit Date SEP 1 1 2012 Town Clerk Description of Goods or Services General Ledser Fund and Account Number 6207103888 4/1/2012 $416.15 $416.16 521630126{] 71112012 $416.15 $416.15 $832.30 $832.30 Anthem BC/BS c~ fl~ {~hLI/ 201 8M9060.8.000.000 Date 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 h~s 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 Retiree Stand Alone 90% Reimbursement ~462.39 less $46.24 ChaHes Burgess Ck~3063 Quarterly 4/1112-6130112 Anthem BCIBS .-~ f~¢ ~0 ~ Retiree Stand Alone ~O'f4 90% Reimbumement ;462.39 less $46.24 Charles Burgess Ck~3063 Quarterly 711 I12-9130112 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 w~th the exceptions or discrepancies noted, and payment is approved Title ~~ Date Z ~ ~ /'~..~ SM9060.8.000.000 Nogtb Havef~, CT 06473-4201 INDWIDUAL MARKET INVOICE PRO_DUCT #EDIGAP PLAN N,COPAY $20. ~I'OTAL ield, oug~ MEMBER NO: 0842H2010 l ME~dBER: CHARLES N BURGESS INVOK~E NO: 5207103885 81CU~ ~T ~; 7010842920101 PERJpD_~VERED . ~ I ~OUNT 0q/0~/20~2 - 06/30/20~2 + ~. K.A.qEN C BU~CHB~WBUii6~ 0c~,~/)~1jc~0/Oj 3063 WAT~FORD ~ ~ / ~ C~s Cir~ ~ ~ Citi=ens Bank ~nn~ For. . _. . d Blue ?O}08qEq2O}O& 2 S207.~03865 ~ OO000oqb~3q OqS 8 DETACH AND RETURN THIS PORTION WITH PAYMENT CHARLES N BURGESS 4 HANEL CT HATERFORD, CT 06585-2008 MEM~Ea.UUOER: 0M2M20101 8ILUNG ACCOUNT: 7010842920 lO 1 INVOICE NUMBER: PERIOD COVERED: INDICATE ADDRESS CHANGE BELOW;. MAKE CHECK PAYABLE TO "ANTHEM BCB,S# ITOTAL AMOUNT DUE BY:1 ~ APRIL 1, 2012 ,~ $462.39 5 5207103885 t 04/01/2012 0&/$0/2012 II1,,,,I,,I.,I,1,1,,I,,11,1,1,.I.1,11.1,,I,.,,111,,,I,,I,II Anthem Blue Cross and Blue Shield P.O. Box 110t7 Lewiston, ME 04243-9468 .drllil,fl.lhlU.q.,dl,..q.hllff.hrqhl..,"lHl"..I #CTBSAOO1RCTiH O00qlS 061212 061412 CHARLES H BURGESS 4 HAHEL CT #ATERFORD CT 06585-2008 INDIVIDUAL MARKET INVOICE Si necesita ayuda en espafioi para entenOer este documento, puede solicitarla sin costo cllente que a~re~ al dorso de su tarjeta PRODUCT MEDIGAP PLAN N,COPAY MEMBER NO: MEMBER: INVOICE NO: BILLING ACCT NO: 08fi2M20101 CHARLES W BURGESS 5216501250 7010842920101 l c ss [,__ P~ERI~OD_C~VERE~D --- l ..... ~AMqUNT $20. I 07/01/2012 - 09/50/2012 + 4462.39 ~T'OTAI If you Shielc throu! KAREN C BURGESS CHARLES W BURGESS WATERFORD CT 06386 Date order of ~-~,~P ~7~e-f/~ C? Citizens Circle Account ~ Citizens Bank For Connecticut m: ~? I, i, i, ?0 & i, 3093 51-7011/2111 S962.$9I ~ and Blue ~~-'/~ ~, ~)~ ~nday pE0:3,0705:3,.· 5oq=, 000893133550030500300007010842920101100521630125006121200109500000462391 DETACH AND RETURN THIS PORTION WITH PAYMENT MAKE CHECK PAYABLE TO "ANTHEM BCBS" INVOICE NUMBER; PER;OD COVERED: U CHARLES 91 8URGESS [TOT~M~-U--N'~-~E kY: q 4 HANEL CT IJULY 1, 20~2 WATERFORD~ CT 06585-2008 ~62.39 5 UEUBER NUUBEa; 0M2M20101 B)LLrNG ACCOUNT: 70108~2920101 5216501250 1 07/01/2012 - 09/50/2012 INDICATE ADDRESS CHANGE BELC~N: mm.. mm,mm mi ...... mrna ,..m . .mm. m .mI..I .... Ill I Il md I'l I t Ilh iii i Ii ANTHEH BLUE CROSS ANO BLUE SHIELD ,PO BOX 1168 NE#ARK NJ 07101-1168 PLEASE LXD NOT WEll E BELOW THIS LINE 000893133550030500300007010842920101100521630125006121200109500000462391 4 Hamel Court WTFD, CT. 06385 July 3, 2012 Gordon, After speaking with Debbie, I am re-submitting copies of my 2nd quarter insurance invoices for re-inbursement.. I am also submitting my invoices for the 3rd quarter. I would appreciate prompt attention to this matter. Sincerely, FISHERS ISLAND FERRY DISTRICT VENDOR 014225 BUSINESS CARD 09/11/2012 CHECK 688 FUND & ACCOUNT 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 SM 5711.4.000.000 SM 5711.4.000.000 SM 5710.4.000.400 SM 5710.4.000.400 SM 5711.4.000.000 SM -5711.4.000.000 P.O.# INVOICE DESCRIPTION 48026100-1/12A 48026100-2/12A 48026100-3/12A 48026100-3/12A 48026100-4/12A 48026100-5/12A 48026100-5/12A 48026100-5/12A FINANCE CHARGE-I/12 LATE FEE PAYMENT-2/12 DATA MGT TELEPHONE SPPRT COLOR RIBBON-3/12 COLOR RIBBON RTRND-4/12 NORTON SOFTWARE-5/12 NORTON SFTWR RENEW-5/12 COMMUTER BOOKS-DEPOSIT 48026100-6/12]~ COMMUTER BOOKS-FINAL PYT 48026100-7/12~ POSTAGE- 7/12 48026100- 7/12A ~FiNANCE CHARGE- 7 / 12 AMOUNT 1.00 39.00 49.00 81.90 70.00- 67.65 86.89 500.00 527.44 100.00 51.97 1,434.85 ORDER OF WILMt]NGTO~ DE 198S6~5796 ~l'OOO~88," ,:OS&L, OSL,~,L,~: ~,8 OOl, SO8 9/It/12 AUDIT CHECE NO 688 ] DATE ' A ' I MOUNT I, o9/11720'~2 $1.43~. 85 DOSL~S Town of Southold, New York - Payment Voucher Bank of America 888-449-2273 Invoice Invoice Invoice Venaor PO Box 15731 Wilmington, DE 19886-5731 Purchase Order 14225 Check No. 1127120t2 2/2312012 3112/2012 g~2112012 Discount $1.00/~ Amount Claim~ $1.oo $39.00i ~ $39.00 $49.00 // $49.00 6,7o.0o J ( .$7o.oo $67.65`// $67.65 $86.89i/$86.89 $soo.oo ,/ $800.00 s627..s/ $827. $100.00 '// $100.00 $51.97 ,// $51.97 $t ,434.85 $1,434.85 Payee Certification The undersigned (Claimant) (Acting on behalf of the above named claimant) docs hereby certify that the foregoing claim is ln~ and correct, that no pert has Number Finance Charl]e - Late Fee Payment Data management Telephone Support Ideupemtom color ribbo~ 5/1 ~ Ideupemtore color ribbon resumed //~ Norton Software - ~[I ~ Norton Software annual renewa~ 5]~a Worldwide Tickets/commuter book~, Worldwide Tickets/commuter books Pitney Bowes Postage-FI - -~/r~ Finance Char~le ' '-} I 1 ~ Entered by e'~ Audit Da~ SEP 1 1 2012 Town Clerk SM57tl.4.000.000 SM57tl.4,000.000 SM5711.4.000.00~ SM5711.4.000.000 SM571t.4.000,000 SMfi7tl.4,000.000 8M5711.4.000.000 SM5710.4.00.400 SM5710.4.00.400 SM$71 t.4.000.000 SM5711.4.000.000 Department Certification I hereby certify that the materials above specified have been received by me tn good condition without substitution, the services proFerly performed and that the quantities thereof have been verified with the exceptions or discrepancies noted, and payment is approved. Signature Bank of America FISHERS ISLAND FERRY DST ~1~1~10316 December 28, 2011 * January 27, 2012 Page 3 of 4 Posting Transaction Date Date 12/30 12/30 01/23 01/22 01/27 01/27 12/30 12/28 01/02 12/29 01/06 01/05 01/09 01/06 01109 01/06 01/09 01106 PAYMENT RECEIVED -- THANK YOU PAYMENT RECB~/ED -- THANK YOU PURCHASE *FINANCE CHARGE* MOTION INDUSTRIES RI10 401-7360515 RI MOTION INDUSTRIES RIIO 401-7360515 RI DATA MANEGEMENT INC 325-223-9500 TX BEAR EQUIPMENT INC BUFFALO NY STAPLES 00101873 NEW LONDON CT AURAND MANUFACTURING 513-5417200 OH 12/29 12/28 PITNEYBOWES-POSTAGE 800-468-8454 CT 01/23 01/20 PiTNEYBOWES-POSTAGE 800-468-8454 CT Reference Number 36474405350000500832056 02274405350000501282737 24472681363380118133837 24472681364380161883501 24493982005207422700137 24029462006980001573498 24164072007105103703493 24254772008449622000048 24391211362985050011547 24391212020985050018791 Amount -321.86 14.33,// 15.79,~, 402.88~. 387.00'// 42532 28.50 100.00~. 100.00-/' Your Annual Percentage Rate (APR) isthe annualinterestrale on youraccount. Annual Percentage Rate PURCHASES Balance Subject to Interest Rate 8.24% V $18.17 Finance Charges by Transaction Type $1.00 CASH 19.99% V $0.00 V = Variable Rate (rata may vary), Promotional Balance = APR fcrlimited time on specified transactions. $000 Environmental sustainability continues to be an issue of critical importance to Bank of America and those we serve. As part of that commitment, did you know that we: , Announced in 2010 an ambitious new goal to reduce our absolute greenhouse gas (GHG) emissions by 15 percent over the 2010 baseline by 2015, This goal spans all of the company's global operations in more than 40 countries Bank of Amer,ca FISHERS ISLAND FERRY DST ~1~R1~0316 Janua~ 28,2012- Februa~ 27,2012 Page 3 of 4 Posting Transection Reference Number Amount Date Dete 02/23 02/23 02/27 02/27 LATE PAYMENT FEE PURCHASE *FINANCE CHARGE* 01/30 01/27 CAPCO CRANE & HOIS ROWLEY MA 24224432028101003615381 01/30 01/27 THE HOME DEPOT 6215 WATERFORD CT 24610432028010179741008 59.33,~/ 02/16 02/14 STAPLES 00101873 NEW LONDON CT 24164072046105112219542 ~, 02/24 02/23 BestBuy 00005496 WATERFORD CT 24399002054295070330614 ~00150,,~76,/ 02/27 02/23 THE HOME DEPOT 6215 WATERFORD CT 24610432055010179829882 02/09 02/08 SAFELITE AUTOGLASS 614-210-9186 OH 24493982039026640179340 273,20/ Your Annual Percentage Rate (APR) is the annuallnterest rate on your account. Annual Percentage Rate PURCHASES Balance Subject to Interest Rate 8.24% V $1,546.97 Finance Charges by Transaction Type $10.83 CASH 19.99% V $0.00 V = Vadable Rate (rate may vary), Promotional Balance = APR forlimited time on specified transactions. $000 You are e 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 48O2 6100 9990 0316 February ~8, 2012 - March 27, 2012 Page 3 of 4 Posting Transec~on Date Date Dasufi, otion Reference Number Amount FISHERS ISLAND FERRY DST Account Number: 0310 Payments and Other Credits 03/19 03/18 PAYMENT RECEIVED -- THANK YOU 0787~78625 - 1,091 03 . TO~T_A.L_ I~_YMENTS AND OTHER CREDITS FOR THIS PERIOD '$1,091.03 Finance Charge 03/27 03/27 PURCHASE 'FINANCE CHARGE' 32.08 TOTAL FINANCE CHARGE FOR THIS PERIOD $32 03 EASTER, MARK Account Numhec 9728 02/29 02/28 02/29 02/28 02/29 02/28 03/05 03/O2 03/o9 ....~ ~-o-~- o3~- ~ 03/10 ~13 o-3/12 03/16 03/15 O3/23 03/22 Purchases and Other Charges DEFENDER INDUSTRIES,INC. WATERFORD CT DEFENDER INDUSTRIES INC 800-435-7180 CT~ DEFENDER INDUSTRIES INC 800-435.7180 CT/· THE HOME DEPOT 6215 WATERFORD CT DEFENDER INDUSTRIES,INC. WATERFORD CT MS ·Microsoft Store 877~96-7786 ~ MS 'Microsoft Store 877.696-77~;u~ wA __ DATA MANP~MFNT INC 325.223-95(30 TX DATA MANEGEMENT INC 325.223-9500 TX HAMILTON MARINE SEARSPOR SEARSPORT ME TOTAL PURCHASES AND OTHER CHARGES FOR THIS PERIOD 24610432059004104010425 24610432059004000169440 24610432059004000169457 24610432063010180081499 24610432068004t t~,Eit~7~q 2469216206~00212022346 24692162070000518674904 2.44939~2079~74994~3207 247330920822(X)299300085 362.32~ 155.29 .~ 117.88 18.49 .t,, 212.69 11g.17 V $2,725:1q SCHMID, NINA Account Number: 7724 03/06 03/05 n-4/n7 -'"~/06 ~ 03/~ O3/12 03/10 03/19 03/16 Purchases and Other Charges CDW GOVERNMENT 8004~0-4259 IL ~ .In~l I~Cl3~T¢3R -=~-~ ~.~;--;~7~. ~'~. ' ' ~ S~-A P L E S 00101873 NEW L D~Tt,.- PITNEYBOWES-POSTAGE 800-468-8454 CT -- TOTAL PURCHASES AND OTHER CHARGES FOR THIS PERIOD 24391212076985(350012672 1,007,50~ 127.58 I,'~ ~i 100.00 I/ $1,396.~3 YourAnnuat PurcentageRate (/U~R) ~ theannuatintelt~strateonyour account. Annual Percentage Rate Balance Subject to Interest Rate Finance Charges by Transactio~ Type PURCHASES 8.24% V $4,898.01 CASH 19.99% V $0.00 V -- Vedable Rate (rate may vary). Promotional Balance = APR for limited t~me on specified transactions. $~.08 ~.~ Envirmmental sustainabillty continues to be an iasue of critical Importance to Bank of America and those we serve. As part of that commitment, did you know that we: · Announced in 2010 an ambitious new goal to reduce our absolute greenhouse gas (GHG) emissions by 15 percent over the 2010 baseline by 2015. This goal spans all of the company's global operations in more than 40 countries AUG-8-2012 01:19P FROM:DATA MGMT INC. 3252239184 TO:916317885523 TlmeCIoc, k PlusTM · by Data Managemeflt, Inc. 3'322 Loop 306, San Angelo, TX 76904 325 2.23-9500 ~ 3,~5 ~3-~1~ .:_. The Rshe~ Islam Fern/Dlltflct Dabble DoucoLte (931) 768.7463 5 Wator St Ff~t PARK New London, CT 06320-6310 :~ee332 85,35 I 03/t2/2012 I::)^1D 03/12/2012 Debbie DouC,~l~ (~31) 78~7463 [ 5 Water St Fret PARK , New Lmdon, CT 06320.6310 [~::i.~.;~:..IT~.?;:.--::I~,.~, W~'~ ? ', '~' .::."~..'!:...::.:: :i~..' :' !~": i::: ~.or~,~;i:= ::" :..: .:.. :::...'"::. ~ :~ '":'.'.:~: ":~- ~ ~Pi~nW~~ ,~ I .~.,A I B¥~.,A [Telephon(iActiValliOn [Vlsal~lS02...gT2eGxp04/2013 ,, ~:.~ -~ ..oki1~,.: .... ........... ___.~ ...... .,.~r~,~st%.. ~.:~<~,~ 99-100 Support Incident 49.00 49.00 Customer Invoice This is lhe ONLY invoice you will re{:eive. SubtOtal: 49.0( $ & H: O.O0 Total: 49.00 250 "H" Street, #510 Blaine, WA 98230 USA Phone: 1.800.667.1772 Fax: 1.800.550.8006 Emaih sales@idsuperstore.com Invoice [Invoice Date: 12'Mar'12 I order#i 31~ 10nllne Order #: ~ ~Custom~rlD#: 29817 Deb Doucette Fishers Island Ferry District 261 Trumball Ave Drawer H Fishers Island NY 06390 I United States Contact Number:I Ship TO: Nina Schmid Fishers Island Ferry 261 Trumball Ave Drawer H Fishers Island NY 06390 United States 631 788 7463 Contact Number:[ 631 788 7463 Terms: PrePaid [ pO~ Payment M~thod: Vis~ 1 Last 4 digits: 7724 Shipped via: UP~ Groued I Tracking info: 1z79255w03575~6475 SKU DESCRIPTION ORDERED1 SHIPPED P~AL 800015-440 Zebra Y~CKO F~li Color Ribbon with Resin ElacR Panel ~ 200I 1 ! 1 I $7{~9500 $7i 195 prints/rD Subtotal $71.95 Shipping ~ $9.95 Discounts sa ance ~in~ · $0.00 Thank you for your order. Please reference order number on remittance and all correspondence. BankofAmerica FISHERS ISLAND FERRY DST ~ 0316 March 28, 2012- April 27, 2012 e3of4 Date Defe Desc~pSon Reference Number Amo~,,~ FISHERS ISLAND F--;<;~y DST Account Nmnber: 0316 Pey.,,,=,~i. and Other Credits ~. , 04/02 04/01 PAYMENT RECEIVED - THANK YOU 09274405350000501792391 - 1,065.02 ............... '41,065.02 04/2? 04/27 33.32 EASTER, MARK $33 TOTAL PAYMENTS AND OTHER CREDITS FOR THIS PER OD Finance Charge PURCHASE'FINANCE CHARGE* TOTAL FINANCE CHARGE FOR THIS PERIOD Account Number:9720 Purchases and other Charges 04/05 04/04 DEFENDER INDUSTRIES,INC, WATERFORD CT 04/09 04/05 DIESEL SPECIALISTS MOTO 225-9281913 LA 04/16 04/13 SAMTAN ENGINEERING CORP 781-3227880 MA SCHMID, NINA TOTAL PURCHASES AND OTHER CHARGES FOR THIS PERIOD Account Number: 7724 04/24 24610432095004101152895 24639232097900010100090 24418002105105061911007 18.66 210.41 7700 $306.u/ ~ Pa~,,*=ii;=. and Other Credits ' -- 04/21 IDSUPERSTOR "n"~?-Ti 772 W~'. . __7449215211 ........ . TOTAL PAYMENTS AND OTHER CREDITS FOR THIS PERIOD --~. ~ ,:o~,~4z/z13472 - 70.00 P~ch~e$ and Othm;Char9e~ ................... 4_70_.0_0 04/24 TARGET,COM ° 877-848-4483 MN 24431062115083042553740 2,218 12 TOTAL PURCHASES AND OTHER CHARGES FOR THIS PERIOD Your Annual Percentage Rate (APR) is the annual interest rate on your account. Annual Balance Subje¢l Percentage Rate to Interest Rate CASH 19.99% V $0.00 V = Va#able Rate (rate may vary). Promo~onal Balance = APR for limited time on speci~ed trancec~ons. Finance Charges by Transaction Type $33.32 $0.00 250 "H" Street, #510 Blaine, WA 98230 USA Phone: 1.800.667.1772 Fax: 1.800.550.8006 Email: sales@idsuperstore.com Invoice Billed To: Deb Doucette Fishers island Ferry District 261 Trumball Ave Drawer H Fishers Island NY 06390 United States Contact Number:l 631 788 7463 1 Online Order #: 33768 ~ Customer iD #: 29817 J Ship To: Nina Schmid Fishers Island Ferry 261 TrumbalJ Ave Drawer H Fishers Island NY 06390 United States !Contact Number:! 631 788 7463 Term~:i pt~PaiCl [po~ Payment M~hed~ Visaill iI Last 4 digits: Shipped via: Ground J Tracking Info: l Z79255W0357389025 SKU DESCRIPTION ORDERED SHIPPED PRICE TOTAL ~800015-940 Zebra YMCKO 5 Panel Color Ribbon with 1 Resin Black 1 I i ~010000 J Panel - 200 prints/roll Returned (1) 800015-940: Zebra YMCKO 5 Panel Color Ribbon jI j 1 I ($70.0000) [ 'with 1 Resin Black Panel - 200 prints/roll iaSubt°tal J $0'00 ~ipping J $9.95 iscounts J C oral J $9.95 lance ~ing J $0.00 Comments Tmnsacti0n IDi 8RG222898U~48384B P~ymem Type: Credit Card (WPP) Timestm'np: 2012-03-06T15:57:10Z Payment Status: Authorization AVS Code: ZCVV2 Code: MAmount: 79.95 USD Thank you for your order. Please reference order number on remittance and all correspondence. · BankOf America Business Card Account Infon~ation: www. pankof~mence.oum Mail Billing Inquiries to: BANK OF AMERICA PO BOX 982238 EL PASO, TX 7999~2238 Mail Payments to: BUSINESS CARD PO BOX 15796 WILMINGTON, DE 19886-5796 Customer Service: 1.800,673,1044, 24 Hours FISHERS ISLAND FERRY DST Apdl 28, 2012- May 27, 20t 2 New Balance TOtal .................................... $9,106.75 Past Due Amount .......................................... $99.14 Mtn~ Payment Due ............................ $290,S2 Payment D~e Date .................................... g~/21112 Minimum Payment Warning: If you make only the minimum payment each para)d, you wilt pay more in interest and it will take you Iong,a' to pay off your balance. TrY Nearing Impaired: 1.888.500.6267, 24 Hours Outside the U.S.: 1.509.353.6656, 24 Hours For Lest or Stolen Cartl: 1.800.673.1044, 24 Hours Business O~fers: www.bankofamenCa.ourn/mybusinessceoter Company Statement Previous Balance ..................................... S6,615.53 Payments and Other Cred~ ........................... $0.00 Balance Transfer Activity ................................ $0.00 Cash Advance Activity .................................... $0.00 Pumbaess and Other Charges ................ $2,355.09 Fees Charged .............................................. $84,001 Finance Charge ........................................... $52,13 New Balance Total .................................. $9,106,75 Credit Limit ....................................... . ..~...... $~0,000 Credit Available ................................. ~_.,. $893.25 Statement Closing Date ............................. 05/27/12 Days in Billing Cyole ............................................ 30 Account Number Cre~t Urn# Total Activ~ Credits AOt~ EA~ r:~ MARK 10,000 1,507.89 0.00 0.(30 ScH~T0,~A .................. ~1~7724 10,000 882.2O 0.00 0.00 Purcheess and OUter AC~ Char~s Fees Chef, ecl 0.00 1,472.89 35.00 Bank of America FISHERS ISLAND FERRY DST Alxi128, 2012 - May 27 20!2 e3of4 Data Date Desc#pbon FI~;F.~$ ISLAND ;~.;~..y DST Accmmt Numbe~. 0315 F~es 05/24 05/24 Reference Numbar Amou,,~ LATE PAYMENT FEE TOTAL FEES FOR THIS PERIOD Finance Charge 05/25 05/25 PURCHASE 'FINANCE CHARGE* TOTAL FINANCE CHARGE FOR THIS PERIOD Account Number:. 9726 ~ Purchases and Other Chmrn.,~ ~07~-~05~ NORTON 'SOFTWARE ' NORTON.COM/NSCA 05/10 05~9 DEFENDER INDUSTRIES,iNC. WATERFORD CT 52,13 246921621250004348801 ~7 24610432130004104147816 05/11 05/09 THE HOME DEPOT 6215 WATERFORD CT 24610432131010183577236 O5/21 05/18 LOWES #02263* WATERFORD CT 24892162139000250954554 350.78 05/23 05/22 Best BW 00005496 WATERFORD CT 24399002143295070752513 42.53 05~25 0=----------------~24 DEFENDER INDUSTRIES,INC. WATERFORD CT 24610432145004108174801 44752 TOTAL PURCHASES AND OTHER CHARGES FOR THIS PERIOD Fees Charged ................. $1,~7_2_.8~9 05/01 05/01 ANNUAL MEMBERSHIP FEE TOTAL FEES FOR THIS PERIOD 35.00 SCHMID, NINA $3~ ~':'- Account Nmnber: 7724 Purchases and Other C:.,it~:~ , 0~ 04~27 PITNEYBOWES.POSTAGE 800-468-84S4 CT 24391212'[18985050000875 100.00 ~14 NORTON *ANNUAL RENEWAL 877-294-5265C'A----'~ 24692162135000155909798 ~-"~R--~'~ h I ~.~5/21 0~_.18 WORLDWIDETICK~T - 954-4262~?rj~FFL o'~zz o5/21 SIGNARAMA NE~"'V~ mu.