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HomeMy WebLinkAboutAU-10/09/2012 Fishers IslandFISHERS ISLAND FERRY DISTRICT VENDOR 001327 AIRGAS EAST, INC 10/09/2012 CHECK 743 FUND & ACCOUNT P.O.# INVOICE DESCRIPTION SM .5710.4.000.000 116391456 (2)PROPANE-FORKLIFT NL SM .5710.4.000.000 116432735 (2)PROPANE-FORKLIFT NL TOTAL J~vlOUNT 73.35 73.35 146.70 Town of Southold, New York - Payment Voucher Vendor Tox ID Number or Social Secufi~ Number !Vendor Address Vendor No. 1327 P.O. Box 827049 Vendor Name Philadelphia, PA 19182-7049 Airgas East Vendor Telephone Number 860 ~.:: .3055 Vendor Contact Date Number ~voice To~ Discoum $73.35 $73.35 $146.70 Amou~lalmed P~ch~e0rderNumber $73.35 $73.35 $146.70 116391456 911312012 116432735 9/2512012 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. Desfr. iption of Goods or Services IPro~e for Fork Lift NL ProCaine for Fork Lift NL Check No. Entered by Audit Date OCT 0 9 2012 General Ledger Fund and Account Number SM5710.4.000.000 SM5710.4.000.000 Department Certification ! hereby certify that the materials above specified have been received by mc in good condition without substitution, the services properly performed and that thc quantities thereof have been verified with the exceptions or discrepancies noted, and payment is approved. Signalure~ Title ~/t Company Name ~" e /- Date Signature~/~ T~,,e ~ Date SEL 001000 'OUR REMITTANCE. FOR QUESTIONS ON YOUR ACCOUNT PLEASE CALL: 888-757,.0030 835057-00 I 116391456 02081 09/13/12 FISHERS ISLAND 465 841 812 CUST PICKUP ~ NET30 DAYS 1 ** LOCATION: B6 ** 83505~09,'1~ PR 33A 2 C PROPANE 32LBS ALUMINUM iL 32.6754 65.35 N z VOL: 64 83505~ 09,'13 ~AZHAZMAT 1 C HAZARDOUS MATERIAL CHARG 'ZA 8.0C 8.00 N Slb total 73.35 TOTAL CYLIND~ {S SHIPPED: 2 RETURNEE 2 TAX CD,: }00000006 TAX ESCRP CCNN[ST] ]U EXMPT CD: 0 EXMPT/CERT ~UNICIP1LITY I $.oo J J 73.35 SHIP TO: - ' J'JJJ ~JJJ~. www. airgas.com FISHERS ISLAND ACT. NAME AIRGAS EAST Airgas East FERRY DISTRICT ACT. NO. 8606074799 17 Northwestern Drive PO BOX H PNC BANK- ABA NO. 031000053 Salem, NH 03079 FISHERS ISLAND NY 06390-0607 REF. 116391456102081 ORIGINAL INVOICE DELIVERY ORD For location nearest you visit www. airgas.com -- SOLD BY: AIRGAS EAST 130 CROSS RD WATERFORD CT 06385 -- SHIP TO: FISHERS ISLAND FERRY DISTRICT PO BOX H P/O J~ us~om, ' 91 ORDER NO: 83g0~7~00 -- SOLD TO: FISHERS TSLAND o~ DA~: 0~ OF 001 J~HIPTOi! ~057-00 CUSTOMERX ~ /~/~ I~ ' FERRY DISTRICT / ~~~ I 835057-00 0~/13/12 Cg, S~T PICKUP -NONE- ~ ~ ~ · '' ~ TERMS AND CONDITIONS iENCY RESPONSE INFORMATION PLEASE RETURN THE UPPER PORI~ON WITH YOUR REMITTANCE. FOR QUESTIONS ON YOUR ACCOUNT PLEASE CALL: 888-757-0030 915637-00 116432735 , I 02081 09/25/12 FISHERS ISLAND 1,46S 841 I 812 CU~TpICKUp I N~0DAYS 1 I** LOCATION: B6 9156350~2[PR 33A PROPANE 32LBS ALUMINUM ~[ 32.675~ 65.35 N 2 2 VOL: 64 ', Suh total 73.35 TAX C~: 000000006 '['AX ESCR~: C{NN} 2'Pi2~ EXMPT CD: 0 EXMPT/CER"[ MUNICIP~ .ITY : : Airgas s.,,,o: - - · www.airgas.com FISHERS ISLAND ACT. NAME AIRGAS EAST Airgas East FERRY DISTRICT ACT. NO. 8606074799 17 Northwestern Ddve PO BOX H PNC BANK - ABA NO. 031000053 Salem, NH 03079 FISHERS ISLAND NY 06390-0607 REF. 116432735/02081 ORIGINAL INVOICE BY ~ FILLED rrmM C~NT DELIVERY ORDER For location nearest you visit www. aiRqas;com WATERFORD CT 06385 -- SHIP TO: FISHERS ISLAND FERRY DISTRICT PO BOX H FISHERS ISLAND NY 06390-0607 p/o NO: 25-SEP-12 Og:44A~ INTERNAL USE ONLY CUST. NO: ORI~R NO: ORD DATE: C R : '[HAi~gg~PAGENO: PKG {D~ ACCEP1ED FOR THE ABOVE cus~c~ X /bl~FV,.~ NY 06390-0607 ' ~'~ ~66-~ I (1~1 - ~l: 1-703-5~-~8~ I ~8:ERS ISLAND FERRY DISTRICT !PO BOX H FISHERS ISLAND AIRGAS PERSONNEL DATE T.O.D. FISHERS ISLAND FERRY DISTRICT VENDOR 019500 AT&T 10/09/2012 CHECK 744 FUND & ACCOUNT P. O. # INVOICE DESCRIPTION SM .5710.4.000.100 AMOUNT 86044201651012 TEL/NL TERM 9/15-10/14 283.79 TOTAL 283.79 ~'OOO?h~ll' ':O;~ Vendor No. Town of Southold, New York - Payment Voucher 19500 Vendor Tax ID Number or Social Security Numl~r Vendor Address AT&T Vendor Name P.O. BOX $082 AT&T Carol Stream, IL 60197- Vendor Telephone Number 800-321-2000 Vendor Contact Check No. Entered by ~._~_ Audit Date OCT 0 9 2012 Invoice Invoice Invoice Net Purchase Order Number Date Total Discount Amount Claimed Number Description of Goods or Services General Ledger Fund and Account Number 8604420165 9116120t2 $283.79 $283.79 NL TerminaITel 8M57t0.4.000.100 19115112 - 10114/12 $283.79 $283.79 Payee Certification The undersigned (Claimant) (Acting on behalf of the above named claimant) does hereby certify that the foregoing claim is hoe and correct, that no part has been paid, except as therein stated, that the balance therein stated is actually Department Certification [ hereby certify that thc 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 due and owing, and that taxes from which the Towa is exempt are excluded. Company Name J~ or discrepancies noted, and payment is approved. Signature Title ,~- Date at&t Monthly Statement FISHERS ISLAND FERRY DISTRICT Page I of 9 PO BOX H Account Number 860 442-0165 078 FISHERS ISLE NY 06390-0607 Billing Date Sep 15, 2012 Web Sits att,corn Previous Bill 550.79 Payment 546.59CR Adjustments .00 Past Due - Please Pay Immediately 4.16 Current Charges 279.63 Total Amount Due $283.79 * Current Charges Due in Full by Oct 14, 2012 · Thank you for being an ALL DISTANCE® customer. Your ALE DISTANCE® savings includes: Promotions and Discounts 270~ No. Date Description Adiustments Payme,ts I. 8-20 Payment 286.37 2. 9-17 Payment 26~.22 Totals 546.09 Questions? Call: Plans and Services 1 800 321-2OO0 Repair: 1 800 246-8464 Internet Services: 1 877 722-3755 Total Current Charges Page 1 · PREVENT DISCONNECT · CARRIER INFO · KEEP YOUR DISCOUNT · FUSF RATE See "News You Can Use" for additional information. 279.63 279.63 Promotions and Discouots 3. Save 8ite-S Colln-$27 oft -12mo term 27.00CR Monthly Se~ice - Sep 15 thru Oct 14 Cha~Jes for 860 44Z-0165 4. Monfllly Charges 12260 Chamges for 860 4434851 5. Monfllly Charges 28.35 ChaflJes for 860 444-0320 6. Monfl0y Charges 2838 Cha~ges for 860 447-9371 7. Moi~fllly Charges 2835 Total Moathly Sewice 207.65 Directory Assistance 8. 2 Call(s) billed at $1.99 each 3.98 Call Charges Bus Block of Time 708 g 2Y Summary 1017 Minutes Used 700 Minutes Allowed Instate Long Distance 2,31 Out el State Long Distance 1124 Call Plan Summary Total 13.58 9. Bus Block of Time 700 II 2Y 30.00 *BASIC $15502 NON BASIC $128.77 at&t FISHERS ISLAND FERRY DISTRICT PO BOX H FISHERS ISLE NY Page Account Number Billing Date Web Site 2of8 860 442-0165 078 Sep 15, 2012 att.com Call Charges - Continued Charges for 860 442-0165 Item No. Date Tim~ PI~;~ BemizeO Calls 1. 8-10 820A FISHERSIS Z 8-10 g21A FISHERSIS 3, 8-10 ~3A FISHERSIS 4, 8-10 ~4A HSHERSIS 5. 8-10 I~A FISHERS IS 6. 8-10 1131A MARLBORO 7. 840 120~P FISHERSIS 8. 8-10 135P RSHERSIS 9. 8-10 154P FISHERSIS 10. 8-10 247P FISHERSIS IL 8-10 321P BOSTON 12. 8-10 ~P COCOA ~3. 8-10 ~2P FISHERSIS 1¢ 8-10 3~P FISHERSIS 15. 8-10 ~TP FISHERSIS 16. 8-10 ~P C~NTRAISLP Number NY 631 788-7323 NY 631 788-7463 NY 631 788-7463 NY 631 788-7345 NY 631 788-7463 MA 508 460-7730 NY 631 788-5515 NY 631 788-74~3 NY 631 788-7345 NY 631 788-7919 MA 617 331-9375 FL 321 482-3786 NY 631 788-7463 NY 631 788-7463 NY 631 788-7463 NY 631 853-5730 17. 841 120~P NWYRCYZN01 NY 646431-3388 18. 8-13 758A FISHERSiS 19. 8-13 932A FISHERStS 20. 8-13 1133A FISHERSIS 21. 8-13 1134A FISHERS IS 22. 8-13 1135A FISHERS IS 23. 8-13 1135A FISHERS IS 24. 8-13 1203P FISHERS IS NY 631 788-7345 NY 631 788-7345 NY 631 788-4227 NY 631 788-4227 NY 631 788-7455 NY 631 788-5515 NY 631 788-7224 28. 8-13 101P POUGHKEPSI NY 845656-1677 26. 8-13 153P FISHERStS 27. 