~N OT , 24431 u~,z 13~zu~e~zouo~ _ 2473309214;~2L~339500066 53.18 / 05/25 05/23 SEARS ROEBUC INTERNET 800-876-5543 TX 24387752145004038281'[32 31.24 / TOTAL PURCHASES AND OTHER CHARGES FOR THIS PERJOD $882.20 Y°~AnnuMPercentegeRate(APR)mtheannuali~estrateonyouraccou~, Annual Percentage Rate PURCHASES 8.24% V Balance Subject to Interest Rate Finance Charges by Transaction Type $52.13 CASH 19.99% V $0.00 V = Va~fable Rate (rata rney vary), PromotionaIBalance = APR for ~mited Umw on specified transa~#ons. $0.00 already mailed it, thank you. want y~u to know that w~ received your current payT~eflt due. ~fld your Paymeflt due today. If you have Page 1 of 3 J~[~ TO help protedc your privacy, links to images, sounds, or other external content in this message have been blo~ed. Cli~k here to unblock content. J Miller From: Symantec CorpomtJon [ordem~mail.florton.com] TO: 3 Hiller Cc: Subject: Norton Store - Order Confirmation For Order #NP133695295 Attachments: Sent: 1t~u 8/23/2012 3:23 PM This is an automated message. Please do not reply. Dear Mark Easter, Thank you for ordering from the Symantec Store. v~ hope that you had a pleasant shopping experience. Below is a summary of the order that we are currently processing for you. Please retain this email as your proof of purchase. If you paid by credit card, please look on your credit card billing statement. For any further questions cancaming your Symantec Store order, please visit Symantec Customer Service Centre Siecemly, Custome~ Service Symantec Store Order Details / Invoice OrderNumper NP133695295 Order Date May 4, 2012 Billing & Shipping Details Billing Infomtation Mark Easter 5 Waterfront Park Fishers Island Feny District New London, CT 06320 United States Payment Method Mark Easter VISA xxxxxxxxxxxx9726 Product Description Norton 360TM Vemlon 6.0 1 year protection for up to 3 PCs Product Key TB9XK76PRCMR7BCXQWFYC2R3J Serial number: H87QT87TRXH8 If you have a Norton Product already installed and are having trouble installing your new purchase pfck one of the following help topics for assistance My Nor(on product doesn't install after startinq the Download Operating System Delivery Qty Price W~ndows 7 / XP / XP Pro / Vista I $ 69.99 http://mail.fiferry.com/exchange/j miller/Inbox/Norton%20Store%20-%20Orde~fi20Confir... 8/23/2012 Page 2 of 3 **No acgon is required at this time.** Thank you for purchasing Norton Virus Removal Assurance This purchase entities you to cell our Virus Removal agents in the event that your computer is or becomes infected with a virus or spyware at any time during the subscription period Keep these instructions in case you need to redeem this if you believe your computer is infected with a virus or spyware, follow these instructions to speak with an expe~t: Have your order number ready to provide to the NortonLive Expert Call 877 327 7358 Go to help norton corn and enter the 6 digit code provided by your NortonLive Expert PLEASE NOTE: This service and its agents are not available to answer general suppor[ questions or provide technical suppo~ for issues not related to a virus or spyware infection. Technical support for all issues other than the specific removal ora virus or spyware should be initiated through our free technical suppo~ at This service is available 24 hours a day, 7 days a week (this service is only available for computers with the corresponding active Norton product installed). Tax $ 0.67 $ 67.65 Your Norton Account This order was placed using your Norton Account email address - cgilbert~fiferTy.net. However, the password provided at the time of purchase did not match our records. To save this order in your Norton Account, please visit:www.myNodonAccount com. Once saved, you will be able to view and manage your products including any Automatic Renewal seffings, To sign in, use your email address: cgilbert~fifer~y.net Norton Automatic Renewal Service · Norton 360TM Version 6.0 With your purchase today, you enrolled in the Norton Automatic Renewal Service for the product subscription(s) listed above. The Norton Automatic Renewal Service helps keep your computer protected against the latest Intemet threats and dsks by renewing your product subscription(s) automatically. By enrolling in the Norton Automatic Renewal Service, you authorize Symantec to automatically charge the then current renewal subscription foe (plus applicable taxes) to your credit or debit card pdor to expiration of your product subscription. You will receive a pre-billing notification by email shortly before your subscription expires and before any payment is billed to alert you that your product subscription will be automatically renewed. You may cancel your enrollment at any time by visiting www myNortonAccount com or contacting Cus~)mer Support, However, cancelling may leave your computer at dsk of becoming unprotected from the latest security throats unless you remember to follow the prompts displayed by your Norton product to renew your Norton product subscription. http://mail.fi ferry.com/exchange/j miller/Inbox/Norton%20 Store%20-%20Order%20Confir... 8/23/2012 Page 3 of 3 Tax Dtsclo~me Symantec Corporation 350 Ellis Street, Mountain View, CA 94043 USA FBN: 77A)181864 Canadian GST #: 12801 3208 RT0001; QST # 1211858032 Rebates Rebates are valid in US & Canada only. For mom information conceming rebates, please visit hi[p ,,w ~v~; ~ym~r ~[ec.~ll~4 =~[c~ For all other questions or assistance related to this o~der, please visit Symantec Custorller Service at http//www norton corn/cs Make sure that our ema!l elld up ill yOLIf inbox and nol itl your bulk or iurlk folders by simply adding orders(~mail norion (:om to your efllail address book or trusted-sender ist 0 0 0 http ://mail.fi ferry.com/cxchangc/j miller/Inbox/Norton ¼20Store ¼20- ¥o20Ordc¢/o20Confir.** 8/23/2012 Page 1 of 2 O To help protect your pdvacy, to unb ock content. 3 Hiller From: To: Cc: Subject: Attachments: Norton Renewals [noreply_subscriptJons~su bscdptions.norton.com] 3 Miller links to images, sounds, or other external content in this message have been blocked. Click here Sent: Thu 8/23/2012 3:23 PM Your Norton 360'" subscription has been renewed - renewal price enclosed Thank You for Choosing Norton Your Automatic Renewal Status Your subscription to Norton 360TM was renewed on May 14, 2012 and your subscription extension is being processed. We are pleased to inform you that your Norton 360TM subscription has been renewed and your subscription extension is being processed. We appreciate your business and are happy to safeguard your personal data, your family and your computer for another year. Your credit card listed below was automatically charged USD 86.89 on May 14, 2012 for another year of protection. MY NORTON BILENG INFORMATION Order Number: AP134641819 Name: THOMAS DOHERTY~¢__.__.~, Card Ending In: 7724 /~ ~ ,~ Amount Charged: USE[86.89~.~ Product serial number :'~ 2946HWQYWRWH Please note, subscription renewals purchased through the Norton Automatic Renewal Service may be returned within 60 days of purchase.* Key Benefits of Automatic Renewal Service: · Peace of Mind - Don't worry about your subscription expiring. Your PC stays protected with Norton, the world leader in security. · Time Savings - Save time and effort with one less thing to-do. · Convenience - Continue to receive FREE protection updates and new versions with your product subscription. Get the latest version now. As a valued Norton Automatic Renewal customer, you will never have to worry about there being a lapse in your protection. Over the next year Norton will work hard to protect you and your family and continue to give you peace of mind. Norton Account I Norton Support I Privacy Policy I Update Your BiltinR Profile * Norton products, including subscripbsn renewals purchased through t~e Norton Automatic Renewal Sennce, may be rofumed w~tfun 60 days of the purchase date. Shipping, handling, and applicable taxes are refunded on eligible returns. For full details on our Return Policy, click here, To request a refund, please contact Customer Service at one of the telephone numbers listed below. You can verify yo~r subscription by signing in to your Norton Account at www myNorlonAccou nt. com or by viewing the subscription status in your product If the product subscription status is not up to date, please click here and follow the instpact~3ns tf you wish to cancel your enrollment in the Norton Automatic Renewal Senrice for future renewals of this product subscription, please sign-in to your Norton Account at www.myNortonAccou nt corn and turn off the auto*renewal feature. For detailed instructions click her__e. 0 0 0 0 0 http://ma~ferry~c~m/exchang~/jmi~er/Inb~ x/Y~ur%2~N~rt~n ¼2~36~ ¥~E2 ~84 ~A2 ~2~ 8/23/2012 Page 2 of 2 Automatic Renewal Service, please note that if your billing address changes after you receive a renewal notification by email and before final billing, the price, tax and currency may be affected depending on your updated billing profile http://mail.fi ferry.com/exchange/j miller/Inbox/You~/o20Norton%20360%E2%84%A2%20... 8/23/2012 3606 Quantum Blvd. Boynton Beach, FL 33426 Tol! free: 877-426-5754 www.worldwid eticketcraft.com PLEASE REMIT U.S.$ FUNDS DRAWN ON A U.S. BANK TO: Worldwide TIcketcreft 3606 Quantum Blvd. Boynton Beach, FL 33426 Invoice DATE INVOICE # 6/8/2012 43363 BILL TO Fishers Island Ferry 261 Trumbull Drive Fishers Island, NY 06390 P.O. NUMBER SHIP TO Fishers Island Ferry 261 Tmmbull Drive Fishers Island, NY 06390 F.O.B. TERMS REP Prepaid TC-... SHIP VIA 6/4/2012 UPS Digitik Boynton Beach IPROJECT 6/4/12 QUANTITY ITEM CODE DESCRIPTION PRICE EACH AMOUNT 1,000 0.995 995.00 Compu-Tik Shipping/Handling Shipping/Handli... 32.44 32.44 Did you know we sell and repair thermal ttcket printers? Please call 877-$26-$?$4 for more info. Thank you for your business Total $!,027.44 I.,Attachmentscan contain viruses that harm computer. Attachments may not display correctly. may your The sender of this message has mcluested a read receipt. Click here to send a receipt, Page 1 of 1 J Miller From: Gerry Covitz [gerryc@wwtJcket.com] To: I MJller Cc: Subject: Invoice from Worldwide ~cketcrarc Attachments: j Inv 43363 from Worldwide Tickets And Labeis Inc. S:[2.odf(129KB~ Sent: Thu 8/23/2012 3:07 PM Dear Customer: Your invoice is attached as requested, Thank you for your business - we appreciate it very much. Sincerely, Gerry Covitz Worldwide Ticketcraft Worldwide TJcketcraft O O 0 http://mail.fi ferry.com/exchange/j miller/Inbox/Invoice ~A20fi'om ~20Worldwide ¼20Ticket... 8/23/2012 Bank of America FISHERS ISLAND FERRY DST 4802 6100 9990 0318 May 28, 2012- June 27, 2012 3of4 Date Oete DescrfptJon Reference Nureber Amount 0~27 ~/27 Im,,~HEP~ ISLAND rgr~k~' DST Accou~ Namtber: 0316 LATE PAYMENT FEE TOTAL FEES FOR THIS PERIOD Finance Charge PURCHASE 'FINANCE CHARGE* TOTAL FINANCE CHAROE FOR THIS PERIOD 49.OO ..................... $49.00 66.92 See n~ Account Numbe~. 9726 O6/O7 O6/O6 06/15 06/14 00/06 OO/0d 06/07 06/06 SCItMID, NINA LOWES #02263' WATERFORD CT HAMILTON MARINE SEARSPOR SEARSPORT ME TOTAL PAYMENTS AND OTHER CREDITS FOR THIS PERIOD Purchases and O~her Charges THE HOME DEPOT 6215 WATERFORD CT LOWES f~2263' WATERFORD CT TOTAL PURCHASES AND OTHER CHARGES FOR THIS PERIOD 74692162158000485572404 7473,3092166200299300865 24610432157010182922010 24692162158000485571856 - 25.68 -$298,49 48.07 155.16 1~ $203 ?a A~4mt Number: 7724 O6/~$ 06/14 P&yTF, C-,-,~ and Other Credits CLOUDMARK SPAMNET 4155431220 CA TOTAL PAYMENTS AND OTHER CREDITS FOR THIS PERIOD O6/O5 06/18 06122 06/21 PUmhases end Other Charges CLOUDMARK SPAMNET 415.543-1220 CA WORLDWIDE TICKET 954-426-5754 FL PITNEYBOWES.POSTA-G~ ' 800-468-8454 CT BARCO PRODUCTS 800-338-2697 IL TOTAL PURCHASES AND OTHER CHARQES FOR THIS PERIOD 74493962166200588000343 - 19.95 ,/ ........... -$19.95 24391212170985050018104 100,00 ,/ 241 1 03921 7381 6001582814 170.30 $817.69 Your Annual Percentage Rate (APR) is the annual Interest rate on your account. Annual Balance Subject ...... Percentage Rate to Interest Rate l~R C;FIA~E~ .... 8.24% V $9,560.33 CASH 19.99% V $0.OO V = Vadeb/e Rate (rate may very), Pmrriogonal Balance = APR for limited Ume on specilled transacUons. Finance Charges by Transaction Type $66,92 Thank you for being a vak~cl customer. Perhaps it is an ovef~ght; however, we have not received your payment. Please make your payment today, ff you have already made the payment, thank y~J. 3606 Quantum Blvd. Boynton Beach, FI. 33426 Toll free: 877-426-5754 www.worldwideticketcmft.com BILL TO Fishers Island Ferry 261 Trumbull Drive Fishers Island, NY 06390 Invoice DATE I INVOICE 6/8/2012 43363 SHIP TO Fishers Island Ferry 261 Tmmbull Drive Fishers Island, NY 06390 P.O. NUMBER iERMS REP SHIP I VIA Prepaid TC-... 6~/2012I UPS QUAN~iY 1,000 ITEM CODE Digitik Shipping/Handli... Compu-Tik Shipping/Handling DESCRIPTION F.O.B. I PROJECT Boynton Beach 6/4/12 PRICE EACF AMOUNT 0.995 995.00 32.44 32.44 Did you know we sell and repair thermal ticket printers? Please call 877-426-$754 for more info. Thank you for your business Total $1,027.44 Bank of America Business Card Account Information: www.bankofamerios.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 800673 1044, 24 Hours TTY Hearing Impaired: 1.888.500.6267, 24 Hours Outside the U,S,: 1.509353.6656, 24 Hours FISHERS ISLAND FERRY DST ~0316 June 28, 2012 - July 27,2012 Company Statement New Balance Total .................................. $6,382.64 Minimum Payment Due ............................$112.50 Payment Due Date .................................... 08/23/12 Minimum Payment Warning: If you make only the minimum payment each period, you will pay more in interest and it will take you longer to pay off your batance, Previous Balance ..................................... $9,933.15 Payments and Other Credits .................. -$3,702.4& Balance Transfer Activity .............................. SQ00 Cash Advance Activity .................................... $0.00 Purchases and Other Charges ................... $100.00 Fees Charged ................................................ $0.00 Finance Charge ........................................... $41.91 New Balance Total ................................ $6,382,64 Credit Limit ............................................... $10,000 Credit Available ................................. $3,617.36 Statement Closing Date ............................. 07/27/12 Days in Billing Cycle ........................................ 30 For Lost or Stolen Card: 1.800.673.1044, 24 Hours Business Offers: www.bankofamerios,ccm/mybusinasscenter OVERDRAFT PROTECTION What You Should Know: If your chscking account was opened in Idaho or Washington and is linked to this credit card for Overdraft Protection, we'll now transfer money in $100 increments (previously $25), Overdraft Protection is an optional service that you can cancel at any time. Anmndment to your Business Card Agreement: Effective August 18, 2012~ the Overdraft Protection section of your Agreement is amended by deleting the phrase "$25 if you opened your checking account in Washington or idaho". [CUSTOME~TATEMEN'r OF DISPtJTED ITEM (You rnus~ ~se a separate forte for eaoh dispute: Please print:~ O3 If you believe a transaction on your statement is an error, complete and sign a copy of this form using blue or black ink, or write a detailed letter on a separate sheet of paper. Then return it to: PO BOX 53101. PHOENIX. AZ 85072-3101 no iater than 60 days after we sent you the first bill on which the transaction or error appeared. If you prefer to speak with a representative about your dispute, please call 1.866,601.44'10, 8am-3pm Est. You do not have to pay any amount in question while we are investigating, but you are obligated to pay the palls 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 is in error. Check one box only. I J 1, I certify that I do not recognize the transaction. I have attempted to contact the merchant to verify this transaction. r~ 2. I certify that the charge listed above was not made by me or a person authorized b~,me to use my card, nor were the goods or services represented by the transaction received by rna or authorized by me. L~ 3 Although I did engage in a transaction with this merchant, I was billed for transaetion(s) totaling $ that I did not engage in. I have my card in my possession. If available, enclose a copy of the sales slip for the valid charge. i ~ 4. I have not received the merchandise that w-as to be shipped to me on / / (MM/DD/YY). I have asked the merchant to credit my account. ] 5. Merchandise shipped to me was not as described. Please explain in detail and if applicable provide proof of return. ~r;.7. Alth~l 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 adjustment. 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 cancel[ation: 9. Although I did engage in the above transaction, I have contacted the merchant for credit. The services to be provided on / 1 (MM/DD/YY) ~ere not received. Please describe the services to be received and explain the merchants failure to provide the services. I ~' 10, I was issued a credit slip that was not show~ on my statement. A copy of my credit slip is enclosed. If the merchant has 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 __/ /.~(MM/DD/YY) and asked the merchant to credit to your account. credit my account, Please orovide oroof of return and describe how the [ ~ 11. The amount of the charge was increased from $ to merchandise was damaged and/or defective. $ or my sa~es 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 statement, 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 S~DES OF THIS STATEMENT FOR YOUR RECORDS PA YMENTS We credit a payment as of the date we receive it if the payment is: 1) received by 5:00 p.m, (Eastern 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. financial Institution or a U.S, dollar money order, 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 requirements, 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 draw. in U.S, dollars and those dram 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 send a wriffen inquiPJ 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 · Bank of America FISHERS ISLAND FERRY DST ~1'0316 June 28, 2012 - July 27, 2012 Page 3 of 4 Account Number Crocit Umit Total Activit2/ SCHMID, NINA Payments and Other Balance Transfer Cash Advance Credits Activity Activity Purchases and Other Charge~ Eee~ Char~jed 100.00 0.00 0.00 0.00 100.00 0.00 Posbhg Transaction Date Date Description FISHERS ISLAND FERRY DST Account Number: 0316 Reference Number Amount 07/12 07/12 07/27 07/27 Payments and Other Credits PAYMENT RECEIVED -- THAN K YOU 19474405350000500733914 - 3,702.48 TOTAL PAYMENTS AND OTHER CREDITS FOR THIS PERIOD -$3,702.48 Finance Charge PURCHASE *FINANCE CHARGE* 51.97 TOTAL FINANCE CHARGE FOR THIS PERIOD $$1,97 SCHMID, NINA Account Number: 7724 07/18 07/17 Purchases and Other Charges PITNEYBOWES-POSTAGE 800-468-8454 CT TOTAL PURCHASES AND OTHER CHARGES FOR THIS PERIOD 24391212199985050001354 100.00 $100.00 Your Annual Percentage Rate (APR) is the annual interest rate on your account, Annual Percentage Rate Balance Subject to Interest Rate Finance Charges by Transaction Type PURCHASES 8.24% v $7,671.99 CASH 19.99% V $0.00 V = Variable Rate (rate may vary), Promotional Balance = APR for limrted brae on specified transactions. $51,97 $0.00 Bank of America FISHERS ISLAND FERRY DST 4802 6"r~O 9~30~0~1~ao June 28, 2012 - July 27, 2012 Page 4 of 4 O0 FISHERS 1SLAND FERRY DISTRICT VENDOR 005440 EMPIRE HEALTHCHOICE, INC. 09/11/2012 CHECK 689 FUND & ACCOUNT P,O,# INVOICE DESCRIPTION SM .9060.8.000.000 SM .9060.8.000.000 598599-1-9/12 598599-2-9/12 VISION-SUB GRP 1-9/12 VISION-SUB GRP 2-9/12 TOTAL .~d~OLrST 26.25 7.50 33,75 /11/12 AUDIT CHECK NO, 689 J 533.75 TH£ ORDER OF PO NEWARK NJ 0<7{0~1~4~4~ ~'O5)OF=~,q,' ':OEI, t, OSL,~,L,.: ~:t5 O0~.50E ~,' Vendor No. Town of Southold, New York - Payment Voucher 5440 Vendor Tax ID Number or Secial Security Number P.O. Box 11744 Newark, NJ 07101-4744 Check No. Entered by Audit Date Empire HealthCholce Assurance, Inc. Vendor Telephone Number 866422-25583 Vendor Contact SEP 1 1 ,n~, Town Clerk .... Invoice Number 598599 598599 Date 81t 112012 - 811112012 Invoice Net Total Discount Amount Claimed $26.25 $26.25 $7.50 $7.50 Purchase Order Number Description of Goods or Services Sept 1-Oct 1 Vision sub ~lrp t Sept l-Oct 1 Vision sub Grp 2 General Ledl~er Fund and Account Number 8M9060.8.000.000 SM9060.8.000.000 $33.76 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 Company Name Da /r ~. Department Certification I hereby certify that the materials above specified have been received by me in good condition without substitution, the services properly per~'ormed and that thc quantities thereof have been verified with the exceptions or discrepancies noted, and payment is approved COMMUN'rTy RATED ~ROUP NUMBER SUB GRP. S98S99 1 ~ILLIND TYPE REGULAR BILL BILLING FREQUENCY HONTHLY :BENEFITS CONSULTANT COMMERCI~AL ACCTS DATE BILLED 08/11/12 BILLED PERIOD 09/01/12 10/01/1:~ PAYMENT DUE DATE 09/01/12 PAGE: I THE PREMIUM BILLED IS SUBJECT TO I CHANGE UNDER APPLICABLE LAW I I FOR BILLINGINFORMA~ON: (866)422-2583 GORDON MURPHY FISHERS ISLAND FERRY DISTRICT PO BOX H FISHERS ISLE, NY 06390 PRIOR BILLING PERIOD PRIOR AMOUNT BILLED PAYMENTS I RECEIVED DATE STATUS CURRENT BILLING PERIOD CURRENT AMOUNT BILLED NET ADJUSTMENTS CURRENT DUE ] 09/01/12 - 10/01/12 26.25 0.00 26.25 THXS INVOICE REFLECTS ALL PAYHENTS AND ADJUSTNENTS PROCESSED THROUGH 08/11/12. ANY ADJUSTHENTS PROCESSED AFTER THZS DATE HZLL BE REFLECTED ON A SUBSEQUENT ZNVO~CE. PLEASE SEE THE REVERSE SZDE OF TH~S PAGE FOR HORE XHPORTANT NOT~CESo To receive proper crecht, please return tl~e BOTTOM PORTION of this page with your payment. NOTICE; AS requirecl by La,or Law, Section 217, Insurance Law, Sechon 4235 and Co(les, 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, su~cribers and their covered depondent~ shall he afforded the ~Ollowing rights under the terminating pOliCy: f. Any ctalms incurred during the effective dates of th~ group contract will ~e processed and adjudicated in accordance with the forms, corKhtions and provisions of said group contract. 2. Adddional henefits heyond the termination date of the contract may ~e available under the terminbtion contract for conditions which result in a total disability, pursuant to the terns;, conditions alii provisions of the terminating group contract. 3. Rights to convert to a direct pay contract i0etween Emf~re HealthCheice Assurance, loc. and the covered memher, subscriher or cerh/mate holcler, providing for coverage which Is currently offered a direct pay basis, may he available provided the group does not obtain replacement coverage. B. Further, as reqmred by the provisions cited above, you, as the palicyholder, may 10e required [o meat the following obligations: 1. The policyholder, must give written not,ce of the intended termination to each certificate holder resident in New York State insured un,er this group policy by hand-delivering of mailing to the certificate holder a copy of the notice of termination and covering loiter advising the certificate holders of the intencled termination. 2. The pahcyholder's notice to the certificate holder shall be e~ther: a) hanct-41elivered by the pohcyhOlder to the certificate holder at the certificate holder's place et employment (e.g. by inctucling the notice in the certificate holcler's pay envelope) at least nir~ days prior to inten(~ed date of termination; or: b) mailed by the policyholder toleach certificate holder at the certificate holder's last known residential address at least rune days prior to the intenCled date of termination. 3. The policyholder must also pOst a copy of this notice of intent to terminate and the required coverillg letter in consp~cnous locations chosen as most likely to give not,ce to the cert~ficbte holders. The nobce shall he pOsted at least nine days pr~or to the ibtended date of termination. 4. In accordance w~th the prows~ons of Lat)or Law, Section 217 (4), the provis~ons c~ the Codes, Rules and Regulations of the State of New York, Title 11, Insurance Section 55.2 and Labar Law, Section 217 (3) shall not 10e deemed to apply if, at least 10 days prior fo the date of the interlded termination, as specified in the notice of intent to terminate, the policyholder has: a) taken necessary step,s 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 ~or the same certificate holders, and filed an alfidavit with the Commissioner Of Labor and Superintendent of Insurance to t;qat elfect. Aff~lavlts filed with tile Commissioner of Labor shall refer to Labor Law, Section 217, and he acl~ressed to; Director of LaOor Stan~lar~ls-Oepartment of LaOor-Agency Builcling 12, State Off, ce Building Campus-Albany, New York, 12240. Affidavits tiled witl~ the Suparimen(tent of Insurance shaft refer to Laher Law, Section 217 and the Codes, Rules and Regulations of the State of New York, Title 11, insurance, Section 55.2 Part, and Shall be addressed to; Chief, Health an~l Life Policy Bureau New York Stale Insurance Department-Agency Butl~mg t-All, any, 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 ,4djustrnents Worksheet. Do NOT increase/n.'duce 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 AUTOMATICALI.Y BE CANCELLED as of the date to which premiums have been paid. Empire is not £maneially 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 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 1 Group Name: FISHERS ISLAND FERRY Bill Period: 09101/12 To 10/01/12 Payment Due Data: 09/01/12 Prepared Date: 08/11112 INDIVIDUAL DETAIL EXPLANATION OF CHANGE TYPE CODES: SUB iNDIVIDUAL'S ~ONT CHANGE INDIVIDUAL'S I~ME GRP IDENTIFICATION #O)KG IYPE TYPE ADJUSTMENT PERIOD AMOUNT DUE Empire HealthChctce Assurance, Znc · ARRETT FREOERZCK 88886607 O01 12 ~DD 09/01/12 0.00 88886607 001 12 TERN 09/01/12 0.00 BROgN DONALD 85377836 0011 15 ~,DD 09/01/12 - 10/01/12 2.50 BURKE STEPHEN G 8551573& 001 12 ~,DD 09/01/12 - 10/01/12 1.?.5 DOHERTY TNONAS 88240378 001 15 I~DD 09/01/12 - 10/01/12 2.50 EASTER HARK B 88955198 001 12 ~,DD 09/01/12 0.00 88955198 001 12 FERH 09/01/12 0.00 FORD POLLY 86564889 001 14 ~.DD 09/01/12 - 10/01/12 3.75 FORD POLLY C 86106301 001 14 ~,DD 09/01/].2 - 10/01/12 3.75 HXLLER JONATHAN X 84838644 001 12 ~DD 09/01/12 - 10/01/12 1.25 HOCH RXCHARD 88742559 001 22 ~,DO 09/01/12- 10/01/12 1.25 LEFEVRE RAYNOND 86638861 001 12 ~.DD 09/01/12 - 10/01/12 1.?.5 NARSHALL JESSE 89420041 001 15 %OD 09/01/12 - 10/01/12 2.50 NORGAN JOHN E 87023977 OOX 14 ADD 09/01/12 - 10/01/12 3.75 RXCKER KENNETH N 88006302 001 12 ADD 09/01/12 - 10/01/1; 1.?-5 SCHNXD NXNA 89633561 001 12 ADD 09/01/12 0.00 89633561 001 12 TERN 09/01/12 0.00 TRAUB JANES G 8?.517144 001 12 ADD 09/01/12 - 10/01/12 1.25 PAGE TOTAL: 26.25 TOTAL CURRENT ANOUNT PLUS CHANGES: 26.25 BALANCE DUE FRON PRTOR BZLL(S): 0.00 TOTAL AHOUNT DUE: 26.25 PAGE: Group Number: 598599 1 Group Name: FISHERS ISLAND FERRY Bill Period: 09/01/12 To 10/01/12 Payment Due Date: 09/01112 Prepared Date: 08/11112 PAGE: CONTRACT ! RATES I COUNTS SUMMARY GROUP / PACKAGE CONTRACT TYPE RATE COUNT 598599 I / 001 12 1.25 S 14 3.75 3 15 2.50 3 22 1.25 PACKAGE SUB TOTAL 12 GROUP TOTAL 12 PLEASE SEE REVERSE OF THZS PAGE FOR A SUHNARY OF COVERAGE DESCRZPTXONS CONTRACT TYPE TOTALS CONTRACT TYPE SZNGLE THO PERSON FANXLY GRAND TOTAL NO. OF CONTRACTS; 6 3 3 12 3 GROUP / PACKAGE DESCRXPTZON OF COVERAGE 598S99 I / 001 VXSXON PO Box 140~, Church Stre~ Station, Ne~ York, NY 1000~140'~ Member Change/Termination/Reinstatement Worksheet To be completed by employer lot Empire members. Group Name FISHERS ISLAND FERRY DISTRICT Name and Title Group Number 598599 S gnature Subdivisionl Date See reverse side for instructions. Do not return with your payment. Fax your completed worksheet to 1-800-780-1224. Or go to www.en~ireblue.com to process these transactions online. / / / / / / / / / / / / / / / / / / / / _ / / / / / / / / / / / / _ / / / / / / / / / / / / / / / / Member Chan e/Termination/Reinstatement Worksheet Instructions How 'I'o Complete The Worksheet Please print legibly in ballpoint pen. Fill in all fields that apply. COLUMN INSTRUCTIONS 1. Member Identification Number 2. Member Name 3. Member Address 4. Type Enter the member's identification number under which the member is covered. Enter the lull name: last name followed by fu'st name and middle initial. Enter the member's most current address. Enter the type of request. Member Request types include: C f Change T I Termination R = Reinstatement Please note: For change request~ you may only make changes to downgrade a contract O.e. change from family pohcy to single policy). For all other changes, please submit an application. 5. Reason Code Enter the reason code for the request. Reason codes include: D = Deceased LE = LeR 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 termination that is being requested. The effective date is the date of the termination or ~our ~roup's billin[g da~ in the month in which the termination occurred. How To Submit The Worksheet: Fax your competed worksheet to 1-800-780-1224. 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 'Employers' Tab 2. Select 'Log In' 3. Under 'Select Employee', enter your employee's Empire ID or name. Hit 'Go% 4. On your 'Employee Administration: Profde~ page, cY~ck on the type of change you'd like to make. After you receive a conth-mation screen, print and fde 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 empluyment during the period of termination or a COBRA election form ('if applicable) along with your worksheet. Reminders In order to comply with your plan's policies, member changes, terminations and reinstatement reques~ must be reported promptly. · The 'Important Notices' section of your invoice details the maximum allowable retruactivity rules. · Member Reinstatements will be considered within 30 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 enrollment eligibility. SgMB2K (07/11) COHHUNZTY RATED )ROUP NUMBER SUB GRP. 598599 2 )I~ING TYPE REGULAR BILL )ILLING FREQUENCY HONTHLY )ENERTSCONSULTANT COHHERCIAL ACCTS DATE BILLED 08/11/12 BILLED PERIOD FROM TO 09/01/12 10/01/12 09/01/12 PAGE: I FOR BILLING INFORMATION: (866) 422-2583 GORDON MURPHY FISHERS ISLAND FERRY DISTRICT PO BOX H FISHERS ISLE, NY 06390 PRIOR BILLING PERIOD PRIOR AMOUNT BILLED PAYMENTS I RECEIVED DATE STATUS CURRENT BILLING PERIOD CURRENT AMOUNT BILLED NET ADJUSTMENTS CURRENT DUE ] 09/01/12 - 10/01/12 7.50 0.00 7.50 THIS INVOICE REFLECTS ALL PAYHENTS AND ADJUSTHENTS PROCESSED THROUGH 08/11/12. ANY ADJUSTHENTS PROCESSED AFTER THIS DATE MZLL DE REFLECTED ON A SUBSEQUENT ZNVOICE. PLEASE SEE THE REVERSE SIDE OF THIS PAGE FOR HORE IHPORTANT NOTICES. To recetve proper credit, please return the BOTTO~I PORTION of tl3~s page wttl3 your payment. NOTICE: AS reqmred by Labor Law, Section 217, Insurance Law, Section 4235 and Cedes, Rules and Regulations ot tho Stale oi' 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 ho afforded the following rights under the terminating policy: 1. Any claims incurred during tho effective dates ot 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 ot the contract may ho available under the termination contract for conditions which result irt a lob31 disability, pursuant to the terms, conditions and provlslo;ls of the terminating group contract. 3. R~ghts to convert to a (bract pay contract between Empire Hea~thCholce Assurance, Inc. and the covered member, sub~;crihor or certificate holder, providing for coverage which is the group does not obtain replacement coverage. shall ho eithor: a) hand-delivered by the policyholder to the hoKler's pay envelope) at least nine days prior to intended date of termination; or: b) mailed by the policyholder to each certificate hol(ier at tho certificate holder's last known residential address at least nine days prior fo the intended date of termination. 3. The policyholder mnsst also post a copy of this notice oi' intent to terminate and tho required covering letter m cortsplcuous Iocabons chosen as most likely to give notice to the certificate holders. The not,ce shall ho posted at least nine days prior to the intended date of termination. 4. In accordance With the provismns of Labor Law, Section 217 (4), the provisions ot the Co(les, Rules and Regulations of tho State of New York, Title 11, Insurance Section 55.2 and LabOr Law, Section 217 (3) shall not be (teemed to apply ~f, at least 10 days prior to the date of tho 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 w~th another insurer to replace the existing insurer for the providing of similar coverage for the same certificate holders, and filed an affidavit w~th tho Commissioner of Labor and Superintendent of Insurance to that effect. Affidavits filed with the Commissioner ot Labor shall refer to Labor Law, Section 217, and ho addressed fo: Director of Labor Star~lar~ls-Deparfmenf of Labor-Agency Buti~ling 12, State Office Building Campus-Albany, New York, 12240. Ah'idavits filed with tho Superintendent of Insurar~ce shall refer to Laedr Law, Section 217 and the Codes, Rules and Regulations ot the State of New York, Title 11, Insurance, Section 55.2 Part, and shall ho addressed to; Chief, Health an~l Life Policy Bureau New York State Insurance Department-Agency Building 1-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 AUTOMATICAI,LY BE CANCELLED as of the date to which premiums have been paid. Empfl'e is not financially responsible for claims incurred beyond the premium paid to date. In order to ensure proper crediting of your payment, you must ma~l 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 2 Group Name: FISHERS ISLAND FERRY INDIVIDUAL DETAIL Bill Period: 09/01112 To 10101/12 Payment Due Date: 09101112 EXPLANATION OF CHANGE TYPE CODES: SUB INDIVIDUAL'S :ON1 CHANGE INDIVIDUAL'S NAME GRP IDENTIFICATION NC ~KG ~YPE TYPE ADJUSTMENT PERIOD AMOUNT DUE Empire HealthChoXce Assurance, 1'nc FXORA HXCHAEL 83054186 001 12 ~OD 09/01/12 - 10/01/1; 1.~5 LYNCH HATTHEH B 88130034 001 12 ~DD 09/01/12 - 10/01/12 1.25 HARKS JASON 86104510 001 12 !ADD 09/01/12- 10/01/12 1.25 HURPHY GORDON 09539930 001 14 ADD 09/01/12- 10/01/12 3.75 PAGE TOTAL: 7.50 TOTAL CURRENT AHOUNT PLUS CHANGES: 7.50 BALANCE DUE FROH PRTOR BI'LL(S): 0.00 TOTAL AHOUNT OUE: 7.50 PAGE: uJ Group Number: 598599 2 Group Name: FISHERS ISLAND FERRY Bill Period: 09101/12 To 10101112 Payment Due Date: 09/01112 Prepared Date: 08111112 PAGE: CONTRACT / RATES I COUNTS SUMMARY GROUP / PACKAGE CONTRACT TYPE RATE COUNT 598599 2 / 001 12 1.25 3 X4 3.75 X PACKAGE SU~ TOTAL GROUP TOTAL PLEASE SEE REVERSE OF THXS PAGE FOR A SUNHARY OF COVERAGE OESCRXPTXONS CONTRACT TYPE TOTALS CONTRACT TYPE SXNGLE FANXLY GRAND TOTAL NO. OF CONTRACT~ 3 I 3 GROUP / PACKAGE OESCRZPTXON OF COVERAGE 598599 2 / 00! VXSXON PO Box 1407, Church Street Station, New York, NY Member Change/Termination/Reinstatement Worksheet To be completed by employer lot Empire members. Group Name FISHERS ISLAND FERRY Name ,~md Title DISTRICT Group Number 598599 Sign&ture Subdivision2 Date See reverse side for instructions. Do not return with your payment. Fax your completed worksheet to 1-800-780-1224. Or go to ~;~aw.emtaireblue.¢om to process these transactions online. Member Change/Termination/Reinstatement Worksheet Instructions How To Complete The Worksheet Please print legibly in ballpoint pen. Fill in all fields that apply. COLUMN INSTRUCTIONS 1. Member Identification 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 t Change T 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 Enter the reason code for the request. Reason codes include: D ~ Deceased LE ~ Left Employment ME ,= Medicare Eligible O t Other TIE ~ Terminated In Fa-rot TOC = Transferred to Other Coverage · S/xty (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 termination that is being requested. The effective date is the date of the termination or ~/our ~roup's billinl~ day in the month in which the termination occurred. How To Submit The Worksheet: Fax your comp~eled worksheel to 1-800-780-1224. 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 'Employers' Tab 2. Select 'Log In' 3. Under 'Select Employee', enter your employee's Empire ID or name. Hit 'Go'. 4. On your 'Employee Administration: Profde' page, click on the type of change you'd llke to make. A~er 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 terrniriated member, please fax or mail proof of the member's employment during the period of termination or a COBRA election form (if 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 withLrl 30 days from the day we process your request for termination. A/ter that period, a new application (Notice of Election will be required, subject to new ensoll~ent eligibility. FISHERS ISLAND FERRY DISTRICT VENDOR 006155 FEDEX 09/11/2012 CHECK 690 FUND & ACCOUNT P.O.# INVOICE DESCRIPTION AMOUNT SM .5710.4.000.000 SM .5710.4.000.000 SM .5710.4.000.000 7-983-34352 7-983~34352 7-983-34352 AIRBILLS-PAYROLL,WARRANT 353.82 CREDIT-BILLED INCORRECT. 