8-13 204,° FISHERSIS 28. 8-13 343P FISHERSI$ 29. 8-13 414P FISHERSIS 30. 8-13 418P FISHERSIS 31. 8-13 436P FISHERSIS 32. 8-14 952A FISHERSIS 33. 8-14 953A FISHERSIS 34. 8-14 1138A FISHERS IS 35. 8-14 1208P COCOA 3~. 8-14 1289P FISHERS IS 37. 8-14 147P FISHERSIS 38. 8-14 202P FISRERSIS 39. 8-14 318P FISHERSIS 40. 8-10 84~A FISHERSIS 41. 8-15 954A BOSTON NY 631 788-5655 NY 631 788-5545 NY 631 788-7311 NY 631 788-5515 NY 631 788-5515 NY 631 788-7463 NY 631 788-7343 NY 631 788-7857 NY 631 788-7857 FL 321 482-3786 NY 631 788-7463 NY 631 788-7919 NY 631 788-7463 NY 631 788-7463 NY 631 788-7609 MA 617 331-9375 42. 8-15 1032A WATERBURY CT 203754-5334 43. 8-15 1111A FISHERSIS NY 631788-7463 44, 8-15 tIIIA RSHERSIS NY 631788-7345 45. 0-10 It20A FISHERS IS NY 631 788-7463 46. 8-15 138P FISHERSIS NY 631788-7463 47. 8-15 153P FISHERSIS NY 631788-7345 Code Call Charges - Continued Rein ~ Pate 48. 8-15 49. 8-15 50. 8-15 51. 8-15 52. 8-15 1:30+ .00 53. 8-15 1:30+ .00 54. 8-15 0:44+ .00 55. 8-16 0:30+ .00 56. 8-16 2:15+ .00 57. 8-16 2:11+ .00 58. 8-16 1:19+ .00 59. 8-16 2:49+ .00 60. 8-16 0:30+ .QO 61. 8 16 0:58+ .OD 62. 8-16 4:06+ .00 63. 8-16 0:30+ .00 64. 8-16 0:30+ .oo 65. 8-16 2:32+ .00 66. 8-17 0:43+ .O0 67. 8-17 1:44+ .00 68. 8-17 1:12+ .00 69. 8-17 1:40+ .00 70. 8-17 0:30+ .00 7L 8-17 0:30+ .00 72. 8-17 0:30+ .GO 73. 8-17 0:30+ .eD 74. 8-17 1:45+ .00 75. 8-17 0:30+ .00 76. 8-17 0:47+ .00 77. 8-17 3:51+ .0g 78. 8-17 98:06+ .OO 79. 8-17 1:17+ .Og 80. 8-17 0:31+ .00 81. 8-17 0:39+ .00 82. 8-17 9:57+ .00 83, 8-17 0:30+ .OO 84. 8-18 0:33+ ,O0 85. 8 18 2:52+ .00 86. 8-18 0:56+ .00 87. 8-18 1:14+ .00 88. 8 20 1:50+ .00 89. 8-20 0:30+ .00 90. 8-20 7:13+ .00 91. 8-20 2:02+ .00 92. 8-20 10:37+ .00 93. 8-20 1:50+ .00 94. 8-20 0:30+ .00 95. 8-20 0:59+ .00 96. 8-20 1:20+ .00 97. 8-20 0:30+ .00 98. 8-20 0:30+ .00 99. 8-21 100. 8-21 Time Place Number 212P FISHERS IS NY 631 788-7463 226P FISHERS IS NY 631 78~-7463 24OP FISHERS IS NY 631 788-4436 335P FISHERS IS NY 631 788-7345 344P FISHERS IS NY 631 788-7345 414P PROVIDENCE RI 401 275-0643 427P FISHERS IS NY 631 788-7463 740A FISHERS IS NY 631 788-7919 825A FISHERS IS NY 631 788-7463 852A NWYRCYZN01 NY 917 293-0421 1115A NOR~VOOD MA 781 856-5552 1140A FISHERS IS NY 631 788-5673 1203P FISHERS IS NY 631 788-74~3 1246P FISHERS IS NY 631 788-7919 103P FISHERS IS NY 631 788-7463 113P FISHERS IS NY 631 788-7463 238P FISHERS IS NY 631 788-7345 259P FISHERS IS NY 631 788-7463 714A FISHERS IS NY 631 788-7345 741A FISHERS IS NY 631 788-7345 839A FISHERS IS NY 631 788-7919 840A FISHERS IS NY 631 788-7338 909A FISHERS IS NY 631 788-7463 959A FISHERS IS NY 631 788-7255 1002A FISHERS IS NY 631 788-7345 1017A FISHERS IS NY 631 788-7463 1144A NAUGATUCK CT 203723-7413 1155A FISHERS IS NY 631 788-7919 1240P FISHERS IS NY 631 788-7345 II?P FISHERSIS NY 631788-5673 141P FISHERS IS NY 631 788-7463 210P FISHERS IS NY 631 788-7463 232P FISHERS IS NY 631 788-7919 305P FISHERS IS NY 631 788-7463 312P FISHERS IS NY 631 788-7463 334P WlLUMNTIC CT 860 234-9583 1209P FISHERS IS NY 631 788-7926 1255P FISHERS tS NY 631 788-7744 431P EISRERS IS NY 631 788-7742 432P EISREHS IS NY 631 788-7400 825A FISHERS IS NY 631 788-7857 827A EISHERS IS NY 631 788-7463 955A FISHERS IS NY 631 788-5550 1029A FISHERS IS NY 631 788-5655 1033A POUGHKEPSI NY 845656-1676 1035A POUGHKEPSI NY 845656-1677 1103A HARTFORD CT 860883-9499 lt09A FISHERS IS NY 631 788-7311 114OA WASHINGTON DC 202 309-3920 1156A FISHERS IS NY 631 788-7449 229P FISHERS IS NY 631 788-7463 815A FISHERS IS NY 631 788-7463 91lA NEWCANAAN CT 203972-3408 Code D D D 1 1 1 1 1 O 0:35+ .00 0:30+ .00 0:30+ .00 2:11+ .00 1:23+ .00 9:03+ .00 0:45+ .00 2:21+ .00 0:46+ .00 0:55+ .00 7:55+ .00 1:23+ 33:14+ 1:22+ 0:56+ 0:30+ 0:39+ .00 0:30+ .00 0:49+ 0:30+ .00 1:06+ ,00 0:31+ .00 0:32+ 0:30+ .OD 0:35+ .00 2:41+ .00 2:50+ ,00 0:30+ .00 0:30+ .00 0:30+ .00 1:21+ 3:37+ 1:33+ .00 0:30+ .00 3:40+ .00 1:04+ .00 5:01+ .00 1:08+ .00 0:30+ .00 1:10+ .00 0:42+ .00 1:16+ 1:48+ .00 0:30+ 0:30+ 0:30+ 0:52+ 1:58+ 0:41+ 0:30+ 0:30+ .00 5:08+ .00 0:35+ .00 7875.008.076056.01.04.0000000 NNNNNNNY 51047.152259 FISHERS ISLAND FERRY DISTRICT P~ 3 o1 8 at&t ,.ox. ,...._, FISHERS ISLE NY O6390-0607Billing Date Sep 15, 2012 Call Charges - Continued Item ~ Date .T~ PIo~o 1. 8-21 914A FISHERSIS 2. 8-21 93OA GRAFTON 3. 8-21 939A COCOA 4. 8-21 942A FISHERSIS 5. 8-2t 1020A FISRERSIS 6. 8-21 1021A FISHERS IS 7. 8-21 10e4A FISHERS IS 8. 8-21 1048A FISHERS IS 9. 8-21 tlI2A FISHERSIS 10, 8-21 1125A NEWPORT 11. 8-21 1131A NEWPORT 12, 8-21 1148A FISHERS IS 13. 8-21 1142A FISHERSIS 14. 8-21 1266P FISHERS IS 15. 8-21 119P FISHERSIS 16. 8-21 230P FISHERSIS 17. 8-22 828A FISHEHSIS 18. 8-22 836A FISHERSIS 19. 8-22 1021A FISHERS IS 20. 6-22 1032A FISHERS iS 21. 8-22 1119A FISRERSIS 22. 8-22 1126A FISHERS IS 23. 8-22 1245P FISHERS IS 24. 8-22 1t0P FISHERSIS 25. 8-22 243P FISHERSIS 26. 8-22 310P FISHERS IS 27. 8-22 348P BALTIMORE 28. 8-22 349P FISHERSIS 29, 8-23 745A BOSTON 30. 8-23 812A FISHERS IS 31. 8-23 835A DANBURY 32. 8-23 662A FISHERS IS 33. 8-23 809A RSHERSIS 34. 8-23 919A FISHERS IS 35. 8-23 933A DANBURY 36. 8-23 1034A HARTFORD 37. 8-23 112OA FISHERS IS 38. 8-23 1230P FISHERS IS 39. 8-23 124~P FISHERS IS 40. 8-24 718A FISHERS IS 41. 8-24 747A FISHERSIS 42. 8-24 752A FISHERSIS 43. 8-24 766A WH PLAINS Number NY 631 788-7463 MA 668 887-0277 FL 321 482-3786 NY 631 788-7311 NY 631 788-7463 NY 631 788-7744 NY 631 788-7744 NY 631 788-7744 NY 631 788-7345 RI 401 832-4567 RI 401 832-4567 NY 631 788-7251 NY 631 788-7520 NY 631 788-7251 NY 631 788-7215 NY 831 788-7463 NY 631 78~-7919 NY 631 788-7463 NY 631 788-5550 NY 631 788-7463 NY 631 788-7345 NY 631 788-7281 NY 631 788-7249 NY 631 788-5673 NY 631 788-7281 NY 631 788-7345 MD 410 925-6884 NY 631 288-7091 MA 617 721-6679 NY 631 788-7463 CT 203 775-1268 NY 631 788-7463 NY 631 788-7345 NY 631 788-5673 CT 203775-1288 CT 860 289-0267 NY 631 788-7463 NY 631 788-7463 NY 631 78~-7483 NY 631 788-7345 NY 631 788-7345 NY 631 788-7345 NY 914522-7403 44. 8-24 866A NEWCANAAN CT 203972-3408 45. 8-24 937A NARRAGNSTT RI 4OI 789-3964 46. 8-24 ialSA NARRAGNSTT RI 401 789-3964 42. 8-24 1116A RIVERHEAD NY 631 852-4557 48. 8-24 1116A RIVERHEAD NY 631 852-4557 49. 8-24 1116A RIVERHEAD NY 631852-4552 Code Mien 2:15+ 1:04+ 2:12+ I:1~- 0:30+ 9:01+ 2:02+ 0:30+ 0:30+ 0:30+ 0:30+ 0:30+ 1:07+ 3:24+ 1:13+ 0:42+ 0:38+ 1:05+ 1:12+ 0:30+ 0:30+ 0:30+ 0:30+ 6:26+ 0:30+ 0:30+ 0:40+ 0:30+ 0:30+ 4:01+ 2:56+ 0:52+ 0:44+ 0:36+ 1:51+ 2:14+ 0:59+ 0:30+ 6:35+ 0:36+ 1:26+ 0:30+ 0:30+ D 1:23+ 13:45+ 3:38+ 0:30+ 0:30+ 3:00+ CaR Cl~,rgue - Confinued Item No. Date Tim~ Place Number 66. 8-24 1134A FISHERS IS NY 631 788-7878 51. 8-24 1159A HARTFORD CT 860594-4816 52. 8-24 1212P FISHERSfS NY 631788-7463 .80 53. 8-24 I13P MIDDLETOWN CT 860632-2338 .80 54. 8-24 314P BEAVERDAM WI 920344-6621 .(30 56. 8-24 34OP FISHERS IS NY 631 788-7345 .00 66. 8-24 610P RYE NY 914921-51389 .00 57. 8-25 748A FISHERS IS NY 631 788-~46 .80 66. 8-27 841A PROVIDENCE RI 4OI 272-5468 .0O 59. 8-27 842A PROVIDENCE RI 401 272-5668 .00 60. 8-27 938A MIDDLETOWN CT 860344-5271 .80 61. 8-27 947A FISHERS IS NY 631 788-6673 .80 62. 8-27 954A HARTFORD CT 860841-6860 .00 63. 8-27 1801A HARTFORD CT 860660-2524 .al 64. 8-27 1038A WASHINGTON DC 202 257-6063 .80 65. 8-27 1138A FISHERS IS NY 631 788-7348 .80 66. 8-27 1211P FISHERSIS NY 631788-781g .66 67. 8-27 102P FISHERS IS NY 631 788-7855 .80 6~. 8-27 117P BEAVERDAM WI 920344-6621 .80 69. 8-27 119P FISHERSIS NY 631788-6673 .80 70. 8-27 136P FISHERS IS NY 631 78~-6673 .al 71. 8-27 205P FISHERS IS NY 631 788-6673 .80 72. 8-28 759A FISHERS IS NY 631788-7463 .80 73. 8-28 813A FISHERS IS NY 631 788-7463 .al 74. 8-28 849A PROVIDENCE RI 401 952-7554 .al 75. 8-28 809A FISHERS IS NY 631 788-5673 .80 76. 8-28 916A HARTFORD CT 860 247-3264 .80 77. 8-28 1107A FISHERS IS NY 631 788-7463 .al 78. 8-28 1141A FISHERSIS NY 631788-7345 .00 29. 8-28 1237P FISHERS IS NY 631 788-6650 .80 80. 8-28 214P MILFORD CT 203876-8680 .80 81. 8-28 224P MILFORD CT 203876-8606 .80 82. 8-28 237P WARWICK RI 401 737-6662 .80 83. 8-29 709A FISHERS IS NY 631 766-7463 .80 84. 8-29 980A FISHERS IS NY 631 788-7463 .80 85. 8-29 9~3A FISHERS iS NY 631 7al-7744 .00 86. 8-29 955A STALBANS VT 802527-9100 .80 87. 8-29 959A VERSAILLES KY 866879-4238 .00 88. 8-29 1042A WATERBURY CT 203754-6334 .80 89. 8-29 1220P POUGRKEPSI NY 8456.~-1677 .80 90. 8-29 1254P PUTNAM CT 880663-0766 .80 91. 8-29 103P WILLIMNTIC CT 660254-9663 .80 92. 8-29 104P PUTNAM CT 860963-0766 .80 93. 8-29 141P FISHERS IS NY 631 788-7167 .Oe 94. 8-29 143P NEWYOHK NY 917912-3820 ,80 95. 8-29 280P FISHERS IS NY 631 788-7463 .80 96, 8-30 813A FISHERS IS NY 631 788-7255 .80 97, 8-30 828A FISHERS IS NY 631 780-7463 .al al. 8-30 838A FISHERS IS NY 631 788-7463 .al 99. 8-38 929A FISHERS iS NY 631 766-7463 .80 180. 8-30 966A FISHERSIS NY 631788-6673 .80 101, 8-30 lal0A FISHERS IS NY 631 788-5673 102. 8-38 1805A FISHERS IS NY 631 788-7463 Code 1 2:80+ O 0:52+ I 1:32+ D 1:04+ 1 1:15+ 1 0:30+ 2 0:30+ 2 2:27+ 1 0:45+ t 0:40+ D 2:36+ 1 4:11+ D 4:47+ O 2:05+ 1:28+ 0:30+ 0:42+ 0:46+ 1:80+ 0:30+ 3:12+ 0:30+ 0:34+ 0:3(N- 2:44+ 8:44+ 0:30+ 2:52+ 0:43+ 0:44+ 2:23+ 0:30+ 2:13+ 2:55+ 2:47+ 2:10+ 0:46+ 1:43+ 0:38+ 0:31+ 3:13+ 0:30+ 0:31+ 0:30+ 0:31+ 2:24+ 2:53+ 1:16+ 2:50+ 0:37+ 1:80+ 2:40+ 1:23+ at&t FISHERS ISLAND FERRY DISTRICT P~go PO SOX I~ Account Number FISHERS ISLE NY 06390-0607 Billing Date 4of8 860 442-0165 078 Sep 18, 2012 Cull Chullleu - Continued No. DOX~ ~ Place Number 1. 8-30 1019A FISHERS IS NY 631 788-7281 2. 8-30 1148A GUILFORD CT 203458-4128 3. 8-30 1237P GUILFORD CT 203458-4128 4. 8-30 203P FISHERS IS NY 631 788-7919 5. 8-30 2lIP FISHERSIS NY 631788-7323 6. 8-30 248P FISHERS IS NY 631 788-7463 7. 8-30 318P FISHERS iS NY 631 788-5673 8, 8-30 322P FISHERSIS NY 631 788-7323 9. 8-31 810A FISHERS IS NY 631 788-7463 10. 8-31 829A FISHERS IS NY 631 788-5673 II. 8-31 859A FISHERS IS NY 631 788-7225 12. 8-31 923A FISHERS IS NY 631788-7463 13. 8-31 1042A FISHERS IS NY 631 788-7463 14. 8-31 1048A FISHERS IS NY 631 788-7463 15. 8-31 1057A FISHERS IS NY 631 788-7463 16. 8-31 1117A FISHERSIS NY 631788-7070 17. 18. 19. 20. 21. 22. 23. 24, 25. 26. 27, 28. 29. 30. 31. 32. 33, 34. 35. 36, 37. 38, 39. 40. 41. 42. 43. 44. 45. 46. 42. 48. 49. 8-31 121P BRIDGEPORT CT 203 660-0327 8-31 123P FISHERSIS 8-31 430P FISHERSIS 9-OI 1136A FISHERS IS 9-O1 1255P FISHERS IS 9-03 1009A FISHERS IS 9-03 1045A FISHERS IS 9-03 1158A NEW HAVEN 9-04 821A PLAINVILLE 9-04 838A FISHERSIS NY 631 788-7255 NY 631 788-7345 NY 631 788-7744 NY 631 788-7255 NY 631 788-5515 NY 631 788-5515 CT 203641-9494 CT 860747-9911 NY 631 788-7463 9-04 952AWINDSORLKS CT 860623-8374 9-04 1153A FISHERS IS 9-04 1200P FISHERS IS 9-O4 1230P FISHERS IS 9-04 101P RSHERSIS 9-04 106P FISRERSIS 9-04 109P FISHERSIS 9-04 300P FISHERSIS 9-04 305P HARTFORD 9-04 317P OLD SAYRRK 9-04 336P FISHERS IS 9-04 355P OLD SAYRRK 9*05 844A FISHERSIS NY 631 788-7345 NY 631 788-7345 NY 631 788-5673 NY 631 788-7444 NY 631 788-7444 NY 631 788-7444 NY 631 788-5655 CT 860 841~6860 CT 860 515-2207 NY 631 788-7345 CT 860399-5266 NY 631 788-7224 9-05 852A NARRAGNSTT RI 401 789-3964 9-05 602A FISHERS IS NY 631788-7463 9-05 913A FISHERS 18 NY 631788-5546 9-05 914A MORRISTOWN NJ 973214-1806 9-05 1026A FISHERS IS NY 631 788-5673 9-05 1032A FISHERS IS NY 631 788 7463 9-05 1052A FISHERS IS NY 631 788-5560 9-05 IIIOA FiSHERSIS NY 631788-7255 9-05 1127A BOSTON MA 617 330-5705 9-05 1141A FISHERS IS NY 631 788-7345 Code CMl Charges - Continued Item No. [~ Time Place Number 50. 9-05 1145A FISHERS IS NY 631 788-7444 51. 9-05 1152A NARRAGNSTT Ri 401 788-3964 Min 82. 9-05 328P WELLS ME 207646-4546 1:26+ .00 53. 9-05 338P WELLS ME 207646-4546 5:58+ .00 54. 9-06 829A FISHERS IS NY 631 788-7463 0:36+ .GO 55. 9-06 904A FISHERS IS NY 631 788-7857 0:36+ .O0 56. 9-06 915A FISHERS IS NY 631 788-7463 1:33+ .00 57. 9-06 947A SOUTHINGTN CT 860602-4893 10:60+ .0O 58. 9-06 949A WINDSORLKS CT 860668-0044 3:14+ .0~ 59. 9-06 1011A FISHERS IS NY 631 788-7744 2:45+ .60 60. 9-06 1117A FISHERS IS NY 631 788-7463 1:23+ .60 61, 9-06 1153A NEWBRITAIN CT 860224-6047 0:40+ .60 62. 9-06 1221P FISHERS IS NY 631 788-7323 1:06+ .60 63. 9-06 1226P FISHERS IS NY 631 788-7857 2:45+ .00 64. 9-06 1242P FISHERS IS NY 631 788-7857 0:30+ .00 65. 9-06 1260P SOMERVILLE NJ 9~625-9600 0:30+ .DO 66. 9-06 1258P FISHERS IS NY 631 788-7857 6:24+ .00 67. 9-06 130P FISHERS IS NY 631 788-7857 0:30+ .00 68. 9-06 134P FISHERS IS NY 631 788-7857 0:59+ .00 69. 9-06 215P FISHERS IS NY 631 788-7857 0:37+ .60 70. 9-06 249P FISHERS IS NY 631 78~-7345 0:36+ .60 71. 9-06 324P PLAINVILLE CT 860351-0129 0:57+ .60 72. 9-07 759A HARTFORD CT 860247-32~1 0:37+ .60 73. 9-07 831A FISHERS IS NY 631 788-7463 4:37+ .60 74. 9-07 1041A OLD SAYGRK CT 860 510-6598 1:60+ .00 75. 9-07 1145A GUILFORD CT 203458-4128 2:25+ .00 76. 9-07 1152A CLINTON CT 860669-6013 1:22+ .00 77. 9-07 1218P CLINTON CT 860609-6013 1:34+ .00 78. 9-07 124OP GUILFORD CT 203460-4128 0:30+ .00 79. 9-07 1241P GUILFORD CT 203458-4128 0:39+ .00 80. 9-07 103P FISHERSIS NY 631788-7632 0:39+ .00 81. 9-07 128P FISHERStS NY 631788-7224 0:30+ .DO 82. 9-07 314P FISHERSIS NY 631 788-7345 0:30+ .60 83. 9-07 403P FISHERS IS NY 631 788-7463 0:30+ .60 84. 9-07 421P FISHERS IS NY 631 788-7326 1:39+ .DO 85. 9-07 446P FISHERS IS NY 631 788-7326 0:30+ .60 86. 9-09 410P FISHERS IS NY 631 788-6082 2:31+ .60 87. 9-t0 814A HARTFORD CT 860960-9151 1:16+ .60 88. 9-10 821A HARTFORD CT 860953-9151 0:30+ .DO 89. 9-10 831A FISHERS IS NY 631 788-7857 4:26+ .00 90. 9-10 913A FISHERS IS NY 631788-5560 0:30+ .00 91. 9-10 916A ROSTON MA 617785-0658 0:36+ .60 92. 9-10 931A FISHERS IS NY 631 788-7463 0:30+ .60 93. 9-10 IDO6A FARMINGTON CT 860321-7634 0:42+ .00 94. 9-10 1034A FISHERS IS NY 631 788-7463 28:36+ .00 95. 9-10 1113A FISHERS IS NY 631 788-5673 0:52+ .00 96. 9-10 1137A FISHERS IS NY 631 788-7463 2:60+ .00 97. 9-10 1152A SOUTHOLD NY 631 765-1283 0:30+ .60 98. 9-10 1204P GUILFORD CT 203460-4128 0:37+ .0O 99. 9-10 1244P FISHERS IS NY 631 788-7919 0:54+ .60 100. 9-10 1251P FISHERS IS NY 631 788-5515 0:3(~ .60 101. 9-10 1254P HARTFORD CT 860986-7634 102. 9-10 100P FISHERS IS NY 631 788-7463 D 1 I D I 1:60+ .00 1:19+ .00 1:35+ 3:19+ 1:17+ .DO 8:03+ .DO 0:46+ .60 0:57+ .60 2:42+ .60 2:21+ .60 0:30+ ,00 0:45+ 0:36+ .00 I:00+ .60 0:39+ .60 0:50+ .60 1:39+ .60 0:30+ .DO 1:39+ .60 0:42+ .60 1:45+ .60 0:53+ .00 0:30+ .00 3:03+ .00 0:30+ .60 0:30+ .60 3:31+ .DO 1:13+ 0:45+ .60 4:43+ .60 16:44+ .DO 0:43+ .00 1:39+ .00 1:32+ .DO 3:02+ .DO 0:31+ .DO 0:30+ .DO 3:04+ .60 4:47+ .60 0:30+ .60 2:22+ .30 1:42+ .30 0:39+ .00 1:32+ .DO 0:30+ 7:19+ 1:19+ 1:51+ .DO 1:39+ .60 1:57+ .60 2:15+ .60 5:26+ .60 1:04+ .60 7875.0(N~.0760 56.02.04.000064~ NNNNNNNY 39337,112333 FISHERS ISLAND FERRY DISTRICT P~ 5 ot 8 at&t ,o.ox. ..,.o.,. FISH~:RS ISLE NY 06390-0602 Billing Dale Sep 15, 2012 Call Charges - Continued IEem ~ Date ~D~ Place Number I. 9-10 231P FISHERStS NY 631788-5673 2. 9-10 324P GUILFORD CT 203458-4128 3. 9-11 717A EISRERSIS NY 631788-5550 4. 9-11 747A FISHERSIS NY 631788-7463 5. 9-11 937A FISHERSIS NY 631788-7426 6. 9-11 1115A FISHERSIS NY 631788-7463 7. 9-11 1123A NEWBRITAIN CT 860225-9144 8. 9-11 1137A NEWBRITAIN CT 860225-9144 9. 9-11 1143A FAIRFIELD CT 203418-4270 10. 9-11 1159A FISHERSIS NY 631788-7463 II. 9-11 1201P FAIRFIELD CT 203418-4270 12. 9-11 1202P FAIRFIELD CT 203418-4270 13. 9-11 1203P FISHERSIS NY 631788-7463 14. 9-11 1237P FISRERSIS NY 631788-7463 15. 9-11 1256P GOSTON MA617686-6547 16. 