158.40- CREDIT-BILLED INCORRECT. I5.52 TOTAL 179.90 ONE RUNDRED ~VENT¥ NI~E A~ 9~/t~ UOL~J%RS P~¥ TO THI~ ORDER PITTSBURGH PA i~25Q~74~I OF 9/~T/12 ADI~IT CHgCK NO. 690 [ D^T5 I ^UOU~Z 0~/ll/2QT2 $179.90 Town of Southold, New York - Payment Vouch? , Vendor Tax ID Number or S~cial Security Number Vendor Name Fedex Vendor Telephone Number 800-622-1147 Vendor Contact Invoice Number 7-983-343~ 7-983-343~ 7-983-3435 Invoice Invoice Date Total 811312012 $353.82 Discount v~nd~r No. Vendor Address P.O. Box 371461 Pittaburgh, PA 16250-7461 Net Purchase Order Number $353.82 -$158.40 -$18.52 6155 Was billed to our account , mistake Was billed to our account r mistake Check No. Entered by Audit Date SEP 1 1 2012 General Ledger Fund and Account Number SM5710.4.000.000 $353.82 $179.90 Payee Certification The undersigned (Claimant) (Acting on behalf oftbe above named claimant) does hereby certify that the foregoing claim is tree and cotrecl, that no pari 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 Name 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 the~of have been verified with the exceptions or discrepancies noted, and payment is approved Invoice Number Page 7-983-34352 InvoiceDal~ '~1 AccountNumbe, Aug 13~ 2012 1206-0334-5 FedExTax ID: 71-0427007 1 of 7 Billinq Address: FISHERS ISLAND FERRY DISTRICT DEB DOUCETTE PO BOX H FISHERS ISLAND NY 06390-0607 Invoice Summary Aug 13, 2012 Shippinq Address: FISHERS ISLAND FERRY TERMINAL 5 WATERFRONT PARK NEW LONDON CT 06320 invoice Questions? Contact FedEx Revenue Services Phone: (800) 622-1147 M-Sa 7-6 (CST) Fax: (800) 548-3020 Internet: www.fedex.com FedEx Express Services Transportation Charges 339,90 Base Discount -38,92 Special Handling Charges 52.84 Total Charges USD $353.82 TOTAL THIS INVOICE USD $353.82 You saved $38.92 in discounts this period! Other discounts may apply. Detailed descrilp~!9o~ O~ §~ghar9es can be located at fedex.com Invoice Number Adjustment Request Fax to (800) 548-3020 7-983-34352 Aug 13, 2012 1206-0334-5 2of~Z Use this form to fax requests for adjustments due to the reasons indicated below. Requests for adjustments due to other reasons, including service failures, should be submitted by going to vvvwv.fedex.com or calling 800.622.1147. Please use multiple forms for additional requests. ~ Please complete all fields n black ink. ~ Requestor Name 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 IDatel I ]/I I I/I I I~ ;~;Phone III I-I I I I*1 I I I I Fax#1 I I I-I I I I-I I I I I E-mail Address [~ Yes, I wantto update account contact with the above information. ii'ii TrackingNumber IIIIIIlllllllll !i~i!il I I I I I I I I I I I I I I I Bill to Account IIIIIIIIII IIIIIIIIII IIIIIIIlll $ 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 ] I I I I I I I,I I I ~ DVC - Declared Value INW - Incorrect Weight INS - Incorrect Service OCF - Grd Pick-up Fee OCS - Exp Pick-up Fee OVS - Oversize Surcharge RSU- Residential Delivery PND - Pwrshp Not Delivered SDR - Saturday Delivery For all Service failures or other surcharges please use our web site wvaa.fedex.com or call (800) 62Z- 1147 Rerate information only (round to nearest inch) LBS L W H Tracking Number Code $ Amount ?~ii~l I I I I I I I I I I I I I I I I I I I I I I I I Iol 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 II I I Ixl I I Ixl I I · II I I II I I Ixl I I lxl I I . II I I II I I Ixl I I Ixl I I . II [ I II I I Ixl I I Ixl I I I I I II I I Ixl I ] Ixl I I Invoice Number · o 7-983-34352 FedEx Ezpress Shipment Summary By Payor Type ~ Shipments (Original) Invoice Date Aug 13, 2012 Account Number "~ 1206-0334-5 Page 3of7 Shipper 6 27.0 Recipient 4 2.0 257.60 44.22 82.30 8.62 -28.44 273.38 -10.48 60.44 Total This Invoice USD $353.82 invoice Number 7-983-34352 '~ FedEx Express Shipment Detail By Payor Type (Original) InvoiceDate'~I AccountNumber '~ Au.q 13, 2012 1206-0334-5 - 4of7. · FuelSurcharge FedExhasappliedafuelsurchargeof1200%tothisshipment · Distance Based Pricing, Zone 8 r correct packages, weight and se~ce Any changes made are reflected m the invoice arnoun (~ Automation USAB Sender Recieient Tracking ID 876909082053 SUSAN JEFFRIES PETER LEICDNER O/0 SUSAN JEFFR .~-"x--"-~' ,r Service Type FedEx PrioriW Overnight FISHERS ISLAND FERRY TERMINAL Package Type Customer Packaging 5 WATERFRONT PARK 9161 HAZ£N DR Zone 08 NEW LONDON CT 06320 US BEVERLY HILLS CA 90210 US Packages 1 Rated Weight 19.0 lbs, 8.6 kgs Residen6al Delivery Svc Area A1 Account Number Correction 11.00 Signed by P.PATTY Fuel Surcharge 15.19 FedEx Use 018400929/0001618/_ Total Charge USO $158.40 · · FueISurcharge -FedExhas applied a fuelsurcharge of12.00% tothis shipmentDistm~ce Based Pricing, Zone 2 Automation USAB Sender Reci,ient Tracking ID 858871129714 FISHERS ISLAND FERRY TERMINAL J PRENTA Service Type FedEx Standard 0vernight 5WATERFRONT PAI~K 11542ND Package Type FedEx Envelope NEW LONDON CT 06320 US NEW YORK NY 10065 US Zone 02 Packages 1 Rated Weight N/A Delivered Jul 16, 2012 13:37 Transportation Charge 16.50 Svc Area A1 Discount 2.64 Signed by J.PRENTA Fuel Surcharge 1.66 FedEx Use 019501493/0000200/_ Total Charge USD $15.52 Fuel Surcharge - FedEx has applied a fuel surcharge of 12 00% to this shipment 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 packsgeweight exceeds the max'mum for the packaging type, therefore, FedEx Envelope was rated as Customer Packaging Automation USAB Sender Tracking ID 875071430176 DEBBIE DOUCETTE Service Type FedEx Standard Overnight FISHERS ISLAND FERRY TERMINAL Package Type Customer Packaging 5 WATERFRONT PARK Zone 02 NEW LONDON CT 06320 US Packages I Rated Weight 3.016s, 1.4 kgs Delivered Jul 19, 2012 10:52 Transportation Charge Svc Area AM Discount Signed by A.DIANA W ~uel Surchar~§ FedEx Use 020001414/0001283/_ Total Charge Recinient ATTN ACCOUNTING DEPT TOWN OF SOUTHOLD 54375 MAIN RD SOUTHOLD NY 11971 US USD 21.60 2.16 2.33 $21.77 Invoice Number 7-983-34352 Invoice Date ~ J Aufl 13,2012 Jl Account Number '~ Page 1206-0334-5/ 5 of 7 FuerSurcharge FedEx has appliedafuelsurchargeof?200%tothisshipment. Distance Based Pricing, Zone 2 Fed£xhas audited this shipment for correct packages, weight, and service Any changes made are reflected in ~he invoice amount. The package weight exceeds the maximum for the packaging type, therefore, FedEx Envelope was rated as FedEx Pek Automation USA8 Sender Tracking ID 872893382167 DEBBIE DOUCETTI- Service Type FedEx PriorHy Overnight FISHERS ISLAND EERR¥ TERMINAL Package Type FedEx Pek 5 WATERFRONT PARK Zone 02 NEW LONDON CT 06320 US Packages 1 Rated Weight 2.0 lbs, 0.9 kbs Delivered Aug 01,2812 11:00 Transportation Charge Svc Area AM Discount Signed by C FOSTER Fue! Surcharge FedEx Use 021301442/0001486/_ Total Charge Recioient ATTN ACCOUNTING DEPT TOWN OF SOUTHOLD 54375 MAIN RD SOUTHOLD NY 11971 US USO 22.85 2.20 2.47 $23~3 Fuel Surcharge - FedEx has applied e fuel surcharge ef 1000% to this shipment Distance Based Pricing, Zene 2 FedEx has audited this shipment for correct packages, weight~ and service Any changes made are reflected in t~einvoice amount The package weight exceeds the maximum for the packaging type, therefore, FedEx Envelope was rated as Customer Packaging Automa0on USAB Sender Tracking ID 812893382156 DEBBIE DOUYOETTA Service Type FedEx Priority Overnight FISHERS ISLAND FERRY TERMINAL Package Type Customer Packaging 5 WATERFRONT PARK Zone 02 NEW LONDON CT 06320 US Packages 1 Rated Weight 30 lbs, 1.4 kbs Transportation Charge Delivered Aug 09, 2012 10:56 Fuel Surcharge Svc Area AM Courier Pickup Charge Signed by C CONKE[N Disceunt FedEx Use 022102109/0001486/ Total Charge Recinient ATTN ACCOUNTING DEPT TOWN OF SOUTHOLD 54375 MAIN RD SOUTHOLD NY 11971 US USO 25.75 2.32 0.00 $25.49 Fuel Surcharge - FedEx has applied a fuel surcharge of 1000% to this shipment Distance Based Pricing, Zone 7 Package Delivered to RecipientAddress Release Authorized Automation USAB Tracking ID 875071430187 Service Type FedEx Standard Overnight Package Type FedEx Envelope Zone 07 Packages 1 Rated Weight N/A Delivered Aug 10, 2012 H:48 Svc Area A2 Signed by see above FedEx Use 022201015/0006255/02 Sender G S MURPY FISHERS ISLAND FERRY TERMINAL 5 WATERFRONT PARK NEW LONDON CT 06320 US Transportation Charge Residential Delivery Fuel Surcharge Discount Total Charge Recipient SOPHIA PAYNE 1293 ROARY SPRLGS RD FORT WORTH TX 76114 US 28.00 3.00 2.65 USD $29.17 Shipper Subtotal USD $273.38 I InvoiceNumber ~[ InvoiceDate ~ll 7-983-34352 Au,q 13t 2012 Account Number "~, Page 1206-0334-5] 6 of 7. Fuel Surcharge - FedEx has applied a fuel surcharge of 12 00% to this shipment 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 the maximum for the packaging type, therefore, FedEx Envelope was rated as FedEx Pek, Automation USAB Sender Tracking ID 875366961329 JANICE L JOGLIA Service Type FedEx Priority Overnight TOWN OF SOUTHOLD Package Type FedEx Pek 53095 ROUTE 25 Zone 02 SOUTNOLD NY 11911 4642 US Packages 1 Rated Weight 1.0 lbs, 0.5 kgs Delivered Jul 16, 2012 09:12 Transportation Charge Svc Area PM Fuel Surcharge Signed by M.CATTANACH Discount FedEx Use 019502039/0601486/ Total Charge Recieient GORDON MURPHY FISHERS ISLAND FERRY DISTRICT FISHERS ISLAND NY 06390 US USO 22.40 ~__ 2.42 ~' 2.24 ~ · F~eISurcharge FedExhasappliedafue[surchargeof12.00%tothisshipment 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 wei§ht exceeds the maximum for the packaging Wpe, therefore, FedEx Envelope was rated as FedEx Pek. Automation USAB Sender Tracking ID 875366961546 DIANA WHITECAVAGE Service Type FedEx Priorily Overnight TOWN OF SOUTHOLD Package Type FedEx Pek 53095 ROUTE 25 Zone 02 SOUTHOLD NY 11971-4642 US Packages 1 Rated Weight 1.0 lbs, 0.5 kgs Delivered Jul 19, 2012 09:44 Transportation Charge Svc Area A4 Discount Signed by LCATTANACH Fuel Surcharge FedEx Use 020002640/0001486/ Total Charge Recipient GORDON MURPHY FI FERRY DISTRICT 5 WATERFRONT PK NEW LONDON CT 06320 US USD 22.40 2,24 2.42 $ZZ58 " Fuel Surcharge - FedEx has applied a fuel surcharge of 12 00% to this shipment · Distance Based Pricing, Zone 2 Automation USAB Sender Tracking ID 875366961524 JANICE L FOGLIA Service Type FedEx Priority Overnight TOWN OF SOUTHOLD Package Type FedEx Envelope 53095 ROUTE 25 Zone 02 SOUTDOLO NY 11971-4642 US Packages Rated Weight N/A Delivered Jul 27, 2012 09:46 Transportation Charge Svc Area PM Fuel Surcharge Signed by P.FORD Discount FedEx Use 020803288/0000186/_ Total Charge Recioient GORDON MURPHY FISHERS ISLAND TERRY DISTRICT FISHERS iSLAND NY 06390 US USD 1825 $17.64 · FuelSurcharge-FedExhasapplied afuelsurcharge of 12.00% to thisshipment · Distance Based Pricing,Zone 2 Automation USAB TrackingID 875366961513 Service Type FedEx PtiorityOvernight Package Type FedEx Envelope Zone 02 Packages 1 Rated Weight N/A Delivered Aug 02,2012 09:55 Svc Area A4 Continued on next page Sender Recioient DIANA WHITECAVAGE GORDON MURPHY TOWN OF SDUTHOLD FI FERRYY DISTRICT 53095 RDUTE 25 5 WATER FRONT PK SOUTHOLD NY 11971 4642 US NEWLONDON CT 06320 US Transportation Charge Fuel Surcharge 18.75 1.89 Tracking ID: 875366961513 continued Signed by A.TRAUB FedEx Use 021402049/0(~0186/ Invoice Number '~ Invoice Date '~ l 7-983-34352 Au,q 13, 2012 Discount Total Charge Account Number '~ Page 1206-0334-5J 7 of 7 USD $17.64 Recipient Subtotal USD $80.44 Total FedEx Express USD $353.82 1224-01-00-0013680 0001.0035662 08/23/2012 12:50:22 PH *0000 FEDEX CALL CENTER PAGE I OF 1 August 23, 2012 JOBINA MILLER FISHERS ISLAND I:ERRY DISTRICT PO BOX II FISHERS ISLAND, NY 063900607 Dear Jobina Miller: 'lhank you lbr your inquiry of August 21, 2012. Your invoice a¢ljustmcnt toque.st has bccn proccsscd. Bclow is thc list of invoicc(s)/tracking number(s) that havc bccn credited along with an updated balancc. Invoice Nbr Airbill Nbr credited New Inv Bal 7-983-34352 858871129714 $15.52 $179.90 Thank you lbr choosing l"cdEx. Wc apprcciatc your business anti look forward to meeting your lhturc shipping nccds. Sincerely, Fedex Billing De~artment l"ax: 1-800-548-3020 FISHERS I~A~ FERRY DIS~ICT VENDOR 006373 FISHERS ISL~2~D FERRY DIST 09/11/2012 CHECK 691 FUND & ACCOUNT P.O.~ IN¥OICE DESCRIPTION ~J~OUNT SM .5710,4.000.000 082012 PETTY CASH-4/25-8/16/12 282.19 TOTAL 282.19 TWO tU314DRED EIGHTY T~O AND,,19gl00 DOLLARS 9/11/12 A~IT C~ECK NO. 691 !' ,' DATE , 1, AMOUNT 09/1~/2~'~2 S282.19 TOTHE PE~T¥ cA~~ ORDER Town of Southold, New York - Payment Voucher Vendor T~x ID Number or Social Security Number Vendor Address Vendor Name Fishers Island Ferr~ District -Petty Cash Account Vendor Telephone Number Vendor No. 6373 P.O. Box H Fishers Island, Ny 06390 Check No. Entered by Audit Date SEP 1 1 2012 Vendor Contact Number Date 8120/2012 Invoice Net Total Discount iAmount Claimed $282.t9 $282.19 Purchase Order Number Description of Goods or Services Petty Cash Receipts 4/25/t 2-8/16/12 Please note that we are missing a $4.00 receipt that was to purchase 1 gallon of gas for the weedwaker General Ledser Fund and Account Number 8M5710.4.000.000 $282.19 $282.t9 Payee Certification 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 the Town is exempt are excluded Signature ~ Title Company Name~'-~_ Date 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 or discrepancies noted, and payment is approved Signature Title Date ~ ~- .~. __~"~ J.~. ~7 I go., 'z)9. :zo" Print RadioOepo .com the Bl~t P~ees Ola Rldie Equiimmlt ami Ae~e~m'/ (888-733-7681) 1050 Oleflbrook Way, Suite 480, #104 Hendersonvllle, TN 37075 61 5-822-7905 (Tel) 615-822-7977 (Fax) sales~radiodepot .cum S01d To Matthew Lynch 65 Os,~egatchie Road Waterford. CT 06385 Sales Receipt EPNN9288A S&H (Non-Taxable) Date Sale No. 7/19/2012 RD7008 R ol. com· SALES - RENTALS - SERVICE O ICOM' Lee Dearmin ...... ~"'" 29 industrial Park Drive Hendersonville, TN 37075 www. radiodepot.com Hendersonville TN 37075 615-822-7905 C 0 1~ ¥ 07/3.9/2012 20:56:52 Sale: Transaction g ~ Card Tgpe: UISR Entry: Manual Invoice ~ 2303 Order ~ 7008 Total: 32 .87 888-RDEPOT1 (Te~) 888-733-7681 (Tel) 615-822-7977 (Fax) sales@radiodepot.com Check No. Payment Method ProjeclJJob Picked Up By: Visa Reference No.: 220121009979 Ruth,Code: 07329B Response: EXRCT H~TCH RUS Resp.: ¥ CQU2 Resp.: H Sequence Number: 0001 HerchantDNumber: 000220001279 Terminal_ID: 72804748 Terminal2Number: 000~ Descdption Power Supply, Motorola, Fits BPR40, CP Series Chargers Shipping & Insurance Charges (Non-Taxable) Rate Amount 19.95 12.92 19.95T 12.92T ~usiness! ·mail sales@radiodepot.com : will show on statement. Subtotal $32.87 Sales Tax (0.0%} $0.00 lotal $32.87 t4ore raving. More doing,~ 816 HARTFORD TPK. WATERFORD, CT 06385 JOHN COURNOYER,STORE MGR.(860)437-1900 6215 00057 72157 05/08/12 09:40 AM CASHTER SELF CHECK OUT - SC0T57 078864070040 BWL BOLWAX #1 PLAIN WAX RING 1,49 SUBTOTAL 1.49 SALES TAX CHANGE DUE 3.42 6215 57 72157 05/08/2012 3929 RETURN POLICY DEFINITIONS POLICY ID DAYS POLICY EXPIRES ON 1 90 08/06/2012 THE HOME DEPOT RESERVES THE PIGHT TO LIMIT / DENY RETURNS. PLEASE SEE THE REIURN POLICY SIGN IN STORES FOR DETAILS. BUY ONLINE PICK-UP IN STORE AVAILABLE NOW ON HOMEDEPOT.COM. CONVENIENT, EASY AND MOST ORDERS READY IN LESS IHAN 2 HOURS! ENTER FOR A CHANCE TO WIN A $5.000 HOME DEPOT GIFT CARD! Share Your Opinion With Usl Complete the brief survey about your store visit and enter for a chance to win at: www.homedepot.com/oplnton COMPARTA SU OPINION EN UNA BREVE ENCUESTA PARA LA OPORT UNIDAD DE GANAR. User ID: 150818 ~44660 Password: 12258 ~44603 Entries must be entered by 06/07/2012. Entrants must be 18 or older to enter, See complete rules on website, No purchase necessary. ? Invoice: #944548 Date of Order: Wednesday, 08 August 2012 DELIVER TO: fishers island ferry r lefevre 5 water front park new london, CT 06320 I IIIIII IIIII IIIII IIIII IIIII IIIII IIII IIII BILL TO: fishers island ferry r lefevre 5 water front park new london, CT 06320 rifvr@yahoo.com [ Order; #944548 Date of orderj 08/o8/2o12 payment Methodt CreditCard ] BOSEPS8HDGRY Stanley Bostitch Desktop Electric Pencil Sharpener, 1 $26.03 $26.03' Gray BICWOFQD324 BIC Wite-Out Quick Dry Correction Fluid, 20mi 1 $4.67 $4.67 Bottle, White, 3 p SPR24100 Sparco Hand Tally Counter 12 $2.80 $33.60 SMD15332 Smead Manila File Folder 1 $18.98 $18.98 MMM3710DC Scotch Packaging Sealing Tape, 2" x 55 yards, 3" 6 $1.81 $10.86 Core, Clear Express Processing: $2.99 SubTotal: $94.14 Free shipping for orders over $75: $0.00 $10 off your $75+ order: -$10.00 Total: $87.13 Thank you for purchasing from: Discou ntOfficeltems.com 302 Industrial Drive Columbus, WI 53925 1-866-302-5397 sales@discountofficeitems.com http://www.discountofficeitems.com/ D!scountOfficeltems,com is committed to customer satisfaction. If your items are d.amaged, defective or incomplete, request for a return or . - refund must'be made within 3 business days of the original date of receipt. In the event of a mistake, we will do our best to ensure returns are handled quickly and fairly. Most items are returnable (see return restrictions and reasons below) for any reason. Our Returns Department must be notified of all returns within 30 days of original date of shipment NO returns will be accepted without notification (Return without pdor authorization below). You may noti[y the returns department by email at returns@discountofficeitems.com or calling 866-302-5397 option 4. Requesting an RA# TO return an item, e mail us at sales~DiscountOfficeltems com to obtain an RA# Please provide the following information in your e-mail: Your order number, the item(s) and quantity you wish to retum, and the reason for the return. Within 24 hours of receiving your request, we will e-mail you return directions, including an RA#. In the event you are returning something due to damage, manufacturer\'s defect or an error on our part, we can also e-mail a UPS mailing label to return the items at our expense. Packaging and Sending Returns Once you have your RA# and a return address, carefully repackage the item in its original condition, including all origina~ packaging and matenals (manuals, accessories, etc). Write the RA# on the outside of the shipping package. DO not wdte on the product packaging. Please package the item appropriately for shipment. Send the product to the return address using your preferred shipping method. If possible, save your tracking number and track your return to make sure we receive it, Once received by our Returns Department, DiscountOfficeltems.com accepts full responsibility for all merchandise We are not responsible for loss or theft before the merchandise is in our possession. For valuable items, you may wish to insure them to cover replacement costs in case the package is lost in transit, If a product is being returned as new, but has clearly been used or damaged prior to ils return, we reserve the right to refuse refund completely. Return Restrictions Due to limited shelf life, safety concerns, and potential for fraudulent claims, we do not accept returns on the following items: all toner cartridges, electronics, business machines, hygiene and consumable products (food, beverages, cleaning supplies, pharmaceuticals and paper). These products will only be accepted in the event of a manufacturer's defect or an error on our part. Opened computer software will not be accepted for return In addition, you may not return calendars or dated appointment books from the current or previous calendar years. Return Reasons If you ordered the item incorrectly, or change your mind about an item, we will refund the purchase price of the unopened, restockable item, less shipping costs. Please be aware that when returning a product shipped via Free Super Saver Shipping, our actual outbound shipping costs will be deducted from your return. You will be responsible for the cost of returning the item to DiscountOfficeltems,com. If we sent you a defective item, an incorrect item, or it was damaged in shipment, we will arrange for the merchandise to be returned. If your order is incomplete, or you do not receive your order in a reasonable time frame, please contact us within 2 business days and we will investigate and, if necessary, process a replacement Returns without prior authorization In order to keep prices Iow for all customers, a return authorization is required to return merchandise. If a return is received without prior return authorization the shipment may be refused and/or returned to you at your cost. Thank you for helping us to keep prices Iow for all of our customers. Unless noted otherwise on our site, all products are sold with the full manufacturer's warranty, The period and service of the warranty will vary depending on the manufacturer and product. If you expehence problems with an item al'er the 30-day period has expired, please contact the item's manufacturer. For help or information contacting a manufacturer, call us at 1 866-302-5397 or e-mail sales@DiscountOfficeltems.com. Processing Refunds/Exchanges As soon as we receive your returned items, we will inspect and process the items Replacements and refunds are normally processed within three business days. Allow one week to receive replacement merchandise. Cancellations Orders cannot be canceled once submitted. Due to our commitment to process orders quickly, once the checkout process is completed our warehouse is immediately notified to pick up the order for shipment. The cost of return shipping will be deducted from any refund for refused shipments of undamaged products return to shipper. Please contact us regarding any questions about this policy. PACKING LIST .D!scountO iceltems.com 30'2 INDUSTRIAL DR COLUMBUS WI 53925 SHIP TO: FISHERS ISLAND FERRY 5 WATER FRON'f' PARK NEW LONDON CT 06320 ATTN. R LEFEVRE P.O.