9-12 834A FISHERS IS NY 631 788-7444 17. 9-12 843A FISHERS IS NY 631 788-7444 18. 9-12 1057A NEWHAVEN CT 203640-0681 19. 9-12 1112A FISHERSIS NY 631788-7463 20. 9-12 1130A NEWHAVEN CT 203640-0681 21. 9-12 1146A FISHERSIS NY 631 788-7463 22. 9-12 223P FISHERS IS NY 631788-7225 23. 9-12 225P FISHERS IS NY 631 788-7857 24. 9-12 255P FISHERS IS NY 631 788-7919 25. 9-12 339P ATTLEBORO MA774254-1717 26. 9-12 404P ATTLEBORO MA774254-1717 27. 9-13 831A FISHERSIS NY 631788-7348 28. 9-13 1023A FISHERS IS NY 631 788-5673 29. 9-13 1102A FISHERS IS NY 631 788-7919 30. 9-13 1109A MERIDEN CT 203238-0761 31. 9-13 1154A FISHERS tS NY 631 788-7919 32. 9-13 1200P FISHERSIS NY 631788-7463 33. 9-13 1209P STAMFORD CT 203554-5595 34. 9-13 121RP HARTFORD CT 860982-9339 35. 9-13 1257P FISHERSIS NY 631788-7463 36, 9-13 105P HARTFORD CT 860982-9339 37. 9-13 134P FISHERSIS NY 631788-7463 38. g-13 220P FISHERSIS NY 631788-7919 39. 9-13 233P FISHERS IS NY 631 788-7683 40. 9 13 307P FISHERS IS NY 631 788-7979 41. 0-13 310P FISHERS IS NY 631 788-7919 42. 9-13 325P FISHERSIS NY 631788-7463 43. 9-13 331P HARTFORD CT 860838-40~ 44. 9-13 336P NEWBRITAIN CT 860229-4878 48. 9-14 1156A MILFORD CT 203876-8606 46. 9-14 1200P MILFORD CT 203870-8606 47. 9-14 415P HARTFORD CT 860982-9339 Total Itemized Cella Director/Assi~tauee Seglma~ 2 instate Directory Ass}stance Call(s) Total Charges for 860 442-0165 Call Charges - Continued Charges for g66 443-6851 Item Mo, Date Time Place Number Itemized Calls Code Min 48. 8-10 Ill0A FISHERSIS NY 631788-5522 I 1:58+ .o0 49. 8-10 305P FISHERS IS NY 631 788-5522 O 4:01+ .O0 50. 8-11 1162A FISHERS IS NY 631 788-5522 2 1:19+ .00 51. 8-11 249P FISHERS IS NY 631 788-5522 2 0:39+ .00 52. 8-13 932A FISHERS IS NY 631 788-5522 1 0:30+ 0O 53. 8-13 951A FISHERS IS NY 631 788-5522 1 2:01+ .00 54. 8-13 1003A FISHERS IS NY 631 788-5522 D 1:21+ .00 55. 8-13 217P FISHERS IS NY 631 788-8822 D 2:38+ .OD 56. 8-13 304P FISHERS IS NY 631 788-5522 D 3:17+ .11 57. 8-13 432P FISHERS IS NY 631783-7451 I 0:46+ .03 58. 8-14 1115A FISHERS IS NY 631 788-5522 O 0:30+ .02 59. 8-14 235P FISHERS IS NY 631 788-5522 O 0:30+ .02 60. 8-14 301P FISHERS IS NY 631 788-5522 1 0:30+ .02 61. 8-15 1021A FISHERS IS NY 631 788-5522 1 3:02+ .13 62. 8-15 1106A FISHERS IS NY 631 788-5522 1 1:16+ .85 63. 8-15 1111A FISHERS IS NY 631 788-5522 I 0:31+ .02 64. 8-15 1118A FISHERS IS NY 631 788-5523 I 2:50+ .12 65. 8-15 1142A FISHERS IS NY 631 788-5522 D 0:40+ .03 66. 8-15 1144A FISHERS ~S NY 631 788-5522 1 1:06+ .05 67. 8-15 243P TORRANCE CA 310381-7483 O 2:50+ ,12 68. 8-15 307P FISHERS IS NY 631 788-5522 1:45+ .08 69. 8-15 424P PROVIDENCE RI 401 275-6581 1:15+ .O5 70. 8-16 1043A FISHERS IS NY 631 788-5522 1:31+ .07 71. 8-16 1059A FISHERS IS NY 631 788-5522 0:30+ .02 72. 8-16 310P FISHERS IS NY 631 788-5522 14:55+ .64 73. 8-17 717A FISHERS IS NY 631 788-5522 0:37+ .03 74. 8-17 718A FISHERStS NY 631788-8522 0:30+ .02 76. 8-17 730A FISRERSIS NY 631788-8522 1:38+ .07 76. 8-17 732A FISHERS IS NY 631 788-8522 0:30+ .02 77. 8-17 734A FISHERS IS NY 631 788-5522 D 6:27+ ,28 78. 8-t7 743A FISHERS IS NY 631 788-5522 I 1:43+ .07 79. 8-17 1055A FISHERS IS NY 631 788-5522 I 1:08+ .05 80. 8-17 1246P FISHERS IS NY 631 788-5522 O 1:~8+ .08 81. 8-17 235P FISHERSIS NY 63176~-7192 D 7:(30+ .30 82. 8-17 249P FISHERSIS NY 631788-5523 1 2:10+ .09 83. 8-17 321P FISHERS IS NY 631 788-5522 D 4:10+ .18 84. 8-17 324P FISHERS IS NY 631 788-5522 ] 6:55+ .30 85. 8-18 90DA FISHERS IS NY 631 788-5523 I 4:32+ .19 86. 8-18 139P FISHERS IS NY 631788-5522 I 2:04+ .09 87, 8-19 719A FISHERS IS NY 631788-5523 1 0:30+ .02 88. 8-20 1017A FISHERS IS NY 631 788-5522 1 1:33+ .07 89. 8-2O 1108A FISHERS IS NY 631 788-5522 1 3:37+ .16 90. 8-20 238P FISHERS IS NY 631 788-5822 D 4:47+ .21 91. 8-20 314P FISHERS IS NY 631 788-5522 O 1:35+ .07 92. 8-21 1042A FISHERS IS NY 631 788-5522 O 1:50+ .08 93. 8-21 315P FISHERS IS NY 631 788-5522 0 0:31+ .02 94. 8-21 319P FISHERS IS NY 631 788-5522 O 0:49+ .04 95. 8-22 1027A FISHERS IS NY 631 788-5522 4.02 96. 8-22 1044A FISHERS IS NV 631 788-5522 97. 8-22 316P FISHERS IS NY 631788-5522 98. 8-23 1035A FISHERS IS NY 631 788-5522 4.02 Code 1:54+ 0:32+ .02 0:31+ .02 0:32+ .02 1:37+ .07 0:32+ 02 1;35+ .07 0:30+ .02 0:30+ .02 0:30~ ,02 1:48+ 0:30+ .02 0:34+ .02 0:35+ .03 0:30+ .02 1:17+ .06 0:30+ .02 0:38+ .03 0:30+ .02 0:30+ .02 0:31+ .02 0:54+ .04 0:38+ .0~ 1:15+ .05 0:33+ .02 0:44+ .03 2:11+ .09 1:06+ .05 1:24+ ,06 1:05+ 13:03+ .56 1:31+ .07 0:31+ .02 0:43+ .03 0:30+ .02 0:33+ .02 0:33+ .02 0:30+ .02 0:32+ .02 0:30+ .02 1:24+ .(36 0:53+ .04 0:30+ .02 0:33+ .02 1:36+ 07 0:30+ .02 0:35+ .03 0:34+ .02 1:32+ .07 0:32+ .02 1:37+ .07 FISHERS ISLAND FERRY DISTRICT PaRe 6o[8 at&t PO BOXH Account Number 860442-0165078 FISHERS ISLE NY 06390 0607 milling Date Sep 15, 2012 Call Charges - Continued Item No. 08tg Time Place 1. 8-23 308P FISHERSIS 2. 8-24 913A FISHERS IS 3. 8-24 1111A FISHERSIS 4. 8-24 305P FISHERSIS 5, 8-24 324P FISHERSIS 6. 8-24 356P EISHERSIS 7. 8-25 204P FISHERSIS 8. 8-27 929A FISHERSIS 9. 8-27 1029A FISHERS IS 10. 8-27 310P FISHERSIS II. 8-28 1117A FISHERSIS 12. 8-28 302P FISHERSIS 13, 8-29 103~A FISHERS IS 14. 8-29 1144A FISHERS IS 15. 8-29 258P FISHERS IS 16. 8-30 9§8A FISHERSIS 17. 8-30 1030A FISHERS IS 18. 8-30 314P FISHERSIS 19. 8-31 1035A FISRERSIS 20. 8-31 323P FISHERSIS 21. 9-01 152P FISHERS iS 22. 9-01 3~5P FISHERSIS 23. 9-04 931A FISHERSIS 24. 9-04 1029A FISHERS IS 25. 9-05 838A HARTFORD 26. 9-05 1031A FISHERS IS 27. 9-05 1100A FISHERS IS 28. 9-05 225P FISHERSIS 29. 9-05 227P FISHERSIS 30. 9-05 319P FISHERSIS 31. 9 06 609A FISHERS IS 32. 9 06 828A FISHERS IS 33. 9-06 IIIOA FISHERSIS 34. 9-06 304P FISHERSIS 35. 9-07 lOOSA FISHERS IS 36, 9-07 1036A FISHERSIS 37. 9-07 322P FISHERSIS 38. 9-0~ 141P FISHERSIS 39. 9-10 926A FISHERS IS 40. 9-10 945A FISHERS IS 41. 9-10 311P FISHERSlS 42. 9-11 10~6A FISHERSIS 43. 9-11 1008A FISHERSIS 44. 9-11 1156A FAIRFIELD 45. 9-11 1159A FAIRFIELD 46. 9-11 1208P FISHERS tS 47. 9-12 946A FISHERSIS 48. 9-12 958A FISHERSIS 49. 9-12 319P FISHERSIS Nqml)~r NY 631 788-5522 NY 631 788-5522 NY 631 788-5522 NY 631 788-5522 NY 631 788-5522 NY 631 788-5522 NY 631 788-5522 NY 631 788-5522 NY 631 788-5522 NY 631 788-5522 NY 631 788-5522 NY 631 788-5522 NY 631 788-5522 NY 631 788-5522 NY 631 788-5522 NY 631 788-5522 NY 631 788-5522 NY 631 788-5522 NY 631 788-5522 NY 631 788-5522 NY 631 788-5522 NY 631 788-5522 NY 631 788-5522 NY 631 788-5522 CT 860289-5368 NY 631 788-5522 NY 631 788-5522 NY 631 788-5523 NY 631 788-5523 NY 631 788-5522 NY 631 788-5523 NY 631 788-5523 NY 631 788-5522 NY 631 788-5522 NY 631 788-5522 NY 631 788-5522 NY 631 788*5522 NY 631 788-5522 NY 631 788-5522 NY 631 788-5522 NY 631 788-5522 NY 631 788-5522 NY 631 788-5522 CT 203418-4271 CT 203418-4271 NY 631 788-5523 NY 631 788-5522 NY 631 788-5522 NY 631 788-5522 Code D D I I 1 I 0:32+ .02 0:30+ .02 1:21+ .06 0:33+ .02 0:34+ .02 4:07+ .18 0:30+ .02 0:34+ .02 0:57+ .04 0:33+ .02 ~:37+ .07 0:33+ 02 I:11+ 0:34+ .02 0:32+ .02 0:38+ .03 1:16+ .05 0:34+ .02 1:08+ .05 0:33+ .02 0:31+ .02 0:31+ .02 0:37+ .03 0:39+ .03 0:30+ .02 0:31+ .02 1:17+ .06 0:30+ .02 0:31+ .02 0:32+ .02 0:50+ .04 0:36+ ,03 1:07+ ,05 0:33+ .02 0:57+ .04 0:32+ .02 0:32+ ,02 0:31+ .02 0:32+ .02 0:35+ .03 0:32+ .02 0:59+ .04 0:33+ .02 0:30+ .02 0:30+ .02 0:30+ .02 0:38+ ,03 0:32+ .02 0:32+ ,02 Call Charges - Continued Item No. ~ Tim~ Place 50. 9-13 958A FISHERS IS 51. 9-13 1116A FISHERSIS 52. 9-13 314P FISHERS IS Total Itemized Calls Tetal Charges for 860 443-6851 Charges for ~ 444-0320 Itemized Calls 53. 8-13 220P FISHERSIS 54. 8-14 1210P LINDENHST 55. 8-15 104P LINDENHST 56. 8-16 612A FISHERSIS 57. 8-24 923A FISHERSIS 58. 8-24 927A EISHERSIS 59. 8-28 222P FISHERSIS 60. 9-05 1053A LINDENHST 61. 9-06 213P FISHERSIS Total Itemized Cags Total Charges for 860 444-0320 Charges for 860 447-9371 Itemized Calls 62. 8-10 1016A FISHERSIS 63. 8.!9 1130A FISHERSIS 64. 8-10 324P FISHERSIS 65. 8-13 II10A FISHERS IS 66. 8-13 221P FISHERSIS 67. 8-13 227P FISHERSIS 68. 8-13 251P FISHERSIS 69. 8-13 254P FISHERSIS 70. 8-13 315P FtSHERSIS 71. 8-13 330P FISHERSIS 72. 8-14 921A FISHERSIS 73, 8-14 935A FISHERSIS 74. 8-14 137P FISHERSIS 75. 8-15 IO(~A FISHERS IS 76. 8-15 1142A FISHERS IS 77. 8-15 1205P FISHERS IS 78. 8-15 159P FISHERSIS 79. 8-15 329P FISHERS IS 80. 8-16 1007A FISHERS IS 81. 8-16 230P FISHERSIS 82. 8-16 255P FISHERSIS 83. 8-17 1243P FISHERSIS 84. 8-17 245P FISHERSIS 85. 8-20 100~A FISHERS IS 86. 8-20 1206P FISHERS IS 87. 8-20 1253P LANCASTER 88. 8-20 310P FISHERSIS 89. 8-21 120DP FISHERS IS 90. 8 21 1203P FISHERS IS 91. 8-21 151P FISHERSIS Number NY 631 788-5522 NY 631 788-5522 NY 631 788-5522 NY 631 788-5523 NY 631 225-7911 NY 631 225-7911 NY 631 788-5523 NY 631 788-5513 NY 631 788-5513 NY 631 788-5523 NY 631 225-7911 NY 631 788-5523 NY 631 78~-7255 NY 631 788-7323 NY 631 788-7394 NY 631 788-7463 NY 631 788-7149 NY 631 788-7149 NY 631 788-7311 NY 631 788-5515 NY 631 788-7224 NY 631 788-7343 NY 631 788-7323 NY 631 788-7444 NY 631 788-7919 NY 631 788-7687 NY 631 788-7345 NY 631 788-7463 NY 631 788-7463 NY 631 788-7345 NY 631 788-7255 NY 631 788-7345 NY 631 788-7463 NY 631 788 7255 NY 631 788-7463 NY 631 788-7463 NY 631 788-7433 PA 717 295-0661 NY 631 788-7463 NY 631 788-7520 NY 631 788-7463 NY 631 788-7463 92. 8-22 813A NEWCANAAN CT 203972-3408 Cede 0:33+ .02 0:54+ .04 0:32+ .02 3.97 3.97 1:37+ .07 0:30+ .02 0:30+ .02 1:31+ .07 0:30+ .02 1:39+ .07 1:33+ .07 0:30+ .02 7:02+ .30 .66 .66 2:02+ .09 0:55+ .04 0:50+ .04 0:53+ .04 0:39+ .03 I:00+ .04 0:43+ .03 14:16+ .61 1:21+ .06 0:32+ .02 1:16+ .05 0:38+ .03 3:05+ .13 0:30+ .02 1:13+ .05 0:46+ .03 2:14+ .10 1:53+ .08 3:06+ .13 0:37+ .03 1:04+ .05 0:37+ .03 0:48+ .03 0:57+ ,04 1:38+ .07 0:48+ 3:49+ .16 0:56+ .04 0:30+ .02 2:53+ .12 0:31+ .02 7875.068.076856.03.04.0000000 NNNNNNNY 39339.112335 at&t FISHERS ISLAND FERRY DISTRICT PO B0X H FISHERS ISLE NY 06390-0607 Page Account Number Billing Date 7of8 860 4L42-0165 078 Sep 15, 2012 Call Cbe~ges - Continued Item No. Oqt~ Time Place 1. 8-22 1304A NEWTON 2. 8*23 1020A FISHERS IS 3. 8-23 1130A FISHERS IS 4. 8-23 1132A FISHERS IS 5. 8-23 356P POUGHKEPSI 6. 8-24 130P FISHERS IS 7. 8-24 317P FISHERS IS 8. 8-27 lso7A FISHERSIS 9. 8-28 956A FISHERS IS 10. 8-28 2OOP WORCESTER 11. 8-28 214P FISHERSIS 12. 8-29 11§7A FISHERS IS 13. 8-29 1221P FISHERS IS 14. 8-30 923A FISHERS IS 15. 8-30 94OA FISHERS IS 16. 8-30 1142A WINDSORLKS 17. 8-31 107P FISHERSIS 18. 8-31 222P FISHERSIS 19. 8-31 225P FISHERSIS 20. 8-31 228P FISHERSIS 21. 8-31 310P POUGHKEPSI 22. 9-04 1233P FISHERSIS 23. 9-O4 302P POUGHKEPSI 24. 9-04 330P FISHERS IS 26. 9-05 830A FISHERS IS 26. 9*05 1021A FISHERSIS 27. 9-05 1024A ABILENE 28. 9-06 104DA ESSEX 29. 9-06 959A FISHERS IS 30. 9-06 1035A FISHERS IS 31. 9-30 1126A FISHERS IS 32. 9-30 12SOP FISHERS IS 33. 9-06 133P FISHERS IS 34. 9 10 9OGA WILLIMNTIC 35. 9-10 325P HARTFORD 36. 9-T2 1007A NEWHAVEN 37. 9-12 1SOgA FISHERS IS 38. 9-12 I010A FISHERS IS 39. 9-12 1012A FISHERSIS 40. 9-12 1131A FISHERSIS 41. 9-12 1154A HARTFORD 42. 9-12 1234P FISHER8 IS 43. 9-12 258P GUILFORD 44. 9-12 812P OLD SAYBRK 45. 9-12 604P OLDSAYDRK 46. 9-13 835A MERCERVL 47. 9-13 1231P FISHERSIS 48. 9-13 132P HARTFORD 49. 9-13 223P HARTFORD Total Itemized Calls Total Charges for 860 447-9371 Number Cod~ Min MA 617 656-6547 0:30+ NY 631 788-7463 0:30+ NY 631 730-~673 0:30+ NY 631 788-5673 0:30+ NY 845656-1677 0:30+ NY 631 788-~673 0:59+ NY 631 730-7311 0:35+ NY 631 788-7463 0:51+ NY 631 788-7463 0:43+ MA 508 735-1252 0:43+ NY 631 730-7463 1:54+ NY 631 788-7463 3:57+ NY 631 7SO*7255 2:01+ NY 631 788-7463 0:33+ NY 631 788-7463 0:30+ CT 300 SOS-SO44 O 4:57+ NY 631 788-7251 0:30+ NY 631 788-5673 1:54+ NY 631 788-7255 0:39+ NY 631 788-7225 0:32+ NY 914475-7080 2:45+ NY 63t 788-7463 0:38+ NY 845656-1677 0:57+ NY SO1 788-7345 0:33+ NY 631 788-SO73 1:36+ NY 631 788-7345 0:30+ TX 325232-4460 1:23+ CT 860662-0024 0:47+ NY 631 788-7345 1:05+ NY 631 788-7463 0:53+ NY 631 788-7334 0:30+ NY 631 788-7463 0:54+ NY 631 788-7463 0:30+ CT 860 234-9583 0:30+ CT 860953-9151 0:49+ CT 203641-9494 0:32+ NY 631 788-7255 0:50+ NY 631 788-7123 1:02+ NY 631 788-7255 0:37* NY 631 730-7463 1:26+ CT 8SO 838-4095 1:04+ NY 631 788-7463 7:46+ CT 203458-4128 2:15+ CT 8SO 304-7281 0:48+ CT 860304-7281 0:58+ NJ 6(;9689-3000 1:34+ NY 631 788-7919 1:36+ CT 8SO 594-4816 1:52+ CT 860953-9151 1:19+ .02 .02 .02 .02 .02 .04 .03 .04 .03 .03 .08 .17 .09 .02 .02 .21 .02 .30 .03 .02 .12 .O~ .04 .02 .07 .02 .06 .03 .O5 .04 02 .04 .02 .02 .04 .02 .04 .04 .03 .(36 .05 .33 .10 .03 .04 .07 .07 .30 .05 4.90 4.90 Call Charges - Continued +- Optional Calling Plan Key to Calling Codes 1 Peak 2 Off Peak E Evening N Night/Weekend Total Call Charges Surcharges and Other Fees D Day 43.55 AT&T Connecticut SO. CounecticutE9-1-1Surcharge-4Lines 61. Connecticut Service Fund - 4 Unes 52. Universal Service Fund - Local(4@$1.281 53. Federal Subscriber Une Charge - 4 Unes Total AT&T Connecticut AT&T LO East 54. Federal Regulatory Fee 55. Universal Service Fund - Interstate Total AT&T Long Distance East Total Surcharges and Other Fees Tuna 1.60 .20 5,12 23.84 30.76 SO. Federal 57. State Sales Tax Total Taxes Total Plans and Services 3.59 12.80 16.39 279.63 PREVENT DISCONNECT If your bill shows a past due amount BOTH 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: $155.02 for Cunent Basic Cberge$ $8.00 for Past Due Basic Charges CARRIER INFO Our records indicate t~at AT&T Connecticut 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 el the bill because you subscribe to certain required services, Ior example, because you are an ALL DISTANCE® customer. If you remove any of the services required for a particular discount, reduced rata, 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. FISHERS ISLAND FERRY DISTRICT Page 8 of 8 PO BOX H Account Nurabef 860 442-0165 078 FISHERS ISLE NY 06390-0607 Billing Data Sep 15. 2012 at&t FUSF RATE The Federal Universal Service Fund (FUSF) Interstate charge, applicable to interstate and international Ions distance service provided by AT&T Long Distance East, is calculated using a contribution factor (subject to rounding) established by the FCC. This rate is subject to change quarterly and is posted at fcc.gov/omd/contribution-factar.htmE Bills issued on or after September I, 2012 will reflect any change to the rate. 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 Sma~ink; in-state Calbng Charges; in-state Directory Assistance Charges; the Connecticut E 911 Surcharge; t~e Connecticut Service Fund fee; the Federal Subscriber Line Charge; and the Universal Service Fund - Local fee. NON-BASIC CHARGES Non-Basic Charges are charges for Non-Basic Services. These charges include: Call Charges for out of state calls, 900 calls and calls placed through alternative services providers; Call Charges for in state long distance provided by a company other than AT&i' ConnecticuC 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 DIRECTV, 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. BILL PAYMENT, LATE PAYMENT CHARGES AND OTHER FEES Failure to pay any portion of your bill may result in additional collection action. Any partial payment made will first be applied to Basic Charges, then to Non Basic Charges. Failure to pay your Basic Charges will result in interruption of your local service. If you fail to pay VOUr Non-Basic Charges, your AT&T Connecticut local service will not be interrupted, but ail 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 statement AT&T Connecticut will apply a $20.00 Collection Charge on an account where a termination notice has been sent An explanation of these charges may be obtained by calling AT&T Connecticut atthe number shown on your bill or accessing our website: ht~pJ/www.attcom/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 Internet services are provided by AT&T Internet Services. Wireless services are provided by AT&T Mobility. 