# 944548- 02 R LEFEVRE COMMENTS: EZ-ORDER E.D.I. PURCHASE ORDER QTY QTY )RDERED SHIPPED 12 12 ITEM # UOM SPR 24100 EA ORDER NUMBER: 23D32923 DATE ORDERED: 08/08/2012 DATE SHIPPED: 08/08/2012 ORDER TYPE: USA Express ORDERED BY: DOI ENTERED BY: EZ$ SHIP VIA DESC: UPS Ground SHIP INSTRUCT: 09- USA EXPRESS BILL AS OF: / STAGING LOCN: U PS WAVE NUMBER: 20120808021 TOTAL CARTONS: 1 ESTIMATED WT: 1.76 DESCRIPTION COUNTER,TALLY,SILVER For returns, emaJl us at sales@discountofficeitems.com or contact customer service at (866) 302- 5397. Within 24 hours of receiving your request, we will email you a Return Authorization number. All returns must include an RA number. Our Returns Dept. must receive the items within 30 days of the original shipment date. If your items are damaged, defective or incomplete, requests for replacement or refund must be made within 2 business days of the delivery date. Please visit our websites FAQ for our full return policy. RETURN LABEL DiscountOfficeltems.com SHIP TO: 302 INDUSTRIAL DR COLUMBUS WI 53925 Page 1 of 1 DTSCOUNT OFFTCE FISHERS ISLAND FERRY 5 WATER FRONT PARK NEW LONDON CT 06320 ZTEHS 9qqSqS-OZ 08/08/2012 OSYDVYR CPO#: ORDER: SHIP VIA: UPS REF#:R LEFEVRE Item Number Quantity Unit Ordered As Description UM Ord Ship Price Price BIC WOF~D32~ FLUID,CORRCT,~D,$/PK,HHT PK ~ 1 80S EPS8HDGRY SHARPENER,PNCL,ELEC,HD,GY EA 1 1 M~M 3710DC TAPE,BX SEALING,~8MM,CR EL i 1 l"~M 3710DC TAPE,BX SEALING,~8~,CR EL 5 5 SHD 15332 FOLDER,HLA,1/$CT,LGL,POS2 BX I 1 THANK YOU FOR YOUR ORDER SEE REVERSE SIDE FOR RETURNS INFORMATION PAGE NO: LAST PA~: I PLINSIDE Items should be returned after obtaining a Return Authorization... · With this Packing List · To the Return Address noted on the front of the form · Free from markings · In the original carton and packaging 0833690320-0095 08/15/2012 (860)443-4393 12:46:32 PM Sales Receipt - Product Sale Unit Final Description Oty Price Price (Forever) 1 $9.00 $9.00 Bonsai Double-Sided Bklt/20 Total: $9,00 Paid by: Cash $20.00 Change Due: -$11.00 Order stamps at usps,com/shop or call 1-800-Stamp24. Go to usps,com/clicknship to print shipping labels with postage. For other information call 1-800-ASK-USPS. Get your mail ~hen and ~here you ~ant it ~ith a secure Post Office Box. Sign up for a box online at usps.com/poboxes. Bi11~:1000501740236' Clerk:03 All sales final on stamps and postage Refunds for guaranteed services only Thank you for your business HELP US SERVE YOU BETTER Go to: https://postalexperience.com/Pos TELL US ABOUT YOUR REOENT POSTAL EXPERIENCE YOUR OPINION COUNTS Customer Copy date__~ /~9 //-~NO. 161665 113 Oswe atchle Hills Road dollars .Nla~c, CT 06357 money order ~ There s a way TM #10483 698 BANK ST NEW LONDON, CT 06320 860-4~-3566 262 0377 0021 07/26/2012 12:40 PM ENERGIZER ULTIMATE LITHIUM AA 2S 03980003408 A 4,99 SALE . SUBTOTAL 4.99 SALES TAX A=6.35% 0.32 TOTAL 5.31 CASH lO.O0 CHANGE 4.69 STORE ADVERTISED SAVINGS 1.50 TOTAL SAVINGS 1.50 RFN# 1048-32 0-3775- 207-2603 THANK YOU SAVE ON YOUR PRESCRIPTIONS BY JOINING WALGREENS PRESCRIPTION SAVINGS CLUB SEE PHARMACY FOR DETAILS ~p~ are ~e doing? n~er our monthly sweepstakes fCr $3,000 cash Visit ~.TELL~A8.CDM or call toll free 1-800-763-0547 ~ithin 72 hours to take a short survey about this Nalgreens visit SURVEY# 1048-3210-377 PASSWORD 5120-7260-316 For contest rules, see store or NWN,TELLNAG.COM ~' There s a way~" #10483 698 BANK ST NEN LONDON, CT 08320 860-440-3566 282 J930 0022 00/29/2012 9:50 Ag << BUY 1 GET 1 EQUAL/LESS VALUE 50~ OFF >> BANDAGE STRONG STRIPS 1" 20S FSA 31191710601 A 3,49 BANDAGE STRONG STRIPS 1" 20S FSA 31191710601 A 1,74 BANDAGE STRONG STRP W/PRF 1"20S FSA 31191710603 A 3.49 BANDAGE STRONG STRP W/PRE 1"20S FSA 31191710603 A 1,74 ~ALG IBUPROFEN DYE FREE TABS IOOS 31191708820 A 7.49 SUBTOTAL 17.95 SALES TAX A:6.35) 1.14 TOTAL 19.09 CASH 20,10 CHANGE 1.01 TOTAL FSA ITEMS 11,12 T~TAL RX ITEMS °PRUVED FSA/HRA AMOUN] 0,00 STOP! /,' ~TISED SAVINGS 3,50 TOYAL SAVINGS 3.50 RFN# 1048-3229-93~1-120B-2903 THANK YJU SAVE ON YOUR PRESCRIF¥IONS BY JOINING WALGREEN? PiiESCRIPTiON SAVINGS CLUB SEE PHARMACY FOR DETAILS How ,~r~ ,4e doing? Enter our' month,, weepstakes For $3.0~',~ cash Vtsit NWW.TELLNAG.C~ or call toll free 1-800-763-054! wlthin 72 hours to take a ~hort survey about thls Walgreens vls,t SURVEY# 048-3229-930 PASSWORD 81 20-6290-316 For contest rules, see si:ore (r ~W~,TELLWAG.COM d HARTFORD TPK. WATERFORD. CT 06385 ,OHN COURNOYER,STORE MGR. <~'~60)437-1900 62~5' 00058 26367 06/11/12 01:07 PM CASHIER SELF CHECK OUT - SCOT58 046561091712 HEDGE SHEAR ~A, 19.97 9" WAVY BLADE HEDGE SHEAR 046561191092 BYPAS PRUNER <A~ 11.97 BYPASS TRADITIONAL PRUNER SUBTOTAL 31.94 SALES TAX 2.03 TOTAL $33.97 CASH 20. O0 CASH 20. O0 CHANGE DUE 6.03 6215 58 26367 06/11/2012 2773 RETURN POLICY DEFINITIONS POLICY ~D DAYS POLICY EXPIRES ON A 1 90 09/09/2012 THE HOME DEPOT RESERVES THE RIGHT TO LIMIT / DENY RETURNS. PLEASE SEE THE RETURN POLICY SION IN STORES FOR DETAILS. BUY ONLINE PICK-UP IN STORE AVAILABLE NOW ON HOMEDEPOT,COM. CONVENIENT, EASY AND MOST ORDERS READY IN LESS THAN 2 HOURSI ENTER FOR A CHANCE TO ~IN A $5.000 HOME DEPOT GIFT CARD ! Share Your Opinion With Usl Complete the brief survey about your store visit and enter for a chance to win at: wee. homedepot, com/opl n l on COMPARI'A SM OPINION EN UNA BREVE ENCUESTA PARA LA OPORT UNIDAD DE GANAR. U~er ID: P~ord: Entries must be entered by 07/11/2012, Entrants must be 18 or older to enter. See complete rules on webslte. No purchase necessary. ~ Th~:ce s a way TM #10483 698 BANK ST I!E~V LONDON, CT 06320 880-440-3566 460 4508 0071%/05/2012 8:23 AM WEXFORD VINYL BINDER 0.5" DISP 04902236069 A 7,58 2 ~ 3.79 SUBTOTAL 7.58 SALES TAX A=6,35~ 0,48 TOTAL 8,06 DEBIT CARD 8.06 CHANGE .00 RFN# 1048-3714-5087~1206-0603 Walgreens 10483 AOCT 3258 SEQUENCE 048371002 PAYMENT FROH PRIMARY THANK YOU SAVE ON YOUR PRESCRIPTIONS BY JOINING WALGREENS PRESCRIPTION SAVINGS CLUB SEE PHARMACY FOR DETAILS How are we do ingo Enter our monthly sweepstakes For' $3,OOO cash Visit NWW. TELLWAG .CDM or call toll free 1 -800-763-0547 ~ithim 72 hours to take a short survey about this Na]greens visit SURVEY# 1048-3714-508 PASSWORD 7 1 20-6080-31 6 For contest rules, see store or WWW.TELLWAG.COM lllllm" St°p&Slaop Sl. lbfotM E2 !;lOPPER I~I l:'tle,r, S[~ ~J-I[l'E V'IN[)F;' Fo tc~l $2.69 ~2 69 ~E'VE EN,I[)YIO 5EIWIN[F ¢01..I, Rid] FUTttR~ SHOPI'[hI~; NEEDS I<EF, R/' SHCCH.{ .:;)1¢, MGR 44~-.67/2 A.C.Hoore #44 351G-1 North Frontage Rd. New London, CT 06320 (860)447-1277 STUDENT VAL PK 25P0 08924112374 8.5Xll.75 ROUNDED;NATURAL:8.5 02475143034 8.5XI1,75 ROUNDED:NATURAL:8.5 02475143034 8,5Xl1,75 ROUNDED:NATURAL:8.5 02475143034 4,99 T 7.99 T 7.99 T 7.99 T $28.96 $1,84 $30.80 $40.00 $9.20 SUBTOTAL 6,35% State Tax 'tOTAL OK 5'~ft CHANGE Il Illllllllilllll ltlllllllllllllllllllllllllilllllllllllllllllllll 9120044029665015455~ Craft Your Career ~Jth A.C. To learn more and apply, visit; NNN.acmoore. jobs For Great Deals a Project ideas visit A.C. Hoore onllne ~w~.acmoore.com ~. facebook.com/acmoore tw~tter,com/officJalacmoore ~.youtube.com/off ITEHS 4 04-25-12 10:54A~ 0044 02 9665 Catheri ne Sign up to receive Special on line offers Go to www,ACMOORE.com pdtsmbprt.34865322 -pdtsmbpCt.36634~56 Defender Industries 42 gre~t Neck Road Waterford CT 06385 (860) 701-3400 Ent. By: SJM Jactyn McF Cust 100202676 Fishers Island Ferry Dist Po Box H Attn Mark Easter Fishers Isle NY 08390 CAVINESS VARNISHED PADDLE 38450653 1 @ 14.39 14.39 * Subtota! 14.39 Tax 0.91 T~ta] 15.30 (* ~ Items are taxable) .............. Payments ................ Cash 15.30 Amount Tendered 16.00 Change Due 0.70 Invoice Order Reg. Date Time ?00245822 100246785 1 -0 04/26/2012 02:02pm Packine Slio- PavPal Paee I of 1 Ship To: Address: Fmail: r lefevre 261 Trumbull Dr # 607 Fishem Island, NY 06390-8021 fish94112C~vahoo.com 113- ~ilor330 Descri~ion Paint Rollers 20 4" Mini Rollers & Frame Note: Thank You. www.paintrollersplus.com Ship From: wayne forson Address: 27 cambridge rd. wobnrn= MA 01801 United States Email: ofelia67~.nelzem.com Ootions Qtv Price I $15.99 USD Shipping & Handling: $6.40 USD Shipping Insurance: $0.00 USD Tn~!: $2;'39 USD This is not a bill. https://www.paypal.com/us/c~i-bin/webscr?cmd= shippin~-receiot&info=nEmLObZLWC1-... 5/4/2012 Payment Summary Page 1 of 1 Back to order details Payment Summary Date printed May I0-12 Status: Seller: Buyer: Paid with PayPal on May 04, 2012 ofelco sailor330 Shipping Seller should ship to: r lefevre 261 Trumbull Dr # 607 Fishers Island NY 06390-802! United States Payment Item Name Paint Rollers 20 4" Mini Rotlers & Frame 290654532050 - Price: US $1599 Payment instructions: Payment details: Shipping Economy Shipping: US $6.40 USPS Parce[ Post® Estimated delivery May 8 May 15 Price US $15.99 Subtotal: Shipping & handling: US $15.99 US $6.40 Total: US $22.39 I accept paypal,cashiers check,money order, shipping will be within 24 hrs after check clears. Return unused for bid price refund if not satisfied. PayPal About SSL Certificates http://payments.ebay.com/ws/eBaylSAPl.dll?ViewPaymentStatus&transid=698608531019... 5/10/2012 FISHERS ISLAND FERRY DISTRICT VENDOR 006482 PAUL J. FOLEY FUND & ACCOUNT SM .9060.8.000.000 P.O.# 09/11/2012 CHECK 692 INVOICE DESCRIPTION G0230330801 REIMB.RX-AUG'12 AMOUNT 94.41 TOTAL 94.41 NINETY ORDER OF NE%I',~LONDON ~T e6320 CH~CK NO. 692 Vendor No. Town of Sonthold, New York - Payment Voucher I 6482 Vendor Tax 1D Number or Social Security Number Vendor Address 690 Williams Street N~w Londoh, CT 06320 Paul J, Foley Vendor Telephone Number Vendor Contact Invoice Invoice Invoice Net Purchase Order Number Date Total Discount iAmount Claime~ Number 00230330801 8/1/2012 $94.41 $94.41 $94.41 $94.41 Payee Certification The undersigned (Claimant) (Acting on behalf of tbe above named claimant) does hereby certify that the foregoing claim is a'ue 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 DescriDtion of Goods or Services Anthem Retiree Prescription Plan 90% Reimbureemen~ ;104.90 less 10% ($94.41) Paul Foley ( # 2185 Uheck No. Entered by ~ ~udit Date SEP 1 1 2012 General L~l~¢r Fund and Account Number 8M9060.8.000.000 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 ,~ ~'~~D Title ate_ I Blue MedicareRx'(PDP) I% ''"'l'',l''','ml'l,,ml,mll,ml,,,ml'ml,l,l-,I,.,'-hlllq PAUL O FOLEY 690 WILLIAMS Sm NEW LONDON CT 06320-4132 902640731 G0230330801 Balance Due 09/01/2012 $104.90 Please return the top portion of this form with your payment. See reverse side for payment options. ¢ Retain the bottom 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 one remittance advice and one pa_vment per account. The remittance advice is located on the reverse side of this statement. This will ensure each member account is credited appropriately and timely to prevent disenrollment from the plan, which will result in a lapse of coverage. If you are disenrolled from the plan, you may only re-enroll during a valid el~ion period. Anthem Participant ID: G0230330801 Date: 08/07/2012 I Blue IhdicareRx'(PDP) Transaction Date Description Amount Premium 08/01/2012 August 2012 104.90 . Balance Due 104.90 PAUL J. FOLEY 8~0 WILLIAMS ST. 2193 Da~e Payto~e ~,¢ ~ ... ~ ~ Order of /~ f (l~ .~ ~ ~ _ ~ j $/~ ~ o Please contact our customer service delmflmemt at 1-888~o20-1'/4 / Wltll any qu~suons. 102 ~014;~4~41066~0014)042805 SolimarValidationNum~erO02?~0801 Page 1 of 1 FISHERS ISLAND FERRY DISTRICT VENDOR .02501 BRIANNA JARVIS 09/11/2012 CHECK 693 FUND & ACCOUNT P.O.# INVOICE DESCRIPTION AMOUNT SM .1930.4.000.000 062912 REIMB~VEH.DAMAGE CLAIM 584.34 TOTAL 584.34 FIVE MBlqDRED E~G~g Fl>UR AI~:D J~/t0O DOLJ~iP~S P~Y ~)ITf/E 51 M~DDLE ORDER 9/~/12 AUDIT CHECK NO 693 I'.. ~^'m A~OUN~, 09/11/20't2 $584.3~ II'O00~q%,' ~:O~L, OSL,~h,: r=15 oo;5o~ Town of Southold, New York - Payment Vendor Tax ID Number or Social Securiiy Number BRIANNA JARVIS Vendor Telephone Number 401-447-5134 Vendor Contact Voucher ~endor Address Vendor No. 51 MIDDLE STREET HINGHAM, MA 02043 Check No. Audit Date r · SEP 1 1 2012 Invoice Number Invoice Invoice Date Total 612912012 $584.34 $584.34 Payee Certification Net Discount Amount Claime¢ $584.34 $584.34 The undersigned (Claimant) (Acting on behatf of the above named claimant) does hereby cer~i~ that the foregoing claim is ~'ue and correct, that no part h~s been paid, except ~s therein stated, that the balance therein stated is actually due and owing, and that taxes fi.om which the Town is exempt are excluded Signature ~ Title ~~''- Company Name / ~f Date ~ ~"~ ~.,a~/~..~ ! Parchase Order Number Description of Goods or Services Damage to a ~,~hi¢l, while on the f~rrl/ Genend Ledger Fund and Account Number SM1930.4.000.000 Department Certification t 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 Ti.¢ Date FISHERS ISLAND FERRY DISTRICT DAMAGE/ACCIDENT REPORT Date of Occurance: O- ~q- la- Time ofOccurance: 1,4oo k.s. Vessel: Captain: Trip: Crew Involved: Vehicle Description: Weather and Sea Conditions: Manufacturer: Year: Model: Color: Owner Identification: Name: Address: Or,z~ ~,llr City: Phone: FI Phone: (6a~) 7 8g- -/~tt~' Provide detailed account of incident including accurate description of damage, how it occurred, burden of blame, witnesses, etc.. Preliminary Estimate Customer: 3ARVTS, BRTANNE 3ob Number: Vehicle: 2011 CHEV K1500 4X4 SUBURBAN L'rz 4D UTV 8 5.3L-FI Line Oper Description Part Number Qty Extended Labor Paint Pfi~e $ 1 REAR BUMPER 2 * Rpr Bumoer cover w/reverse sensino 25830552 2.~ 2.S system (PARTIAL PAINT~ 3 Add for Clear Coat 1.0 4 O/H bumper assy 1.7 5 # Repl FLEX ADDITIVE/ADD HARDENER ! 12.00 T 6 # Repl FLEXABLE PARTS ADHESION I 10.00 0.5 PROMOTOR APPLICATION 7 # Refn TINT PAINT 0.5 8 # RepI COVER CAR 1 5.00 X 0.2 9 # Repl WET SAND AND BUFF PANELS 1 1.0 10 # ************VISIBLE DAMAGE 1 ONLY************* SUBTOTALS 27.00 5.9 4.0 ESTZMATE TOTALS Category Basis Rate Cost $ Parts 10.00 Body Labor 5.9 hrs @ $ 43.00/hr 253.70 Faint Labor 4.0 hrs @ $ 43.00/hr 172.00 Paint Supplies 4.0 hfs @ $ 27.50/hr 110.00 Body Supplies 4.2 hfs @ $ 3.00/hr 12,60 Miscellaneous 17.00 Subtotal 575.30 Sales Tax $144.60 @ 6.2500 % 9.04 Grand Total 584.34 Deductible 0.00 CUSTOMER PAY O.00 ZNSURANCE PAY 584.34 8/17/2012 9:58:41 AM 097152 Page 2 BEST CHEVROLET 128 DERBY STREET, HINGHAM, MA 02043 Phone: (781) 927-1286 Preliminary Estimate Workfile ID: 8bd889dd Customer: JARVISt BRIANNE Insured: 3ARVIS, BRIANNE Type of Loss: Point of Impact: Owner: ]ARVIS, BRIANNE Written By: Lauren Affleck Policy #: Date of Loss: Inspection Location: BEST CHEVROLET 128 DERBY STREET HINGHAM, MA 02043 Repair Facility (781) 927 1286 Business Claim #: Daysto Repair: 0 Insurance Company: .lob Number: VEHICLE Year: 2011 Body Style: 4D UTV VIN: Make: CHEV Engine: 8-5.3L-FI License: Model: K1500 4X4 SUBURBAN Production Date: State: LTZ Color: lnt: Condition: 3ob #: 1GNSKKE37BR253100 Mileage In: Mileage Out: Vehicle Out: TRANSMISSION Automatic Transmission 4 Wheel Drive Overdrive POWER Power Steering Power Brakes Power Windows Power Locks Power Driver Seat Power Passenger Seat Power Mirrors Heated Mirrors Memory Package DECOR Body Side Moldings Dual Mirrors Privacy Glass Wood Interior Trim CONVENIENCE Air Conditioning Rear Defogger Tilt Wheel Cruise Control Intermittent Wipers Climate Control Keyless Entry Dual Air Condition Auto Level Rear Window wiper Navigation System Steering Wheel Controls Parking Sensors Power Adjustable Pedals Remote Starter Message Center RADIO AM Radio FM Radio Stereo Search/Seek CD Player Premium Radio Auxiliary Audio Connection Satellite Radio SAFETY Anti-Lock Brakes (4) Driver Air Bag Passenger Air Bag Head/Curtain Air Bags Front Side Impact Air Bags 4 Wheel Disc Brakes Traction Control Stability Control Communications System ROOF Luggage/Roof Rack SEATS Leather Seats Bucket Seats Heated Seats Rear Heated Seats 3rd Row Seat WHEELS 20" Or Larger Wheels PAINT Clear Coat Paint OTHER Fog Lamps Signal Integrated Mirrors TRUCK Running Boards/Side Steps Trailering Package Power Trunk/Tailgate 8/17/2012 9:58:41 AM 097152 Page i Preliminary Estimate Customer: JARVZS, BRZANNE Vehicle: 2011 CHEV K1500 4X4 SUBURBAN LTZ 4D UTV 8-5.3L-FI 3ob Number: PLEASE NOTE >>>> I HAVE WRITTEN THIS APPRAISAL USING THE COMMONLY ACCEPTED DOLLARS TIMES HOURS FORMULA FOR CALCULATION OF PAINT AND BODY MATERIALS COST. WHEN INSURANCE SUPPLEMENT IS NEEDED TO REPAIR VEHICLE. BEST CHEVY MUST HAVE ALL PAPER WORK TO NOTIFY VEHICLE OWNER FOR APPROVAL OF REPAIRS. BEST CHEVY IS NOT RESPONSIBLE FOR DELAYS CAUSED BY MISSING PAPERWORK OR NON SIGNED FIELD NOTES .FIELD NOTES MUST BE NOTED AND SIGNED BEFORE PROCEDING WITH REPAIRS TO NOTIFY OWNER THAT COST WILL BE COVERED BY INSURANCE COMPANY. >>>> ****** THANK YOU FOR YOUR UNDERSTANDING IN THIS MAI-I'ER***** At Best Chevy we stand by our workmanship. Please ask us about our limited lifetime warranty on repairs performed by our technicians who have the proper training to get you back on the road. Our