7875.00~,076058.04.04.0000000 NNNNNNNY 39341.112337 FISHERS ISLAND FERRY DISTRICT VENDOR 002776 CHARLES BURGESS 10/09/2012 CHECK 745 FUND & ACCOUNT P.O.# INVOICE DESCRIPTION AMOUNT SM .9060.8.000.000 070112 SM ~9060.8.000.000 080112 SM .9060.8.000.000 090112 SM .9060.8.000.000 5225501382 PRESCRIPT ARREARS-7/12 94.41 PRESCRIPT ARREARS-8/12 94.41 PRESCRIPT ARREARS-9/12 94.41 4TH QTR 2012 REIMB. 416.15 TOTAL 699.38 :. 1~'0007~5,,' ':02~05~,: KB 00~502 &,,' Vendor No. ! Check No. Town of Southold, New York - Payment Voucher i 2776 "] Vendor Tax ID Number or Social Security Number Vendor Address Entered by ~ ~--'~ 4 Hamel Court [Audit Date " -- Waterford, CT 06385 / CharlesW. Burgess ~ 0 9 2012 Vendor Telephone Number Invoice I Invoice Invoice Net Parchase Order Number Date Total Discount Amount Claime~ Number Description of Goods or Services General Ledger Fund and Account Number 71112012 $94.41 $94.4t Anthem Retiree SM9060.8.000.000 ~ 81112012 $94.41 $94.41 Prescdption Plan - ~'/I; ~ 91112012 $94.41 $94.41 90% Reimbursement - ~/ '~ ~104.90 less 10% ($94.41) Charles Burgess Ckff's :3t00, 3110, & 3119 For Months July-September 2012 year $283.23 $283.23 Payee Certification Department Certification lhe undersigned (Claimant) (Acting on behalf of tbe above named claimant) I hereby certify that the materials above specified have been received by me does hereby certify that the foregoing claim is ~-ue and correct, that no part has in good condition without substitation, the services properly been paid, except as therein stated, that the balance therein stated is actually performed and that the quantities thereof bare been verified with the exceptions due and owing, and that taxes from which the Town is exempt are excluded or discrepancies noted, and payment is approved. Signature ~ Title ~ Signamre C~z/~- CompanyNam Date rO ~ /~ Title ~2,'~A'~ Date fc'~' ~~~.~ I IIIII IIIII IIIII fllll Ill Ill IIII IIIII il IIII IIII md,H,WIIl,,4m,ldhdd,l,p.l"lhplll,.,I,H.l.I, CHARLES W BURGESS 4 HAMEL CT WATERFORD CT 0~385-2008 271437726 G0230329901 Balance Due 08/01/2012 $104.90 Please return the top portion of this form with your payment. See reverse side for payment options. Retain the bott~m ~portion of this form for ~ur r~brds - 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 r~uire one remittance advice and one pavraant ~er 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 m-enroll during a valid election period. Anthem~ Participant II): G0230329901 Date: 07/04/2012 Blue MedicareRx'(PDP) Transaction Date Description Amount Premium 07/01/2012 July 2012 104.90 Balance Due 104.90 KAREN C BURGESS 3100 CHARLES W BURGESS Citizens Bank Cidzens Ckde Account For · Page I of 1 · Anthem~ la ii IIIll fllll IIill fl Ill lira Ill II Ill m-d,l,"mdlll,,hv,,I,.,mhl,m,m,.mmmhmmlll,.ImHmml,,Im CHARLES W BURGESS 4 HAMEL CT WATERFORD CT 06385-2008 271437726 G0230329901 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 ~a_vmant _Der 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, lfyou are disenrolled from the plan, you may only re-enroll during a valid election period. Anthem~ Participant ID: G0'230329901 Date: 08/07/2012 Blue M~licaMix' (PO P) Transaction Date Description Amount Premium 08/01/2012 August 2012 104.90 Balance KAREN C BURGESS ' CHARLES W BURGESs 4 HAMEL CT ~. 3110 Citizens Bank Ci~n, Circle Account Please contact our customer service de~rtment at 1-888-620-1747 with any questions, r'd'l,llllllll,,llr,,Hhlhl,rrmUhulll,,,llHlll.l~ CH~ES W BUROESS 4 HAMEL CT WATERFORD CT 06385-2008 271437726 G0230329901 Balance Due 10/01/2012 $104.90 Please ret~trn 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 remi-ance 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 disearolled from the plan, y~u may only re-enroll during a valid election period. Anthem . Participant ID: G0230329901 Date: 09/06/2012 Blue MedicareR~ (PDP) Transaction Date Description Amount Premium 09/01/2012 September 2012 104.90 Balance Due KAREN C BURGE CHARLEs W 4 HAMEL CT BURGEss WAr~FO~o Cr ~ ~y to t ~ - . ~ Citizens ~.~ Pa~e 1 Town of Southold, New York - Payment Voucher Vendor Tax 1D Number or Social Security Number Vendor Address Vendor No. 2776 4 Hamel Court Waterford, CT 06385 Charles Burgess Vendor Telephone Number Vendor Contact Invoice Invoice Invoice Purchase Order Number Date Total Discount Number Description of Goeds or Services Check No. Entered by Audit Date OCT 0 9 2017 General Ledger Fund and Account Number 5225501382 9/t/2012 $416.t5 Amount Claimed Anthem BC/BS Retiree Stand Alone 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 90% Reimbursement ;462.39 less $46.24 Charles Burgess Ck#3120 Quarterly 101112012.1213112012 $416.15 $416.15 Department Certification Title Date SM9060.8.000.000 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 CHARLES . BURGESS TOTAL AMOUNT DUE BY: J 0 ,~ HAMEL CT OCTOBER 1, 2012 I 0 t4ATERFORD, CT 06585-2008 $462.39 5 9 MEMBER NUMBER: 0842M20101 INVOICE NUMBER; 5225501582 1 BILLINGACCOUNT: 70108~292010! PERIODCOVERED: 10/01/2012- 12/$1/2012 iNDICATE ADDRESS CHANGE BELOW: Lt~.ltlh'l.hq.i..h.hlLml-hlllhrl.rltldll.llltlht AMTHEH BLUE C~ ~ ~ SHIELD ~MA~ ~ 07101-11~ PLEASE ~ NOT WRITE BEL~ THIS LINE 000944171443030500400007010842920101100522550138209121200109500000462391 KAREN C BURGESS 3120 · CHARLES W BURGESS WATERFORD CT 0~.~85 : '~ ~ D_[e °rder °r~ ~/-/L'Y'/~ ~" ! -._ I Citizens Bank Citizens Circle Account Connecticut FISHERS ISLAND FERRY DISTRICT VENDOR 018554 DIVERS COVE LLC 10/09/2012 CHECK 746 FUND &' ACCOUNT P.O.~ INVOICE DESCRIPTION SM .5710.2,000.000 28858 DIVER-BOTH FERRIES TOTAL AMOUNT 106.35 106.35 Town of Southold, New York - Payment Voucher Vendor Tax ID Number or Social Security Number Vendor Address Divers Cove Vendor Telephone Number 860-767-1960 Vendor Contact Invoice Number 28858 Date 9/1012012 Invoice Total 106.$5 7 Essex Plaza Essex, CT 06426 Net Purchase Ord~ AmoumClaimed Numb~ 106.35 106.35 Payee Certification The undersigned (Claimant) (Acting on behalf of the above named claimant) does hereby certi~ that the foregoing claim is true and correct, that no pan 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 No. 18554 Description of Goods or Services Diver for both ferries Check No. '7%, Entered by Audit Date OCT 0 9 2012 106.35 Department Certification Signature ~~~ ~fle Company Name /~ Date ~- ~" General Ledger Fund and Account Number SM87t0.2,000.000 I hereby certify that the materials above specified have been received by me m good condition without substitution, the services properly performed and that the quantities thereof have been verified with the exceptions or discrepancies noted, and payment is approved. Title ~.e~.~ Date Divers Cove Invoice #28858 Page 1 of 1 Divers Cove 7 Essex Plaza Essex CT 06426 860-767-1960 860-767-.3366 COURSES & TRIPS - -CHECK OUT OUR WEBSITE: www.dlverecove.com FISHERS ISLAND FERRY DISTRICT #4411 BOX H FISHERS ISLAND, NY 06390 I @ $100.00 Delivered Description 1 LABOR-BOAT INSPECTION/REPAIR- FIRST HOUR BOAT/DC3763: Invoice #28858 9/10/2012 10:02:11 AM Sales Person: I - ED R. PC TAX Amount R I $100.00 Taxable Amount: $100.00 Service provided Sunday 9/212012 6.35% Sales Tax: Total Due: Total Paid: Balance Due (This Invoice): $6.35 $106.35 $t06.35 THANK YOU FOR SUPPORTING OUR BUSINESSI file ://C :\AJVPOS\HTML\Invoices\28858.html 9/10/2012 FISHERS ISLAND FERRY DISTRICT VENDOR 005255 ED BARTELLI, INC. FUND & ACCOUNT P.O.~ SM .5709.2.000.200 INVOICE 5652 10/09/2012 CHECK 747 DESCRIPTION (3)BACKFLOW PREVENT.TSTS TOTAL AMOUNT 319.05 319.05 Town of Southold, New York - Payment Voucher Vendor Tax ID Number or Social Securiiy Number Vendor Address P.O. Box 23 New London, CT 09320 Ed Bartelll, Inc. Vendor Telephone Number 860-625-4836 Vendor Contact Invoice Number Date Total Discount 5652 9/11/2012 8319.08 Net Purchase Order Amount Claimed Number $319.05 Vendor No. 5255 (~cription of Goods or Services Backflow Preventer Tests NL Terminal $319.05 $319.05 Payee Certification The undersigned (Claimant) (Acting on behalf of the above named claimant) does hereby certify that thc 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. Title Check No. Entered by Audit Date OCT O 0 2017 General Ledger Fund and Account Number SM5709.2.000.200 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 paymem is approved Signature ~ Title ~'~7/~1" Date '~F_d Rart~.lli~ Inc. 777 Broad St. Ext. Waterford, Ct. 06385 Invoice Date 9/11/2012 Invoice # 5652 Bill To Fishers Island Ferry PO Box H Fishers Island ,NY 06390 Terms Project 8/14/12 Due on rece... Quantity Description Rate Amount 3Annual test of the back flow devices luL Jr-~¢~al100.00 300.00T Sales Tax 6.35% 19.05 Please remit to above address. Total $319.05 FISHERS ISLAND FERRY DISTRICT VENDOR 005414 ELECTRICAL WHOLESALERS, INC. 10/09/2012 CHECK 748 FUND & ACCOUNT P. O. # INVOICE DESCRIPTION SM .5709.2.000.200 SM .5709.2.000.200 S021948310.001 NL SHORE POWER PARTS S021974480.000 NL BULBS FOR SECURITY LT TOTAL AMOUNT 87.10 85.40 172.50 "'OOOTt,,q,' I:OBi,~,OS~r=[,,: r:,°, OO;,5O8 Vendor No. 5414 Town of Southold, New York - Payment Voucher Vendor Tax ID Number or Social Security Number Vendor Address Lockbox 9761 Vendor Name P.O. BOX 8500 Electrical Wholesalers Inc. Philadelphia, PA t9178-976t Vendor Telephone Number 800-522-3232 Vendor Contact Number invoice Invoice Net PurcbaseOrder Check No. Entered by Audit Date OCT 0 9 2012 Date Total Discount ~,mount Claimed Number Description of Goods or SeP/ices General Ledger Fund and Account Number S021948310.001 8/3012012 $87.10 $87.10 NL Shore Power Parts SM8709.2.000.200 S021974480.000 91812012 $88,40 $88.40 NL Bulbs for security light~ SM8709,2.000.200 $172.50 $172.50 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 Compan~r Name Department Certification Signature ~ Title. . Date 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 I~lecirlcIiI Wbolemiler~/~ IBc. ELECTRICAL WHOLESALERS INC. P,O. BOX 261797 HARTFORD, CT 06126-1797 1-800-522-3232 Branch: 163 STATE PIER ROAD NEW LONDON,CT 06320 860/443-4381 767 ~ AB 0.374 EO257X 10528D539964963P11727§50001:0001 H. d,"h,",hhdlllqlll"..dlh,IHPl, dh,ql nH FISHERS ISLAND FERRY DI PO BOX H FISHERS ISLAND NY 06390-0607 INVOICE Invoice #: S021948310.001 Invoice Date: 08/3012012 Account #: 28370 Ticket #: D94023 Please Remit AII Payments To: Electrical Wholesalers, Inc Lockbox'8 9761 PO Box 8509 Philadelphia, PA 19178-9761 VISIT US AT: www. usesi.com/ew SHIP TO FISHERS ISLAND FERRY DI JOHN 860-303-8311 Customer WILL-CALL at: CT *NEW LONDON* BRANCH 06320 3 MAINTENANCE MAINTENANCE BO FROM B WO HOUSE ALL BRANCHES DEFREHN, BRUCE 3 LR60 PIS PLUG LKG RING 27.30 3K ITEM-MAY NOT BE RETURNABLE NEW! View, print, download and pay your invoices with ease using Electrical Wholesaler's new Invoice Gateway. Ele~d~l Wholesalem ~ntinues to se~i~ our customem by now allowing easy online ac~ss to all your invoi~s and statements in one ~nvenient Io~tion. Please visit the web address at the boEom of this page and use your unique enrollment token to b~in experiencing the benefits of this gmat new se~ice. I I I * PAYMENT IN FULL IS DUE BY OCT 25TH * 81.9~ TO RECEIVE YOUR INVOICES VIA F~ OR E-MAIL PLEASE CONTACT YOUR ACCOUNT 5.2~ REPRESENTATIVE TE.aS OF ~LE 87. lC S~EC~AL O.O~RSe NON-STOCK aERCHAND~S~ C~OT ~ RETURN~ FOR C.~. NO U~RC.AND~S~ C*. ~ R~TU~N~D FO~ C~ED~T W~THOUT AUTHOm~T~ON. A ~.~MUM 30~ RESTOCKING CHARGE DEDUCTED FROM ALL RETURNED MERCHANDISE. ORIGINAL I~OICE NUMBER MUST ACCOMPANY ALL C~JMS. A SERVICE CHARGE OF 1-1~% PER MONTH, WHICH IS THE EQUIVALENT OF 18% PER YEAR (OR AT SUCH A HIGHER ~TE AS SHALL BE ALLOWED BY ~ ON ALL PAST DUE BA~NCES R~SONABLE A~ORNEY'S ~EES, COURT FEES, AND OTHER COLLECTION COSTS MAY BE ADDED TO DELINQUENT ACCOUNTS. NO DISTRIBUTOR WAR--TIES UNLESS OTHERWISE SPECIFIED IN WRITING. AS VENDOR OF THIS ARTICLE(S), WE MAKE NO WAR~NTIES OR REPRESENTATIONS, EXPRESSED OR IMPLIED, AS TO WORKMANSHIP, PERFOR~CE, QUALI~, DU~BILI~, FITNESS, OR MERCHANTABILI~, TH~ ONLY WAR~NTIES APPLYING TO THE ARTICLE(S) SOLD HEREUNDER ARE THOSE SPECIFICALLY PROVIDED IN WRITING BY THE MANUFACTURER A ~_~ Company 0~01:0001 .... INVOICE GATEWAY: hffp:llewinc.billtrust.~m Web Enrollment Token: VMV D~ ~X Page 1 of 1 EIc (rl¢ ml lime. ELECTRICAL WHOLESALERS INC. P.O. BOX 261797 HARTFORD, CT 06126-1797 1-800-522-3232 Branch: 163 STATE PIER ROAD NEW LONDON,CT 06320 860/443-4381 2381AB0.374 EO238X 10540D543786892P11782880001:0001 FISHERS ISLAND FERRY DI PO BOX H FISHERS iSLAND NY 06390-0607 INVOICE Invoice #: S021974480.000 Invoice Date: 0910512012 Account #: 28370 Ticket #: B98738 Please Remit All Payments To: Electrical Wholesalers, Inc Lockbox~ 9761 PO Box 8500 Philadelphia, PA 19178-9761 VISIT US AT: www. usesl.comlew SHIP TO FISHERS ISLAND FERRY DI Customer COUNTER P/U at: NEW LONDON, CT 06320 6 STEVE STEVE COUNTER P/U HOUSE ALL BRANCHES GRESSLER, MIKE 5 .~EL MVR400/U CLR E37MOG MH LAMP NEW! View, print, download and pay your invoices with ease using Electrical Wholesaler's new Invoice Gateway. Electrical Wholesalers continues to service our customers by now allowing easy online access to all your invoices and statements in one convenient location. Please visit the web address at the bottom of this page and use your unique enrollment token to begin experiencing the benefits of this great new service. I * PAYMENT IN FULL IS DUE BY OCT 25TH * LAMPS/BULBS MAY CONTAIN MERCURY PER FED/STATE LAW MAY NOT BE PLACED IN GARBAGE FOR DISPOSAL! TERMS OF SALE SPECIAL ORDERED NON-STOCK MERCRANDISE CANNOT BE RETURNED FOR CREDIT NO MERCHANDISE CAN BE RETURNED FOR CREDIT WITHOUT AUTHORIZATION. A MINIMUM 30% RESTOCKING CHARGE DEDUCTED FROM ALL RETURNED MERCHANDISE. ORIGINAL INVOICE NUMBER MUST ACCOMPANY ALL CLAIMS. A SERVICE CHARGE OF 1-112% PER MONTH, WHICH IS THE EQUIVALENT OF 18% PER YEAR (OR AT SUCH A HIGHER RATE AS SHALL BE ALLOWED BY LAW) ON ALL PAST DUE BALANCES. REASONABLE ATTORNEY*S FEES, COURT FEES, AND OTHER COLLECTION COSTS MAY BE ADDED TO DELINQUENT ACCOUNTS. NO DISTRIBUTOR WARRANTIES UNLESS OTHERWISE SPECIFIED iN WRITING. AS VENDOR OF THIS ARTICLE S, WE MAKE NO WARRANTIES OR REPRESENTAT ONS, EXPRESSED OR IMPLIED, AS TO WORKMANSHIP, PERFORMANCE QUALITY DURABILITY, FITNESS OR MERCHANTABILITY THE ONLY(vSI/ARRANTIES APPLYING TO THE ARTICLE(S) SOLD HEREUNDER ARE THOSE SPEC F CALLY PROV DED N WR T NG BY THE MANUFACTURER. A US£SI Company 0001:0001 .............. INVOICE GATEWAY: http:llewinc.billtrust.com Web Enrollment Token: VMV DKX FVX Page 1 of 1 O~DER DATE CUSTOMER PO NUMBER SHIP VIA ...... IN OUT T ' ' TOTAL EN[ OF DRDEF; E~EREDBY PICKEDBY PACKEDBY CHECKEDBY DRIVER RO~E BAGS COILS W~BIN SIGNER ACKNOWLE~ES RECEIPT OF MATERIAL IN G~D SUBTOTAL  ' ~ CONDITION & AGREES TO TERMS OF SALE ON REVERSE SIDE. TAX PACKING SLIP , .