guarantee is based on repairing vehicles per the manufacturers and I-Car proceduress. We cannot guarantee paint from flaking, peeling or overspray on mldgs & trim unless the proper procedures are done per the Paint/Oem manufacturers requirements. In some unforseen cases there could be hidden damages (supplement) that could affect the final cost of this repair. This document is an estimate and not necessarily a final bill. The owner would need to approve any additional repairs or parts that would be needed before the completion of repairs. Note: Some vehicles have special factory or non-manufacturers trim or special glass (encapsulated glass) that may possibly be damaged during the necessary removal process. Although manufacturers sometimes allow only a one-time use of these parts, by not doing the required procedures, the paint or body warranty may or may not be affected. We use the utmost care in removing all parts, however, some parts may not be suitable to be re-installed and will warrant replacement. This would be reflected in the final repair cost. ****PARTS PRICES ARE SUBJECT TO INVOICE**** STATE LICENSE # RS3438 THANK YOU FOR L~ I 11NC BEST CHEVY BODY SHOP SERVE YOU!! PER MASSACHUSEI IS REG. lilLE 212 CHAPTER 2.02(5), '"FHIS ESTIMATE HAS BEEN PREPARED AND SWORN TO UNDER THE PENALTIES OF PERJURY," 8/17/2012 9:58:41 AM 097152 Page 3 Preliminary Estimate Customer: 3ARV~S, BRIANNE Vehicle: 2011 CHEV K1500 4Xq SUBURBAN LTi~ 4D UTV 8-5.3L-FI 3ob Number: Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from the Guide DRiGA07, CCC Data Date 8/9/2012, and the parts selected are OEM-parts manufactured by the vehicles Original Equipment Manufacturer. OEM parts are available at OE/Vehicle dealerships. OPT OEM (Optional OEM) or ALT OEM (Alternative OEM) parts are OEM parts that may be provided by or through alternate sources other than the OEM vehicle dealerships. OPT OEM or ALT OEM parts may reflect some specific, special, or unique pricing or discount. OPT OEM or ALT OEM parts may include "Blemished" parts provided by OEM's through OEM vehicle dealerships. Asterisk (*) or Double Asterisk (**) indicates that the parts and/or labor information provided by MOTOR may have been modified or may have come from an alternate data source. Tilde sign (,~) items indicate MOTOR Not-Included Labor operations. The symbol (<>) indicates the refinish operation WILL NOT be performed as a separate procedure from the other panels in the estimate. Non-Original Equipment Manufacturer aftermarket parts are described as AM. Used parts are described as LKQ, RCY, or USED. Reconditioned parts are described as Recond. Recored parts are described as Recore. NAGS Part Numbers and Benchmark Prices are provided by National Auto Glass Specifications. Labor operation times listed on the line with the NAGS information are MOTOR suggested labor operation times. NAGS labor operation times are not included. Pound sign (#) items indicate manual entries. Some 2012 vehicles contain minor changes from the previous year. For those vehicles, prior to receiving updated data from the vehicle manufacturer, labor and parts data from the previous year may be used. The CCC ONE estimator has a complete list of applicable vehicles. Parts numbers and prices should be confirmed with the local dealership. The following is a list of additional abbreviations or symbols that may be used to describe work to be done or parts to be repaired or replaced: SYMBOLS FOLLOWING PART PRICE: m:MOTOR Mechanical component, s=MOTOR Structural component. T=Miscellaneous Taxed charge category. X=Miscellaneous Non-Taxed charge category. SYMBOLS FOLLOWING LABOR: D=Diagnostic labor category. E=Electrical labor category. F=Frame labor category. G=Glass labor category. M:Mechanical labor category. S=Structural labor category. (numbers) 1 through 4=User Defined Labor Categories. OTHER SYMBOLS AND ABBREVIATIONS: Adj.=Adjacent. Algn.=Align. ALU=Aluminum. A/M=Aftermarket part. Bind=Blend. BOR=Boron steel. CAPA=Certified Automotive Parts Association. D&R=Disconnect and Reconnect. HSS=High Strength Steel. HYD=Hydroformed Steel. Incl.=Included. LKQ=Like Kind and Quality. LT=Left. MAG=Magnesium. Non-Adj.=Non Adjacent. NSF=NSF International Certified Part. O/H=Overhaul. Qty=Quantity. Refn=Refinish. Repl=Replace. R&I=Remove and Install. R&R=Remove and Replace. Rpr=Repair. RT=Right. SAS=Sandwiched Steel. Sect-Section. Subl=Sublet. UHS:Ultra High Strength Steel. N=Note(s) associated with the estimate line. CCC ONE Estimating - A product of CCC Information Services Inc. The following is a list of abbreviations that may be used in CCC ONE Estimating that are not part of the MOTOR CRASH ESTIMATING GUIDE: BAR:Bureau of Automotive Repair. EPA=Environmental Protection Agency. NHTSA= National Highway Transportation and Safety Administration. PDR=Paintless Dent Repair. VIN=Vehicle Identification Number. 8/17/2012 9:58:41 AM 097152 Page 4 FISHERS ISLAND FERRY DISTRICT VENDOR 011564 THOMAS KRAFT 09/11/2012 CHECK 694 FUND & ACCOUNT P.O.~ INVOICE DESCRIPTION SM .5710.4.000.300 SM .5710.4.000.300 SM .5710.4.000.300 SM .5710.4.000.300 9887 9887 9887 9887 AMOUNT RP-4524.0 GAL-S3.342200 15,120.11 CT EXCISE TkX-$.5120/GAL 2,316.29 S-F COST RECOVERY .0019 8.60 LUST TAX-$.0010/GAL 4.52 TOTAL 17,449.52 12' AUDIT CHECK NO 694 ~.~ 1~93~5 [' ' DATE ~ t AMOUNT 5o-5~/~ 4 09/i~/2~12 $17,449.52 SEVENTEEN THOUSAND FOUR HUNDRED FOP~y NINE AND 52/100 DOLLARS ORDER OF Town of Southold, New York - Payment Voucher Vendor Tax ID Number or Secial Security Number Dime OII LLC Vendor Telephone Number 203-7544334 Vendor Contact Invoice Number 9887 Date 8/17/2012 Total Discount $15,120.11 i $2,316.291 s8.6oi $4.52; P.O. Box 11125 Waterbury, CT 06703 Net Purch~eOrd~ Amount Claimed Number $15,t20.11 $2,3t6.29 $8.50 $4.82 !Vendor No. 11564 Check No. RP-4824.0 Gal. at 3.342200 CT Excise Tax - $.81201~1al Entered by Audit Date SEP Town Clerk Description of Goods or Services General Ledger Fund and Account Number SM5710.4.000.300 S-F Cost Recovery .0019 LUST Tax - $.0010/gal $17,449.52 $17,449.52 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 Signature__ Company Name 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 or discrepancies noted, and payment is approved. Signature Dime Oil LLC PO Box 11125 · Waterbury,CT 06703 Phone: 203-75~-5334 Date: 08/17/2012 ID, 'T Ir',", ,,:?.* CI, '~ ] IL.. IL ,CS: ]i N V C) il[,S C: EE] Re: Fishers Island Ferry District PO Box H Attn Accounts Payable Fisher's Island, NY 06390- Fishers Island Ferry Dist 5 Water'fr'ont Park-Race Point, New London ACCOUNT NUMBER: AMOUNT ENCLOSED: b,~20165 Page : 1 Teems: NET 30 Days From Invoice Date Date Invoice Char'ges and Credits Amount 08/17/12 9887 #2OR Off Road Diesel ~52&.0 GALS @ 3.3~2200 15120.11 Dyed Diesel Fuel for Off Road Use ONLV. S-F Cost Recover'y State Excise Tax DSL LUST TAX 08/17/12 9887 Fuel Invoice Total Amount 0.0019 8.80 0.5120 2316.29 0.0010 ~.52 174~9.52 Due 174~9.52 **Please include account number' with Fed ID# ~5~111778 payment*** Dime Oil tLC 203-754-533~ Account: ~b20165 - FISHERS ISLAND FERRY DISTRICT VENDOR 013437 MCGUlRE & MCGUIRE 09/11/2012 CHECK 695 FUND & ACCOUNT P.O.~ INVOICE DESCRIPTION SM .1420.4.000.000 10715 LGL THRU-7/5/12-INS CERT TOTAL AMOUNT 175.00 175.00 2 ~ 12 695 $175~00 O0 ~ 50 ~ Town of Southold, New York - Payment Voucher Vendor Tax ID Number or Social Security Number Vendor Address 68 Federal Street Vendor Name ~.O. BOX 270 Vendor No. 13437 Uheck No. Entered by Audit Date McGuire & McGuire Vendor Telephone Number 860-443-4357 Vendor Contact Invoice Invoice New London, CT 06320 Net Purchase Order SEP 1 1 2012 Number Discount Amount Claime~ 81~2012 $175.00' $175.00 Payee Certification 10711 $175.00 $175.00 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 arc excluded Title Number Description of Goods or Services Legal thru 7/,5/t 2 for City of New London Ins Cert General Ledser Fund mid Account Number SMt420.4.000.000 Department Certification I hereby certify that the materials above specified have been received by me in good condition without substi~tion, thc services properly performed and that the quantities tbereof have been verified with the exceptions or discrepancies noted, and payment is approved Signature ~ Title Date McGUI RE & Mc(~UIRE ATTORNEYS AT LAW 68 I~EDERAL STREET POST OFFICE BOX 270 NEW LONDON, CONNECTICUT 06320 TELEPHONE 860-44374357 FISHERS ISLAND FERRY DISTRICT BOX H FISHERS ISLAND NY 06390 Page: 1 August 02, 2012 Statement No: 10715 City of New London 06/29/2012 07/03/2012 07/05/2012 Telephone call to Lauren at City; e-mail to her; E-mail to City; Telephone call to Gordon; e-mail to him; review certificate from Gordon and reply; For Currant Services Rendered Total Current Work 175.00 175.00 Balance Due $175.00 FISHERS ISLAND FERRY DISTRICT VENDOR 014232 NYS DEPT OF LABOR-UI DIV 09/11/2012 CHECK 696 FUND & ACCOLTNT P.O,# INVOICE DESCRIPTION SM .9050.8.000.000 04643094-IN2ND INTEREST-2ND QTR-DOHERTY TOTAL AMOUNT 25. 88 25.88 FIVE AND ]gS/IQ'g CBECK 'NO. 696 O'9/I~Y20!2 $25.88 ' Town of Southold, New York - Payment Voucher Vendor Tax ID Number or Social Security Number Vendor Name New York State Unemployment Insurance Vendor Telephone Number Vendor Contact Invoice 04-64309-4 8/22/2012 Total $20.881 $25.88~ Discount Payee Certification 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 the Town is exempt are excluded. Vendor Address P.O. Box 4301 Signature ~--~ Title ,~n~ CompanyN e / f-f Date Vendor No. Binghamton, NY t3902-4301 N~ Pumhase Order Amoum Claimed Numar $26.88 $25.88 14232 Check No. Entered by ~ Audit Date SEP 1 I 2012 Description of Goods or Services Interest on Unemployment 8M9060.8.000.000 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 w~th the exceptions or discrepancies noted, and paymem is approved. Signature ~~ NEH YORK STATE UNENPLOYMENT INSURANCE PO BOX q301 8INGHAMTON NY 15902-q501 For Otlice Use Only x u FISHERS ISLAND 1~[ ~["~JJ~- ,v,,, '~ ': --~-111 I~dployer Reg. No. Account Status as of FERRY DISTRICT JJlj~l , iii Iii Oq-6qS09 q 08/22/12 SOUTHOLD NY 11971-095~!{ {; ~11/~ g v ')i330 Notice of Reimbursable Billing _._~~ For Completion by Employer Enter Payment Any amounl now due for Unemployment Insurance Benefil Reimbursemenl charges, interest or pena ly s shown be ow as "CmTenl Balance" preceded by the word "Underpaid." A check for this amotml plus any addilional inlerest should be mailed promptly. Enter the payment amount in the employer box above and return this form with your payment. if the amount shown as "Current Balance" is preceded by the word "Overpaid" you will be receiving a refund of this overpaymenL Paymenl on current quarter charges shown as "BR" is due by the end of the month following the end of the quarler or 15 days from the billing dale, whichever is later. This notice does not inclede amounls assessed for Failure to File Penallies or Benefit Claim Penallies. If you have penalties due you will be advised by separale notice. Interest is assessed on late payment of benefil reimbursement charges at the rate of 12 percent per year. Charge Notices, IA 96R, included in billing are dated: 1012 02/03/12through 04/06/12 2012 05/04/12 through 07/06/12 YourPreviousBalanceWas UNDERPAID ~5,211.00 3Q12 08103/12through 10105/12 4Q12 11/02112 through 01/04113 The symbols in Transaction Col 1 Column 1 show Clairnanl Date Period Type Column 2 Column 3 the type of SS Accl # of Amount Due Amounl Paid j liability Liab BR- Benefit Reimbmsement IN- Inlerest PR- Penalty BR '5,211,00 IN $25.88 IA 126R (02-12) UNDERPAID ~25.88 Richard Marino, Director Unemployment Insurance Division NEN YORK STATE UNEMPLOYMENT INSURANCE FO BOX qSO1 BINGHAMTON NY FISHERS ISLAND FERRY DISTRICT PO BOX 1179 SOUTHDLD NY 11971"0959 NOTICE OF OVERDUE TAXES This notice does not include penalty amounts assessed after January 1, 2001. If you have additional penallies due. you will be advised by separate notice. For Office Use ORly Dist. Ind. Assign. Type Form Type T M U Received Date CI Al Employer Reg, No. Account Status as of 0E~-6 q509 ~' 08/06/12 FOR COMPLETION BY EMPLOYER You were previons[y notified that you owe the amount due shown below Unless you pay the arDount due or arrange for prompt payrnent, we will begin colleclion action. Ir] this process il may become necessary to issue a warrant which when (tocketed with the COUldy clerk would become a judgmenl and a lien upon all ~eal property and chattels real, Fudhermore, the warranl becomes a matter of public record and may seriously affect your cledit rating In addition, inlerest must be assessed on late payment ot contributions, re-employment service fund amounls and benefit reimbursemenl cha[Des as applicable at tim rate of 12 percent per year h'om the date due to the date paid This notice is for lhe amount our records show as due It does nol Jelieve you ot legal liabilily for any additional areounts which may later be due for periods prior to the date of this notice EXPLANATION: lHE QUARTER AND YEAR FOR WHICH PAYMENT IS DUE ARE SHOWN IN COLUMNS I AND2 AND THE TYPE OF LIABILITY IS SHOWN IN COLUMN 3. CD-CONTRIBUTIONS (INCI.UOER THE RE-EMPLOYMENT AC-ANNUAL CONTRIBUTIONS lAS-INTEREST ASSESSMENT SURCHARGE INJNTEREST PE-PENALTY BR~BENEFIT REIMBURSEMENTS CLAIMANT'S S,S. ACCT NO. COL. 2 gl)L, 3 tLAST 4 DIGITS) YEAR TYPE AMOUNT DUE 12 BE 5,175.~6 12 IN $5,6q [~_~U..HAVE ALREADy MADE PAYMENT FOLZUE AMOUNTS ;HONN~ P_LEASE DISREGARD THIS NDTICE.~ Use this form for payments only. Do not mail inquiries. Please call 1-800-456-1015 for assistance. 186 11 CURRENT BALANCE TOTAl: ~5,211.00 INTEREST TO DATE OF THIS NOTICE: GRAND TOTAL: ~5~ 221 . .55 ADDITIONAl. DAILY INTEREST OF ,~ 1.71 SHOULD BE ADDED TO GRAND TOTAL WHEN PAYING Richard Marino, Direclor Unemployment Insurance Division lGordon Murphy/ · From: Sent: To: Subject: Attachments: Cushman, John <John.Cushman@town.southold.ny.us> Wednesday, August 15, 20].2 2:5]. PM Gordon Murphy NYS Unemployment FIFD U! Statement.pdf Hi Gordon, The attached statement arrived today. Note the interest due. John John Cushman Town Comptroller Town of Southold 631-765-4333 http://southoldtown.northfork.net/Acct-Fin.htm THIS DOCUMENT IS INTENDED ONLY FOR THE USE OF THE INDIVIDUAL OR ENTITY TO WHOM IT IS ADDRESSED AND MAY CONTAIN INFORMATION THAT IS PRIVILEGED AND CONFIDENTIAL, OR THAT CONSTITUTES WORK PRODUCT AND IS EXEMPT FROM DISCLOSURE UNDER APPLICABLE LAW. IF YOU ARE NOTTHE INTENDED RECIPIENT, YOU ARE HEREBY NOTIFIED THAT ANY USE, DISSEMINATION, DISTRIBUTION, OR COPYING OF THE COMMUNICATION IS STRICTLY PROHIBITED. IF YOU HAVE RECEIVED THIS COMMUNICATION IN ERROR, PLEASE NOTIFY US BY TELEPHONE 63~.-765-4333 AND DESTROY THE DOCUMENT. THANK YOU. NEW YORK STATE DEPT OF LABOR UNEMPLOYMENT INSURANCE DIVISION GOVERNOR W AVERELL HARRIMAN STATE OFFICE BUILDING CAMPUS ALBANY NY 12240 www.labor.ny.gov 63O FISHERS ISLAND August 27, 2012 In reply refer to: CAC ER~ FERRY DISTRICT TOWN OF SOUTHOLD ACCOUNTING & FINANCE PO BOX 1179 SOUTHOLD NY 11971-0959 Dear Employer: A review of the above referenced account disclosed an amount due of $25.88 as of August 24, 2012. The amount due is the result of unpaid interest for the second quarter of 2012. Please remit payment payable to NYS Unemployment Insurance Division to the following address: New York State Department of Labor Unemployment Insurance Division State Campus, Building #12, Room 256 Albany NY 12240 To ensure proper allocation of your payment, please include your eight digit Employer Registration Number (E.R#) on your check and use the enclosed IA 1.6. If you have any questions or wish to pay by telephone, please feel free to contact us at 1-800-456- 1015 or NYS 1-518-457-5789. Enc: iA1.6 Sincerely, Tax Compliance Representative Central Assignment and Collection Section (518) 457-5789 New York State Department of 'Labor Unemployment Insurance Division Employer Payment Transmittal FOR OFFICE USE ONLY ASSIGN. TYPE DIST. IND. T FORM TYPE U RECEIVED DATE CI Al ER#:04-64309 4 FOR COMPLETION BY EMPLOYER ENTER PAYMENT [~~L~ ~ AMOUNT ENCLOSED ENTER YOUR EMPLOYER REGISTRATION NUMBER ON YOUR REMI'FI'ANCE PAYABLE TO NYS UNEMPLOYMENT INSURANCE RETURN THIS FORM WITH YOUR PAYMENT TO: NewYork State Dept. of Labor UI Division Central Assignment and Collections Bldg 12 Room 256 Albany NY 12240-0356 Signature: Title: Telephone Number: Form IA 1.6 (CACS) Page 1 of 1 Whitecavage, Diana From: Whitecavage, Diana Sent: Thursday, August 30, 2012 2:51 PM To: 'Gordon Murphy' Cc: 'J Miller' Subject: FI Unemployment Notice 8/27/12 Attachments: FI UNEMPLOYMENT NOTICE_20120830145052.pdf Gordon, Please see the attached. Please fill out the form IA 1.6 and submit with the check once received after the 9/11/12 audit. Thank you, Diana V~hif¢cavage Account Clerk Town of 5outhold 8/30/2012 FISHERS ISLAND FERRY DISTRICT VENDOR 016659 PRINCIPAL LIFE GROUP FUND & ACCOUNT P. 0. ~ INVOICE 09/11/2012 CHECK 697 SM .9060.8.000.000 DESCRIPTION H19730-1-0912 LIFE PREM-9/12 TOTAL 108.06 108 . 06 'og/Lt/2 0t~ $108':06 ~l'0OO~q?~l. ,:081, t, OS[,&L,,: ~=6 O0~50a Town of Southold, New York - Payment Voucher Vendor To.x 1D Number or Soeial Security Number Principal Life GrouP Vendor Telephone Number 800-843-1371 Vendor Contact Vendor No. 16659 Vendor Address P.O. Box 14513 Des Moines, IA 50306-3813 Check No. Entered by &~ Audit Date SEP 1 1 2012 Number H19730-1 Invoice Date 8/1712012 Invoice Net Total ' $108.06 Discount 'Amount Clmmec $108 06 ~ Purchase Order Number Description of Goods or Services Life Prem 911/12-9/30112 General L~dg~r Fund and Account Number 8M9060.8.000.000 $108.06 $108.06 Payee Certification The undersigned (Claimant) (Acting on bebelf of the above named claimant) does hereby cer[ify that the foregoing claim is true and correct, that no part h~s been paid, except as therein stated, that the balance therein stated is actually due and owing, and that t~xes from which the Town is exempt are excluded. Signature~ Title ~ Company Name ~ 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 bare been verified with the exceptions or discrepancies noted, and payment is approved. Signature Title Group Principal Financial Group Des Moines, IA 50392-0001 Principal Life Insurance Company PREMIUM STATEMENT This statement in no way changes the contract or waives any overdue paymenl Account Number H19730-1 Lb, No. 0819730 00001 93 Due Date 09/01/12 StmtDate 08/17/12 Billing Period 09/01/12 - 09/30/12 000145 FISHERS ISLAND FERRY ATTN NINA SCHMID PO BOX H FISHERS ISLAND NY 06390 Please Pay Balance Due $ 216.12 PLEASE REVIEW ALL MESSAGES BELOW. THEY CONTAIN INFORMATION RELATED TO YOUR PREMIUM PAYMENTS AND THE ADMINISTRATION OF YOUR PLAN, IF YOU HAVE QUESTIONS REGARDING ANY DF THESE MESSAGES, PLEASE CONTACT US AT THE NUMBER LISTED BELDW. IT IS IMPORTANT TO REPORT NEW ENROLLMENTS, TERMINATIONS, AND CHANGES IN DEPENDENT STATUS PROMPTLY TO OUR WEBSITE AT WWW.PRINCZPAL.COM OR NOTIFY OUR ADMINISTRATIDN AREA. WEB REPORTZNG 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 08/31/12. 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. "inancia/ Group TH1'S ZS YOUR COPY. Principal Financial Group Principal Life Des Mo nes, A 50392-0002 Insurance Company PLEASE KEEP FOR YOUR RECORDS. PREMt*UM STATEMENT This statement in no way changes the cor~tract or waives any overdue payment ACCOUNT NO. H19730-1 FISHERS ISLAND FERRY LB. NO. 0819730 00001 93 OdE DATE: 09/01/12 STMT DATE: 08/17/i2 )20098292 TRAUB dAME ~UMMARY TOTALS - TOTAL COVERED 17 .IFE / AD&D PREMIUM TOTALS $108.06 CHARGE/ CREDIT 108.06 FOR ASSISTANCE, PLEASE CALL TOLL FREE: 1-800-843-1371 F396GP-4 ACCOUNT NO, H19730-1 O9/O1/2012 000 000000 oooooo CGS631822301176477001002 0000361 002 o~ 002 FISHERS ISLAND FERRY DISTRICT VENDOR 017991 RACE ROCK GARDEN CO. 09/11/2012 CHECK 698 FUND & ACCOUNT P.O.~ INVOICE DESCRIPTION AMOUNT SM .5709.2.000.000 15245 RPRS ON HDG TRMMR,W/W'S 223.57 TOTAL 223.57 4 6,98 $~23 ~57 "000 Town of Southold, New York - Payment Voucher Vendor Tax ID Number or Social Securliy Number Vendor Name RACE ROCK GARDEN COMPANY, INC. Vendor Telephone Number Vendor Contact Invoice Number 15245 Invoice Date 713t/2012 Invoice Total Discount $223.57 $223.57 , $223.57 Payee Certification Thc 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. Signature~ Title ~ Company Name .t~ Date ~-~ ~ Vendor No. Vendor Address P.O. Box 517 FiShers Island, NY 05390 Net Purchase Order Amount Claime~ Number $223.57 17991 Check No. Entered by Audit D~e SEP 1 1 2012 Description of Goods or Services Mechanic on Sthil Hedge Trimmer, Echo Weed Wacker Trimmer Head, and Poulan Weed wacker General Ledl~er Fund and Account Number $M5709.2.000.000 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. litle ~ Date Race Rock Garden Company, Inc. PO Box 517 Fishers Island, NY 06390 Invoice Date Invoice # 7/31/2012 15245 Bill To FI Ferry District Drawer H Fishers Island, NY 06390 Project Terms Account # Net 30 23 Quantity Serviced Description Rate Amount I 4/30/2012 Mechanic - sthil her~ge trimmer 75.00 75.00 I carb kit 18.53 18.53 0,5 5/12/2012 Mechanic - echo weed wacker 75.00 37.50 1 spark plug 4.18 4.18 I trimmer head 47.08 47.08 0.5 Mechanic - poulan weed wacker 75.00 37.50 I spark plug 3.78 3.78 Phone # Fax # I-mail Total$223.57 631-788-7632 631-788-7634 rrgarden~fishersisland.net FISHERS ISLAND FERRY DISTRICT VENDOR 019267 DEBORAH S. SHILLO 09/11/2012 CHECK 699 FUND & ACCOUNT P.O.# INVOICE DESCRIPTION SM -5710.4.000.000 080112 REC.MINUTES-COMM MTG-JUL TOTAL AMOUNT 756.25 756.25 ~8 OD l, SO 8 Check No. Town of Southold, New York - Payment Voucher Vendor Tax ID Number or Social Securiiy Number Deborah Shillo Vendor Telephone Number 6fl0-242-25t 4 Vendor Contact Number Total Discount $756.25 ~ High Wood Road Bloomfield, CT 06002 Net Purchase Order Amount Claime¢ Number $756.26 V~nd~r No. 19267 Description of Goods or Services Recorder of minutes Comm. Mtgs $0.25 hfs ~ $ 25.00 See adding tape the last ~/16/12 the .25 hour was not added into the iotal Entered by Audit Date SEP 1 1 2012 General Ledger Fund and Account Numl~r SM6710.4.000.000 $756.25 $756.25 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 lown is exempt are excluded Signature e~_~~ Title ~ Company Nam Date~'~ ~ / L Department Certification i hereby certify that the real. rials above specified have beeh',r~eived by me in good condition without substitution, the services pro performed and that the quantities thereof have been verified 72~ or discrepancies noted, and payment is approved. Signature Title Date / 2012 Deborah Shillo 26HighWood Rd. Bloomfield, CT 06002 860 242 2514 $25.00 Hr. JULY TOTAL $750.00 Date lO-Jul ll-Jul ll-Jul 12-Jul 174ul 18-Jul 19-Jul 20-Jul 23-3ul 24-Jul 27-Jul 30-Jul 3-Aug 8-Aug 9-Aug 16-Aug Description 7/3 tape 7/3 tape min spec meeting 7/11 min emails 7/17 meeting 7/17 final 7/3,7/1 lmin emails emails 6/19 & resoluti 7/17 tape 7/18 spec meeting min 7/19 templete & min 7/24 meeting & rain 7/17 tape & 7/30 set up 7/30 meeting 7/30 min emails 7/17,7/24 final 7/30 tape 7/30 final Hours TL 3. $75.00,/ / 3. 575,00 1.5' $37.50/ 0.5 512.50/ 2.5 $62.50// 1.5 $37.50/" 2 $50.00 / 1 $25.00`// 0.5 $I2,50 ~/ 0.5 $~2,50 -/ 5 $125.00~/ 2 $50.00 '/ 2' 550.00 / 2' $50.00 /' 1 525.00 / 2' $50.00 / 0.25 $6.25 / FISHERS ISLAND FERRY DISTRICT VENDOR 019719 STAPLES CREDIT PLAN 09/11/2012 CHECK 700 FUND & ACCOUNT P.O.# INVOICE DESCRIPTION AMOUNT SM .5711.4.000.000 SM ,5711,4.000.000 SM ,5711,4.000.000 3034501001 FI OFFICE SUPPLIES 134,51 3462686001 FI OFFICE SUPPLIES 22.97 3517285001 FI OFFICE SUPPLIES 39.99 TOTAL 197.47 '~'000700"' ,:O~hOSC~'L,I: ~8 00~508 ~,1,, Town of Southold, New York - Payment Voucher Vendor Tax ID Number or Social Security Number Vendor Address STAPLES CREDIT PLAN Dept 51-7820657673 PO Box 689020 Des Moines, IA 50368-9020 Vendor No. 19719 Vendor Telephone Number 800-767-1291 Vendor Contact Invoice Net Purchase Order Total Amount Clalmec Number $134.51 $134.51 Invoice Invoice Number Date 3034501001 7/21/2012 3462686001 8/3/2012 3517285001 8/6/20t2 $22.97 $22.97 $39.99 $39.99 Check No. Entered by ~ Audit Date SEP 1 1 2012 To rk ~ . Description of Goods or Services FI Office Supplies FI Office Supplies FI Office Supplies SM5711.4.000.000 $197.47 $197.47 Payee Certification 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 the Town is exempt arc excluded Signature ~ Title ~ Company Name 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 payment is approved SignaVare Title that was easy~. Cuatomer Service: slaples.sccountonllne.corn I Account Inqulri~: 1-80~-767-1291 Fax 1-801-7'/9-7425 AccoUnt Statement CommerCial FISHER ISLAND FERRY DIST Summary of Account Activity Previous Balance $0.00 Payments -$596.45 Credits -$0.00 Pumhases ~$197,47 Debits +$1,648.74 FINANCE CHARGES +$0.00 Late Fees +$0.00 New Balance $1,249.76 BO~d Notre of Billlag Eh'Ors amd Customer Sen~lce Imluln~e~ to: I STAPLES CREDIT PLAN I PO Box 790449, St. Louis, MO 63179-0449 What's on your ~ new billing ~ statement? ~ -- TRANSACTIONS 07/21 ~923(X)34501_000-001 pUTNAM CT PAYMENTS, CREDITS, FEES AND ADJUSTMENTS Payment Information Current Due Past Due Amount Minimum Payment Due Payment Due Date JCredit Line Credit Available Closing Date Next Closing Date Days in Billing Period $53.00 + $0.00 = $53.00 09/03/12 $10,500 $9,250 08/09/12 09/07/12 31 Please see enclosed sample for additional information on how to read your statement. 22.97 39.99 ;- zz NOTICE: SEE REVERSE SIDE FOR IMPORTANT INFORMATION Page I of 6 Thl~ Account Is h~ued by Citibank, N.A. Information About Your Account. purchases, but not on cash advances, l'flis is called a grace period on purchases, rbe grace period is at least 20 days. To get the glare period on purchases, pay the followind amounts by the due date every billing period: the New Balance (subject lo the Piomotiona] Balance Exceptions), plus the Fninimum monthly payments required for youl No Interest and 0% balances. If you do not, you will not get d grace period (mless you pay those amounts by the due date for fwo billing periods tn a row. The two Promotional Balance Exceptions are: (1) You (Jo not have lo pay any No Interest or 0% balances lhat do not expire by the Next Closing Date shown on the billing statem~nL (2) You can pay any No Interest or 0% balances that do expire by the N(xt (:losing Date spawn on the statement by the later of the plomotion's expiration date or the sfatement's payment due date. In addition, certain promotional offers may take away tile grace period cn pulchases, Other p~omotional offals, in addition to No interest arid 0% hay;rig to pay all or a portion of the promotional balance by the due data. If either is the case, the promotional offer will describe what happens. Balance Subject to Finance Charge. We calculate periodic finance chalges TO get a daily balance, we start with the balance as of the end of the balance any periodic finance charge on the previous day's balance. (~his method (including new transactions). We figure the periodic finance charge by multiplying the daily balance by its daily periodic rate. We do this for each day in the billing period, lbo Balance Subject to Finance Charge ts tile avelage of the daily balances during the bi!ling period. If you multiply td~s figure for each balance by its daily periodic rate and by tl~e number of days in lhe billing period, the resulf is the total peliodic finance charge on that balance Rounding may causeasmalldiflerence. Notify Us in Case of Errors or Questions About Your I]i11. If you think your billing statement is wrong, or if you need more information about a tlansaction on your' billing statement, write to us (on a separate sheet) as possible, We must hear from you in writing no later than 60 days after we Important Payment Instructions. processing faci!ity by 5 o,m. local time there if we do it will b( credited as of that day. A payment received at the p~ocesslng facility in proper fo~m after that time will be credited as of the next day. Allow 5 to 7 days for payments by regular mail to reach us. There may be a delay of up to 5 days in cra&ting address, fl~e correct address for a payment sent by regular mail is the address listed on the return envelope or on the front of the payment coupon A paymenl made in-store is not sent to the correct address, The correct address for a payment sent by courier or express mail is the Express · Enclose a valid check or money order No cash, gift cards, or foreign If you send an eligible check with this payment coupon, you authorize us to complete your payment by electronic debit~ if we do, the checkin~J account will be debited in the amount on the check. We may do this as soon as the day we receive the check. Also, the check will be destroyed. Copy Fee. We chargeS5 for each copy ofabiIHr~gstatement hat dates back Payment Options Other Than Regular Mail · Online Payments. Visit the web address on tl~e fronl and ~;icln up online payments. Enrollmerlt may takea few days If we receive you~ request to make an online payment by 5 p,m. Easte~ n time, we will credit your payment as of that day. If we receive your request to make an online payment after that time, we wH[ credit your payment on the next day. Par your first online payment. · Pay by Phone Service. You may use this service any tm~e to make a payment by phone. You wilt be charged $14,95 to use this serwce, Call by 5 p.m. Eastern time to have your payment credited as of that day. [f you call after that time, your payment will be credited as of the next day, We may process you~ payment elechonically after we verify your idanlity. the Expless Payments address: Customer Service Center; Dept. CCS 922, 4740 1Erst Street, Urbandale, IA 50323. Payment must be received proper form, at the ploper address, by 5 p,m. Central time itl order to be credited as or that day. All payments received in Draper rolm, at the proper address, after that time will be credited as of lhe next day. Report a Lost or Stolen Card Immediately. You may ca!l C Js[omer Service 24 hours a dayr 7 days a week Account: **** **** **** 7673 TRANSACTIONS (cont,) 07f24 PAYMENT - THANK Y0U P9i~09DBLTMJ $ 496121- FINANCE CHARGE SUMMARY Your An.ua! Pementage Rate (APR) ~ ~ annu~ i~er~ r~e on your account. PURCHASES "~n) Rate Fl,alice C~ Rnalme Charge I REGULAR REVOLVING cREDIT PLAN O.0(TYo 0.00000% $o,00 $0.00 Page 3 of 6 1-800-767-1291 staples.accountonline.com Account: **** **** **** 7673 Your new statement: Clear. Concise. Simple to read. Clear. Statements show you exactly how much you've spent, how much you owe, when you owe it anc~ your available credit. Plus our new format providea you with more offers and oroduct information, all highlighted in color Concise. The information is 'bucketecl" i~o sec'dons that make it simple to find what you're looking for and is written ir normal, everyclay language. Simple to read, Not only are ne words themselves clear ano concise, they're in large ano simple TO r~aQ type face. Summary of Account A quick, complete view of your account - all in one place Payment Information Shows what you owe, due dates and minimum payment information Account Number and Contact Information This number identifies your account, and Contact Information tells you where to get fast answers Transactions, Spelts out your purchase activity, including dates, locations and amounts Payments, Credits, Fees and Adjustments A record of payments you've made, credit adjustments, fees and finance charges affecting your account INVOICE DETAIL Invoice Detail Displays products purchased in this billing period, quantities, prices and invoices CRC JUL12 Page 4 of 6 1-800-767-1291 stap/,es.accountonline.com that was easyr INVOICE DETAIL BILL TO: Acct: 6035 5178 2065 7673 PRODUCT SHIP TO: DEB DOUC~ I I ~ FISHERS ISLAND FERRY 261 TRUMBULL DR FISHERS ISLAND, NY 0(XXX~O000 SPLS 8.5Xl 1 COPY CS HP 951 COLOR iNK 3 PACK HP 950XL BLACK INK JULY 12 BUSINESS BUILDER ASTRO 8.5Xll PULSAR PINK SKU # BILL TO: Acct: 6035 5178 2065 7673 0001~ ~3648~ 0(O364~37 ~395335 000491620 Purchased by: DEB DOUCETTE Amoultt Due: PO $134.51 Tra~s Da~: DUE DAI~E: 07/21/12 09~3/12 Invoice #: 3034501001 I Store: 100088887, PUTNAM QUANTITY UNIT PRICE TOTAL PRICE SHIP TO: DEB DOUCE ~ ~ L FISHERS ISLAND FERRY 261 TRUMBULL DR FISHERS iSLAND, NY 000~0000 PRODUCT SKU# PREMIUM STAPLES CHISEL 1/ 000108985 JULYAUGSEPT 2012 PITNEY B 000676748 PLND SPRNGS WATER OFFICE 000713140 K-CUP BREAKFAST BLEND 18/ 000777824 1.0000 CT $37.79 $37.79 1.0000 EA $51.22 $51.22 10000 EA ~.22 $3,3.L~ 1.0000 EA $5.00 $0.00 1.0000 RM $12.14 $12.14 SUBTOTAL $134.51 TAX $0.(~3 SHIPPING $3.99 TOTAL $1~4.51 BILL TO: Purchased by: GORDON MURPHY Amount Due: PO: $22.97 ITrezts ~ DUE DA'FE: 08~3/12 09/03/12 Invoice #: 3462~1 I Store: 100088887, PUTNAM QUANTITY UNIT PRICE TOTAL PRICE 1.0000 BX $3.22 $3.99 1.0(~30 EA $0.00 1.0000 CT $6.99 $6.99 1.0000 BX $11.99 $11.99 SUBTOTAL $22.S? TAX $3.99 SHIPPING $0.00 TOTAL $22.97 SHIP TO: I I DEB DOUC~I I~. Amount Due:I FISHERS ISLAND FERRY 261 TRUMBULL DR ~39.99 FISHERS ISLAND, NY 00000-0000 PO: PRODUCT SKU# SEB BATH TISSUE 80/PK 000375681 Purchased by: GORDON MURPHY Trans Date: DUE DA~E: Invoice #: 3517285001 [S~re: 100088887, PUTNAM QUANTITY UNIT PRICE TOTAL PRICE 1.0000 CT ~.22 $39.99 SUBTOTAL $,39.99 TAX $o.o0 SHIPPING $5.~ TOTAL $39.99 Page 5 of 6 1-800-767-1291 stapt~.accountonline.com This page intentionally left blank. Page 6 of 6 1-800-767-1291 stapies .eccounlonline.c.~m 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. REFER TO THIS ORDER NO. FOR ALL INOUIRIES I STAPLES that was easy SHIPPING LOCATION: Putnam, CT FC FISHERS ISLAND FERRY DISTRICT DEB DOUCETTE ~ TOTAL PACKAGES: 2 261 TRUMBULL DR FISHERS ISLAND, NY 063908021 Contact; (631) 788-7463 - DEB DOUCETTE PA~E: 1 Order Date: 07/21/2012 go and other adjustments are deducted after the Merchandise Total. ~n/~e orders some boxes may be arriving in separate shlpments. i ;~/58¢~ SPLS 8,~x11 coP~ cs /13~8~8-~ CT 1 1 37.79 37.79 Please tell us how w~'re doing for a chance to win $2500! TO participate co to WWW.SURVEY4STAPLES.COM and enter Survey Code 9230034501 For rules visit www.survey4staples.com. 2 364836 HP 951 COLOR INK 3 PACK ~ /CR314FN#140 EA 1 1 51.29 51.29 3 364837 HP 950XL BLACK INK ;,// ,~N045AN#14//~, 0 EA 1 1 33.29 33.29 5 491620 ASTRO 8.5Xll PULSAR PINK R~ '~//21031/21628 RM 1 1 12.14 12.14 Thank You For Your Order! Staples, 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. 4051825224 7/23t12 9230034501-000001 STAPLES that was easy FISHERS ISLAND FERRY DISTRICT DEB DOUCETTE Floor: 1 261 TRUMBULL DR DRAWER H FISHERS ISLA/gD, NY 063908021 Contact: (631) 788-7463 - DEB DOUCETTE SHIPPING LOCATION: Putnam, CT FC CARRIER ROUTE:UPS/UPS /U2 TOTAL PACKAGES: 2 PAGE: 2 Order Date: 07/21/2012 M ~=rc] andise Total ....... 134.51 D_=li~ ery ................. 00 Check your order statu: online by going to www. Staples.com and clicking on "My Orders". 00~ Thank You For Your Order! Staples, Inc. THIS IS NOT,4N 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 ISLA/fD FERRY DISTRICT 1 DEB DOUCETTE Floor: 1 261 TRUMBULL DR FISHERS ISLAND, NY 063908021 Contact: (631) 788-7463 - DEB DOUCETTE REFER TQ THIS ORDER NO. FOR ALL INOUIRIES 4051825224 8/03~12 9230462686-000001 CT FC CAI~Z ER ROUTE:UPS/UPS /U2 TOTAL PACKAGES: 2 Order Date: 08/03/2012 Coupons and other adju~ ments are deducted after the Merchandise Total. On large orders some bcxes may be arriving in separate shipments. 1 108985 PREMIUM STAPLES CHISEL 1/4 /35450 BX 1 1 3.99 3.99 3 713140 PLND SPRNGS WATER OFFICE BX 24/101252 CT 1 1 6.99 6.99 4 777824 K-CUP BREAKFAST BLEND 18/BX /15554/0520 BX 1 1 11.99 11.99 M, ~rcl landise Total ........ 22.97 D,~li- rery ................. 00 T, ~x ..................... 00 Check your order status online by going to www. Staples.com and clicking on "My Ord(rs". ~ Need to return something? Please .as~asw call Customer Service to process TOTAL VALUE '~' a return. OF ORDER: 22 . 97 00~ Thank You For Your Order! Staples, Inc. THIS1S NOT AN INVOICE · Staples.corn® I Printable Order Summary Page 1 of 2 that wes easy~, Printable Order Summary Thank You for Your Order For complete details of your order, including estimated tax and delivery info, be sure to check for an email from Staples at the address below. Order confirmation will be sent to: ddoucette@fiferry.com Order number 1:9230517285 Order date: August 6, 2012 You'll also find complete details of this order in the Order Status section of My Account. Shipping Address Deb Doucette Fishers Island Ferry District 261 Trumbull Dr Drawer H Fishers Island, NY, 06390-8021 (631) 788-7463 Not going to be around to receive or sign for your order? Please fill out a Driver Release Agreement: http://www.staples.com/sbd/content/help/shipping/nothome_popup.html Billing Address Gordon Murphy Fishers Island ferry District 261 Trumbull Dr Fishers Island, NY, 06390-0607 (631) 788-7463 Your order may be sent in different shipments. If it is, no additional charges will apply. Order number: 9230517285 Item I Sustainable Earth by StaplesTMStandard Expected business-day Qty: 1 Price: 37568! IBath Tissue, 2-Ply, White, 80/Case ~'delivery: Wed 08/08 at $39.99 $39.99 80/Case I suutom: $a9.99 Coupons: $0.00 Estimated Tax: Tax Exempt Delivery: $0,00 Total: $39.99 Remaining Balance: $39.99 https://www.staples.com/office/supplies/orderconfprnt?catalogld=10051 &orderId= 1530427... 8/6/2012 " Staples.com® I Printable Order Summary Page 2 of 2 Remaining Balance will be applied to following: Staples Credit Card ending in 5882 Hold on to your Staples Rebate Visa Cards and Prepaid Gift Cards until your order has been received If you have any questions or concerns about your order, please call 1-800-STAPLES (1-800-782-7537) or email support@orders.sta pies.corn Important information concerning coupons and sales tax can be found at: http://www,staples.com/salestax The tax shown is estimated. Your Order Confirmation Email will include shipment details, product availability and estimated tax. Important information concerning return policy can be found at: http://www.staples.com/sbd/content/help/using/returns policy popup,html This Web site is intended for use by US residents only. See Tnternational Sites. See our delivery policy for full details. Copyright 2012, Staples, Inc., All Rights Reserved. Questions? Call 1-800-STAPLES (1-800-782-7537) or email us. Site Nap I RSS Feed I AdChoices https://www.staples.com/office/supplies/orderconfprnt?catalogld=10051 &orderId= 1530427... 8/6/2012 FISHERS ISLAND FERRY DISTRICT VENDOR 020151 TECHNICOLOR, INC. 09/11/2012 CHECK 701 FUND & ACCOUNT P.O.# INVOICE DESCRIPTION AMOUNT SM .7155.4.000.000 85654994 FILM DEL/PU FEES 300.00 TOTAL 300.00 $300. O0 Town of Southold, New York - Pal ment Voucher Vendor Ta~ ID Number or Social Security Number TECHNICOLOR, INC. Vendor Telephone 800-993-4567 Vendor Contact invoice Invoice i Vendor No. 20151 Vendor Address Department 848498 Los Angeles, CA 90084-8498 Net Purchase Order Check No. Entered by ~ Audit Date SEP 1 1 2012 Number Date : Discount :AmountClaime~ Total 85654994 8/13/2012 $300.00 $300.0{] $300.00 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. $300.00 Signature ~ _ Title Company Nan~ -~fp Date Number Description of Goods or Services Film OellPU Fees General Leds~r Fund and Account Number SM7155.4.000.000 Department Certification I hereby certify that the materials above specified have been received by me in good condition w~thout 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 t, h i i _ec..n.co.or Page: 1 of 1 INVOICE TO: Shipped To: 1000448 Community Zhtr New London, CT 06320 Conlmunit y Thtr Po Box 607 Circuit or Fishers Island, NY 06390 9wner 1000448 i 08/13/12 : 85654994 i 08/27/12 PRINT MANAGEMENT DR. SEUSS THE LORAX 35 r~m Film 1 25.00 8151599 07/26/12 128FYllS0322817813 Print BRAVE 35 ~ Film i 25.00 8157188 08/02/12 1ZSFYllS0322908251 Print ANLAZING SPIDER-MAN 35 mm Film 1 25.00 8158929 08/01/12 1Z8FYl150322908537 Print PROMETHEUS 35 ~ Film 1 25.00 8158929 08/01/12 1ZSFYl150322908555 Print THE DICTATOR 35 ~ Film 1 25.00 8157187 08/08/12 1Z8FYl150323018854 BEST EXOTIC MARIGOLD HOTEL 35 ~ Film 1 25.00 8157187 08/08/12 1ZSFYl150323018934 Print WANDERLUST Print Return 1 25.00 8151599 07/26/12 1Z8R7Y657822810064 (PM) WE BOUGHT A ZOO Print Return 1 25.00 8154078 07/27/12 1ZSR7Y657822812124 (PM) MADAGASCAR 3 Print Return 1 25.00 8154079 07/31/12 1ZSR7Y657822816880 (PM) BATTLESHIP Print Return 1 25.00 8157188 08/02/12 1Z8R7Y657822868780 (PM) DR. SEUSS THE LOP. AX Print Return 1 25.00 8154080 08/06/12 1Z8R7Y657822912892 (PM) PROMETHEUS Print Return 1 25.00 8157187 08/08/12 1Z8R7Y657822975039 (PM) S~/bt otals: 0 00 0.0 0.©0 330.00 300.00 Packag .ng Materials Sales Iax ShiDping Subtotal FOR ADDRESS CORRECTIONS: 0;00 0~00 0.00 300.00 300.00 1 800 99-FILMS TECHNICOLOR, INC. Department 848498, LOS ANGELES, CA 90084-8498 1000448 08/27/12 I 85654994 08/13/12 I PAY 300. O0 THIS AMOUNT 1-800-99VILMS (993-4567) FISHERS ISLAND FERRY DISTRICT VENDOR 021506 UNITED PARCEL SERVICE 09/11/2012 CHECK 702 FUND & ACCOUNT P.O.# INVOICE DESCRIPTION SM .5710.4.000.700 26639332 W/E 8/18/12 (14) TOTAL AMOUNT 512.51 512.51 ,'000 70 1'~7 Z2 7~UDIT CHECK NO. 702 Town of Southold, New York - Payment Voucher Vendor Tax ID Number or Social Security Number Vendor Name United Parcel Service Vendor Telephone Number 800-811-1648 Vendor Contact Number Date Total Discount Vendor Address P.O. Box 724?-0244 Vendor No. 21506 Philadelphia, PA 19170-0001 Net Purchase Order Number 26639332 811812012 $512.51 Description of Goods or Services wle 8118/12 Check No. Entered by ~ Audit Date S£P 1 1 2012 SM67t0.4.000.700 $512.51, I $512.51 Payee Certification The undersigned (Claimant) (Acting on behalf of the abevc named claimant) does hereby ccrti~ that the foregoing claim is tree and correct, that no pan has been paid~ except as therein stated, that thc balance therein stated is actually due and owing, and that taxes from which thc Town is exempt are excluded Date Department Certification ] hereby certi~ 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. Shipped from: FISHERS ISLAND FERRY 1 STATE ST NEW LONDON, CT 06320 Delivery Service Invoice invoice date August 18, 2012 Invoice number 0000026639332 Shipper number 026639 Control ID N522 Page 1 of 5 0720A00000266392 77366300011967 FP 01 075853 23595[236 A**3DGT FISHER ISLAND FERRY PO BOX 607 FISHERS /SLAND, NY 06590 Sign up for electronic billing today! Visit ups.corn/billing For questions about your invoice, call: (800) 811-1648 Monday - Friday 8:00 a.m. - 9:00 p.m.E.T. or write: UI~ P.O. Box 7247-0244 Philadelphia, PA 19170-0001 Account Status Summary Weekly Payment Plan Amount Dee This Period $ 512.51 Amount Outstanding (prior invoices) $ 2,124.30 Total Amount Outstanding $ 2,636.81 Please include the Return Portion of each outstanding invoice with your payment. See Account Status for details. New time-savers from UPS At UPS, we're aJways looking to save you time in your day. You can take advantage of several new technology enhancements introduced this summer, including an upgrade to the UPS Time and Cost Calculator. Find out more at compass.ups.com/U PS-upgrades-save-time. Thank you for using UPS. Summary of Charges Page Ch~ge Outbound 3 UPS WoddShip $ 444.19 3 Adjustments & Other Charges $ 44.34 5 Fees $13.98 Service Charges $10.00 Amount due this period $ 512.51 UPS payment terms require payment of this invoice by Augusl 29, 2012. Paymertts not received by September 12, 2012 are subject to a late tee of 6% of the Amount Due This Period. (Details in UPS Tariff, available at ups.corn) Note: This invoice may contain a fuel surcharge as described at ups.com. The published fuel surcharge is 7.0% for UPS Ground Services and 10.0% for UPS Air .~vices, UPS 3 Day Select, and Intema#onal services. For more informatfon, visit upa.com. Delivery ~ervi~e Invoice Invoke date August 16~ 20'12 Invoice number 0000026639332 Shipper number 026639 Page 2of5 Account Status Weekly Payment Plan Payments Applied Amount Invoice Number Invoice Date Paid 0000026639262 06/30/2012 $ 32.77 0000026639272 07/07/2012 $ 64.09 Account Status Weekly Payment Plan Amount Outstandin9 (prior invoices): Please include the Return Portion of each outstanding invoice with your payment. Baiance Invoice Numbe~ Invoice Date Due 0000026639282 07/14/2012 $ 94.58 0000026639292 07/21/2012 $ 233.05 0000026639302 07/28/2012 $ 619.24 0000026639312 08/~4/2012 $ 473.11 0000026639322 08/11/2012 $ 704.32 Total $ 2,124.30 Outstanding balances reflect any payments received as of 08/17/2012, Please ignore this message if a recant payment has been made for any outstanding invoicee. Outbound ups WorldShip Delivery Service Invoice Invoice date August 18, 2012 invoice number 0000026639332 Shipper number 026639 Page 3 of 5 Pickup Pickup Number of Billed Date Record Message Codes Packages Charge 08/14 9121173386 r 6 239.64 08/15 9121173390 3 36.33 08/16 9121173401 1 6,66 9121173412 r 1 56.18 08/17 9121173423 r 3 105.38 Total UPS WorldShip 14 Package(s) 444.19 Total Outbound 14 Package(s) 444.19 Adjustments & Other Charges Address Corrections Number of Biffed Tracking Number Service Packages Charge 1Z0266390341728908 Ground 1 11.00 1st ret: CARSYN BAKER FINY 06390 2nd ret: SAME Recorded: CARSYN BAKER Corrected: CARSYN BAKER CARSYN BAKER 21373 STONEBRIDGE DRIVE 21373 STONEBRIDGE CT SPRINGFIELD LA 70462 DENHAM SPRINGS LA 70726 Total Address Corrections 1 Package(s) 11.00 ~ Residential/Commercial Adjustments ~ UPS WorldShip ~ Shipped Pickup Recorded Biffed Adjus~nent ~_ Date Record Entry Tracking Number Corrected Charge Amount ~ 08/06 9121173342 1 1Z0266390341584840 Residential -37~14 ~-~ Residential Surcharge -2.55 ~ Commemial 37.14 ~ Fuel Surcharge -0A8 -2.73 ~ 1st ret: Wilfiam Hall FINY 06390 2nd ret: 281-684-7718 ~' 2 lZ0266390340147850 Residential -41.90 Residential Surcharge -2.55 Commemial 41.90 Fuel Surcharge -0.18 -2.73 let ret: William Hall FINY 06390 281-684-771 3 1Z0266390340087264 Residential -17.79 Residential Surcharge -2.55 Commemial 17.79 Fuel Sumharge -0.18 -2.73 1st ret: William Hall FINY 06390 08/09 9121173375 3 1Z0266390340644223 Residential -44.05 Residential Surcharge -2.55 Cammemial 44.05 Fuel Sumharge -0 18 -2.73 15t ret: Mrs Donald Young FINY 06390 08/15 9121173390 I lZ0266390342380095 Commercial -14.12 Residential 14.12 Residential Surcharge 2.55 Fuel Surcharge O. 18 2.73 1si ref: Harolds 075853 2/3 Delivery Service Invoice Invoice date August 18, 2012 Invoice number 0000026639332 Shipper number 026639 Page 4 of 5 Adjustments & Other Charges Residential/Commercial Adjustments UPS WorldShip (continued) Shipped Pickup Recorded Billed A~us~nent Date Record Enb*y Tracking Number Corrected Chal~le Amount 08/15 9121173390 2 lZ0266390341153109 Commercial -9.60 Residential 9.60 Residential Surcharge 2.55 Fuel Surcharge 0.18 2.73 1st ret: Hareld's 3 1Z0266390340702517 Commercial -10.23 Residential 10.23 Residential Sumharge 2.55 Fuel Sumharge 0.18 2.73 1st ret: Hsrold's 08/17 9121173423 2 1Z0266390340784153 Residential -7.37 Residential Surcharge -2.55 Commercial 7.37 Fuel Sumharge -0.18 -2.73 15! ret: The Beach Plum FINY 06390 2nd ret: 631 788 7731 3 1Z0266390341455560 Commercial -69.02 Residential 69.02 Residential Sumharge 2.55 Delivery Area Sumharge - Extended 1,25 Fuel Surcharge 0.27 4.07 let ret': The Beach Plum FINY 06390 2nd ret: 631 788 7731 Total UPS WorldShip 9 Package{s) -1~39 Total Residential/Commercial Adjustments 9 Package{s) -1.39 Shipping Charge Corrections Learn how to avoid future shipping charge corrections. Visit www.ups.com/avoidcharges, Pickup Tracldng Original Service/ ZIP Billed Adjustment Date Number Corrected Sew[ce Code Zone Weight Charge Amount 08/14 1Z0266390340179272 Ground 75205 7 Additional Handling - Not encased in cardboard 1st ret: G. Solomon FINY 06390 Sender : FISHERS ISLAND FERRY NEW LONDON CT 06320 2nd ret: SAME Receiver: Glenn Solomon DALLAS TX 75205 8.50 8.50 1Z0266390340327487 Ground 75205 7 58 40.71 Ground 75205 7 60.9 41.39 Dimensions = 38 x 19 x 14 in Additional Handling - Not encased in cardboard 8.50 Fuel Surcharge 0.05 9.23 1st ret: Glenn Solomon FINY 06390 2nd ret: SAME Sender : FISHERS ISLAND FERRY Receiver: Glenn Solomon NEW LONDON CT 06320 DALLAS TX 75205 1Z0266390341110431 Ground 77027 7 Additional Handling - Not encased in cardboard 8.50 8.50 1st ret: K Young 7832Ctaypoint rd FINY 06390 2nd ret: 713 818 9049 Sender : FISHERS ISLAND FERRY Receiver: Kelley Young NEW LONDON CT 06320 HOUSTON TX 77027 08/16 1Z0266390342154535 Ground 83340 8 Additional Handling ~ Not encased in cardboard 8.50 8.50 1st ret: Linde Musser FINY 06390 2nd rel: 631 788 7330 347 880 25 58 Sender : Receiver: C/O Tressa Pembertan FISHERS ISLAND FERRY Brooks Preston NEW LONDON CT 06320 KETCHUM ID 83340 Total Shipping Charge Corrections 4 Package{s) 34.73 Total Adjustments & Other Charges 44.34 Fees Delivery Service Invoice Invoice date August 18, 2012 Invoice number 0000026639332 Shipper number 026639 Page 5 of 5 WeekEnding Unpaid Billed Date Balance Rate Charge 07/21 Late Payment Fee 233.05 6.00 % 13.98 Pursuant to the UPS Tariff, a late payment fee has been assessed. Total Fees 13.98 Invoice Messagin~ Code Dimensional weight applied 075853 3/3 FISHERS ISLAND FERRY DISTRICT VENDOR 007609 WALT DISNEy STUDIOS MOTION PIC 09/11/2012 CHECK 703 FUND & ACCOUNT P.O.# INVOICE DESCRIPTION AMOUNT SM .7155.4.000.000 080812 FILM:BRAVE 343.14 TOTAL 343.14 ~l'OOO ?0 5,' ~:OB~qOSq~q~: ~8 00~508 DI' Town of Southold, New York Vendor Tax ID Number or Social Security Number Walt Disney Studios Motion Pictures Vendor Contact - Payment Voucher I Vendor No. Vendor Address 13497 Collections Center Drive Chicago, iL 60693 Invoice Invoice Invoice ; Purchase Order Number Date Total i Discount Number Net 'Amount Claimed $343.14 8/8/2012 $343.14 $343.14i , $343.14 Payee Certification The undersigned (Claimam) (Acting on behalf of thc above named claimant) does hereby certify that the foregoing claim is true and correct, that no part has been paid, except as therein stated, that the balance therein stated is actually due and owing, and that taxes from which the lown is exempt are excluded Signature ~ Title'~/~ Company Name f~ Date~' 7609 Description of Goods or Services Film: Brave Check No. Entered by .~ Audit Date SEP 1 1 2012 General Led$er Fund and Account Number SM7155.4.000.000 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 is approved. Signamre ~~ FISHERS ISLAND FERRY DISTRICT VENDOR 025182 ZURICH 09/11/2012 CHECK 704 FI/ND & ACCOUNT P.O.# INVOICE DESCRIPTION AMOUNT SM .1910.4,000.300 M0206190540812 WORKER'S COMP INS-8/12 9,902.40 TOTAL 9,902.40 812112012 3:57:38PM Wait Disney Studios Motion Pictures t of 1 ACCOUNTS RECEIVABLE STATEMENT All Billings Statement Payor. FISHERS ISLAND FERRY DIST Stateme.t Address: P.O. BOX H FISHERS ISLAND CT 06390-5390 ~ (~ ~.~/~t~ Theatre: FERRY DISTRICT City: FISHERS ISLAND State: CT r~?~- Film: SECRET WORLD OF ARRI (ARRIETT) Booked aZU~ PaM / Film Total: $256.00 $89.60 $8.00 $89.60 Film: MARVEL'S THE AVENGER (AVENGER) Booked Baled Paid ~. ~"~ ~, ~ ~['~ Film Total: $810.00 $305.00 $0.00 $305.00 Film: BRAVE W/IA LUNA (BRAVE) Booked ~1~ ~ B®ainDate WK Gr~s Ded HouseAII Terms Cont Bill Type Bpx Off ~ Amopnt .~ Arrmpnt Bidance Film Total: $602.00 $343.14 $8.00 $343.14 Film: WAR HORSE (WARHORS) Booked Billed Paid ~_.~_)~_~%.Z~. Film Total: $864.00 $145.60 $8.00 $145.60 Theatre Total: $1,832.00 $883.34 $8.00 $883.34 Town of Southold, New York - Payment Voucher Vendor Tax ID Number or Social Security Number 36-4233459 Vendor Name ZURICH NORTH AMERICA Vendor Telephone Number 800-332-6641 Vendor Contact Invoice Invoice Number Date 8113/2012 Total $9,902.40, Vendor Address PO BOX 4664 CAROL ~EAM, IL 60197-4664 Net Discount Amount Claimer $9,902.40 ~ Payee Certification The undersigned (Claimant) (Acting on behalf of thc above named claimant) d~es hereby certify that the foregoing claim is ~ruc 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. $9,902.40 $9,902.40 Purch~eOrder Number SignatUryN~me~~ Title Description of Goods or Services Workers Compensation Insurance Cheek No.~ Entered by Audit Date SEP 1 1 2012 Town Clerk Gan=rat Ledfier Fund and Account Number SM1910.4.000.300 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 Zt-~/~ /'~'~ Fa:Zurich Insurance Services To:Jobina ($63178855~3) ~JRICH INSURANCE SERVICES, INC. 13:39 88/22/12 EST P9 1-2 ZURICH FAX TRANSMISSION To: Jobina From: Fmc 16317885523 Pages: 2 Re: Bate: Aug 22, 2012 Urgeat For Review Please Please Reply Comment For laformation ~.0. BOX 5387 · Jack:,~nville, FL 32247-5387 Agency: ALL RISKS, LTD Invoice Account Name: Account Number. Invoice Date: Due Date: Current Balance: Minimum Due: FISHERS ISLAND FERRY DISTRICT M020619054-001-00001 08-13-12 09-02-12 $16,494.00 $9,902.40 Please see reverse side for other messages and important billing information. PAYOR NAME AND ADDRESS FISHERS ISLAND FERRY DISTRICT PO BOX H FISHERS ISLAND NY 06390 ZURICH IF WE DO NOT RECEIVE THE MINIMUM DUE BY THE DUE DATE ON THIS INVOICE, YOUR ACCOUNT WILL BE ASSESSED A LATE FEE OF $20.00 ZURICH AMERICAN ~NSURAN£E CO, AMERICAN ZURICH ~NS. CO., AMERICAN GUARANTEE & LIABILITY, STEADFAST INSURANCE, ZURJCH AMERICAN OF ILLINOIS, MARYLAND CASUALTY COMPANY, NORTHERN INSURANCE COMPS, Ny OF NEW YORK. ASSURANCE COMPANY OF AMERICA, FIDEDTY AND DEPOSIT MARYLAND SUMMARY OF ACTIVITY SINCE YOUR LAST INVOICE POLICY EFFECTIVE ACTIVITY TRANSACTION MINIMUM NUMBER DATE AMOUNT DUE WC 4686248 08-01-12 PREVZOUS STATEMENT BALANCE ZNSTALLMENT FEE WORKERS COMP - NEW BUSZNESS 0,00 6.00 16,494,00 9,896.40 FUTURE SEMI-ANNUAL INSTALLMENTS Please note that changes to your policy coverage may change your installment schedule, Due Date Premium Fee Amount Due Due Date Premium Fee Amount Due 6,597.60 6. O0 6,603.60 THANK YOU FOR CHOOSING ZURICH. LISTED BELOW IS A GUIDE TO ASSIST YOU IN REVIEWING YOUR INVOICE. Additional Provisions FOR BILLING INQUIRIES PLEASE CALL OUR CUSTOMER SERVICE DEPARTMENT AT 1-800-332-6641. PLEASE SEND ANY WRITTEN CORRESPONDENCE VIA TOLL FREE FAX TO 1-856-301-0306, iNCLUDE YOUR ZURICH AI.'OOUNT NUMBER ON ALL CORRESPONDENCE. An installment fee is added to all installment invoices. However. if you decide to pay the entire annual premium in full on the first invoice, you do not need to pay the fee. If your policies are issued after the date that coverage began, your Iirst invoice for those policies may include more than one installment. We reserve the right to withdraw payment by installments in the event your premium payments are received after the due date. Except for Virginia insureds, if a check is returned by your bank for any reason, yonr next invoice will include a check processing fee. For auditable policies, once we perform the audit and record the resulting premium, the audit premium will be billed to you in the next scheduled invoice. Payment for the audit is due within twenty {20) days after the invoice date. If you pay less than the Minimum Due, we will apply your payment first to amounts owed with the earliest due date. If you pay more than the Minimum Due, we will apply the extra funds to your next installmef)t(s). Refunds, other than audits, on individual policies will be returned only after all balances on the account have been paid in full. LATE PAYMENTS/CANCELLATION if you fail to pay the Minimum due by the due date, you will be assessed a late fee, except for Virginia and Missouri insureds. In addition, the date of your next payment will be due as provided on the front of your invoice, and a cancellation notice will be issued if the amount specified is not paid in full by the due date. If we receive a payment after the cancellation effective date, we will apply that payment towards any unpaid balance on your account before we refund any remainder, but your coverage may not be reinstated. After coverage is cancelled, we will bill you for any unpaid earned premium. If you do not pay, the matter may be forwarded to a collection agency. Messages TRY ZURZCH EZPAY AND PAY ON-LZNE. IT'S EASY AND EFFZC[ENT. SET UP YOUR RE-OCCURRZNG, AUTOMATZC PAYMENT TODAY. LOG ON TO OUR NEB SETE "ZURZCHNA.ZNETBZLLER.C0M". NEN PAYMENT OPTIONS ARE NON AVAILABLE. CALL 866-350-7599 TO MAKE AN ELECTRONZC CHECK PAYMENT BY PHONE. A CONVENIENCE FEE OF $1.95 NILL BE CHARGED FOR EACH ELECTRONIC CHECK PAYMENT. ALL OTHER PAYMENT OPTIONS REMAIN AVAZLABLE AT NO COST. H0N TO REPORT A NORKERS' COMP CLAZM : TEMELY CLAZM REPORTZNG HELPS MANAGE YOUR LOSS COSTS . FOR YOUR CONVENZENCE, ZURZCH PR0VZDES ACCESS TO NORKERSI COMP CLAIMS REPORTZNG - 24 HOURS A DAY , SEVEN DAYS A NEEK . PHONE : 1-500-987-3373 ; ONLINE : NWN.ZURICHNA.C0M AND CLICK ON THE CLAIMS TAB ; FAX : 1-877-962-2567 ; OR BY MAZL : P.O. BOX 49547 , COLORADO SPRZNGS , CO 80949 .