~:E~D OF' TERMS OF SALE SPECIAL ORDERED NON-STOCK MERCHANDISE CANNOT BE RETURNED FOR CREDIT. NO MERCHANDISE CAN BE RETURNED FORCRED~TWITInOU} AUYH©RiZATION 30% RESTOCKING CHARGE DEDUCTED FROM ALL RETURNED MERCHANDISE. ORIGINAL INVOICE NUMBER MUST ACCOMPANY ALL CLAIMS, A SERVICE CHARGE OF 1-1 1/2% PER MONTH, WHICH iS THE EQUIVALENT OF 18% PER YEAR. (OR AT SUCH A HIGHER RATE AS SHALL BE ALLOWED BY LAW) ON ALL PAST-DUE BALANCES REASONABLE ATTORNEY'S FEES, COURT FEES, AND OTHER COLLb. C IIU~N UOS'FS I'¢~ BE ADDED TO DELINQUENT ACCOUNTS. NO DISTRIBUTOR W,~RRANTIES UNL:':SS OTHERWISE SPECIFIED IN WRITING. AS VENDOR OF THIS ARTICLE(S), WE MAKE NO WARRANTIES OR REPRESENiATIONS EXPRESSED OR IMPLIED, AS TO WORK- MANSHIP, PERFORMANCE QUALITY DURASiLiT¥ FITNESS OR MERCHANTABILITY THE ONLY WARRANTIES APPLYING TO THE ARTICLE(S) SOLD HEREUNDE.q, ARE THOSE SPECIFICALLY PROVIDED IN WRITING BY THE MANUFACTURER ATTENTION: CASH RETURNS 1. ALL RETURNS MUST BE W~THIN 7 DAYS AND BE ACCOMPANIED BY THE INVOICE 2. A 30% HANDLING CHARGE OR S3,00 WHICHEVER IS GREATER ON ALL MERCHANDISE NO SPECIAL ORDERS OR CUT WIRE CAN 3. MERCHANDISE REFUNDED ONLY - NO CASH FISHERS ISLAND FERRY DISTRICT VENDOR 005442 EMPIRE DENTAL 10/09/2012 CHECK 749 FUND & ACCOUNT P.O.~ INVOICE DESCRIPTION AMOUNT SM .9060,8,000.000 4943902-10/12 DENTAL PREMIUM-10/12 1,053,75 TOTAL 1,053.75 Town of Southold, New York - Payment Voucher Vendor Tax ID Number or Social Security Number Empire Dsnt~l Vendor Telephone Number Vendor Contact Invoice Invoice Number Date 4943902 9/14/2012 $1,053.75 $1,053.75 P.O. Box 202837 Department 83703 Payee Certification The undersigned (Claimant) (Acting on behalf oftbe above named claimant) does hereby cer[i fy 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 Town is exempt are excluded Signature Title Datl ~-Y ~' //~ Compan Dallas, TX 75320-2837 Net Pumhase 0~ Amount Claimec Number $1,083.75 $1,083.75 Vendor No. 5442 Check No. Entered by .~ Audit Date OCT O 9 2012 Description of Goods or Services 1011/12-10131112 General Ledger Fund and Account Number SM9060.8.000.000 Department Certification I hereby certify that the materials above specified have been received by mc in good condition without substitation, the services properly performed and that the quantities thereof have been verified with the exceptions or discrepancies noted, and payment is approved. Signature Title STATEMENT PAGE 1 EMPIRE PO 50X 956 MINNEAPOLIS MN 55440-0859 ACCOUNT NAME ACCOUNT # BILLING DATE BILL/PYMT ENROLLMENT FISHERS ISLAND FERRY DISTRICT ENY456i25i 09/14/2012 877-606-3409 800-928-6459 FISHERS ISLAND FERRY DISTRICT ATTN: ASSISTANT MANAGER DEBBIE DOUCE 50 TRUMBULL ST PO BOX H FISHERS ISLAND NY 06390 REMIT TO: EMPIRE DENTAL PO BOX 202837 DEPARTMENT 83703 DALLAS TX 75320-2837 INVOICE TRANSACTION TRANSACTION DUE REFERENCE TRANSACTION AMOUNT NUMBER DATE DATE AMOUNT DUE 4943902 09/14/2012 INVOICE 10/01/2012 01/OCT/12-31/OCT/12PREMIU 1 ,053.75 I ,053.75 CURRENT DUE PAST DUE TOTAL AMOUNT DUE I - 30 DAYS 31 - BO DAYS 61 - 90 DAYS OVER 90 DAYS 1,053.75 0.00 0.00 0.00 0.00 1,053.75 AMOUNT REMITTED YOUR BALANCE IS DUE BY THE FIRST OF THE MONTH. PLEASE INCLUDE A STATEMENT COPY WITH YOUR PAYMENT. $ Emp.,,ire . . INVOICE PAOE 1 EMPIRE PO BOX 856 MINNEAPOLIS MN 55440-0856 ACCOUNT NAME ACCOUNT # BILLINO DATE BILLING/PYMT FISHERS ISLAND FERRY DISTRICT ENY4661251 INVOICE# 4943902 09/14/2012 SUBSCRIBER PERIOD 10/01/2012 - 10/31/2012 877-606-3409 CLAIM PERIOD FISHERS ISLAND FERRY DISTRICT ATTN: ASSISTANT MANAGER DEBBIE DOUCETTE 50 TRUMBULL ST PO BOX H FISHERS ISLAND NY 06390 REMIT TO: EMPIRE DENTAL PO BOX 202837 DEPARTMENT 83703 DALLAS TX 75320-2837 CUSTOMER NUMBER OF NUMBER OF CLAIM ADJUSTMENT RATE TOTAL REPORTING NUMi)ER CURRENT CLAIMS AMOUNT AMOUNT AMOUNT AMOUNT EMPLOYEES 466126 - 0001 - 0001-550 17 375.80 37.58/ER/MO 306,72 76.68/ER/MO 91.89/ER/MO 279.34 139.67/RE/NO INVOICE TOTAL 17 0 $0.00 $0~00 $1,053.75 $1,053.75 YOUR BALANCE IS DUE BY THE FIRST Of THE MONTH. PLEASE INCLUDE A STATEMENT COPY WITH YOUR PAYMENT. SUBSCRIBER LISTING PAGE EMPIRE PO BOX 856 MINNEAPOLIS MN 55440-0856 ACCOUNT NAME ACCOUNT # BILLING DATE ENROLLMENT FISHERS ISLAND FERRY DISTRICT ENY4561251 INVOICE # 09/14/2012 SUBSCRIBER PERIOD 800-928-6459 4943902 10/01/2012 - 10/31/2012 FISHERS ISLAND FERRY DISTRICT ATTN: ASSISTANT MANAGER DEBBIE DOUCETTE 50 TRUMBULL ST PO BOX H FISHERS ISLAND NY 06390 REMIT ENROLLMENT CHANGES TO: EMPIRE PO BOX 838 MINNEAPOLIS MN 55440-0838 ATTN: ENROLLMENT DEPARTMENT CUSTOMER REPORTING NUMBER 456125-0001-0001 FISHERS ISLAND FERRY DISTRICT LAST NAME FIRST NAME REF # SUBSCRIBER EFFECTIVE COVERAGE CURRENT RETRO TOTAl ID DATE TYPE AMOUNT AMOUNT AMOUNT BARRETT FREDERICK N/A 8B3Nl1083 05/01/2011 EMPLOYEE 37.58 BROWN DONALD N/A 895M11083 05/01/2011 EMPLOYEE+SPOUSE 76.68 BURKE STEPHEN N/A 648M11229 05/01/2012 EMPLOYEE 37.58 FIORA MICHAEL N/A 878Ml1083 05/01/2011 EMPLOYEE 37.58 FOLEY PAUL N/A 877M11083 05/01/2011 EMPLOYEE 37.58 FORD POLLY N/A 337Nl1227 04/01/2012 FAMILY 139.67 HILLER dONATHAN N/A 252Ml1092 07/01/2011 EMPLOYEE 37.58 HOCH RICHARD N/A 882Ml1083 05/01/2011 EMPLOYEE 37.58 KNAUFF ROBERT N/A 884M11083 05/01/2011 EMPLOYEE+SPOUSE 76.68 LEFEVRE RAYMOND N/A 881M11083 05/01/2011 EMPLOYEE 37.58 LYNCH MATTHER N/A 880M11083 05/01/2011 EMPLOYEE 37.58 MARKS JASON N/A 626Ml1227 04/01/2012 EMPLOYEE 37.58 MARSHALL OESSE N/A 896Ml1083 05/01/2011 EMPLOYEE+SPOUSE 76.68 MORGAN dOHN N/A 897M11083 05/01/2011 EMPLOYEE+SPOUSE 76.68 MURPHY GORDON N/A 095M11203 03/01/2012 FAMILY 139.67 SCHMID NINA N/A 898Ml1083 05/01/2011 EMP+CHI LD(REN) 91.89 TRAUB JAMES N/A 879M11083 05/01/2011 EMPLOYEE 37.58 10 INDIVIDUAL 375.80 0.00 375.80 4 EMPLOYEE+SPOUSE 306,72 0.00 306.72 I EMP+CHI LD(REN) 91.89 0.00 91.89 2 FAMILY 279.34 0.00 279.34 SUBSCRIBER TOTAL FOR HE ABOVE CUSTOMER RE ~ORTING NUNB 17 1,053.75 0.00 1,053.75 SUBSCRIBER LISTING EMPIRE PO BOX 856 MINNEAPOLIS MN 55440-0856 ACCOUNT NAME ACCOUNT # BILLING DATE ENROLLMENT FISHERS ISLAND FERRY DISTRICT ENY4561251 INVOICE # 09/14/2012 SUBSCRIBER PERIOD 800-928-6459 4943902 10/01/2012 - 10/31/2012 CUSTOMER REPORTING NUMBER SUBSCRIBER EFFECTIVE COVERAGE CURRENT RETRO TOTAL LAST NAME FIRST NAME REF if ID DATE TYPE AMOUNT AMOUNT AMOUNT 10 INDIVIDUAL 375.80 0.00 375.80 4 EMPLOYEE+SPOUSE 306.72 0.00 306.72 1 EMP+CHI LD(REN) 91.89 0.00 91 .89 2 FAMILY 279.34 0.00 279.34 GRAND TOTAL FOR ALL T}E CUSTOMER REPORTING NUMBERS 17 1,053.75 0.00 1,053.;-~ ENROLLMENT CHANGES MUST BE RECEIVED AT LEAST 5 BUSINESS DAYS PRIOR TO YOUR SCHEDULED BILL RUN DATE. FISHERS ISLAND FERRY DISTRICT VENDOR 006155 FEDEX 10/09/2012 CHECK 750 FUND & ACCOUNT P.O. ~ INVOICE DESCRIPTION AMOUNT SM .5710.4.000.000 SM .5710.4.000.000 SM .5710.4.000.000 2-012-22227 2-012-22227 2-012-22227 AIRBILLS,PAYROLL,WARRANT 215.08 CREDIT-BILLED ACCT INCRT 71.12- CREDIT-BILLED ACCT INCRT 30.87- TOTAL 113.09 "'000750"' ':0~lh05hhK': h6 00150~ Il,' Vendor No. 6155 Town of Southold, New York - Payment Voucher Vendor Tax ID Number or Social Security Number Fedex Vendor Telephone Number 800-622-t 147 Number Date 2-012-22227 9110120t 2 Vendor Address ln¥oiee Total $215.08 -$71.12 -$30.87 $2t5.08 Payee Certification The undersigned (Claimant) (Acting on behalf of the above named claimant) does hereby eeflify that the foregoing claim is true and correct, that no part has b~n p~id, except as therein stated, that the balance therein stated is acttmHy due and owing~ and that taxes from which the Towa is exempt are excluded ,P.O. Box 371461 Pittsburgh, PA 15250-746t -$71.12 -$30.87 Des~rlption of Goeds or Services Airbills-Pay roll,Wa rmnt Was billed to our account by mistake Was billed to our account by mistake Check No. '150 Entered by ~ Audit Date OCT 0 9 2012 SM5710.4.000.000 Department Certification I hereby cemfy that the materials above specified have been received by me in go~d cond/tion without substilution, the services properly performed and that the quantities thereof have been verified with the exceptions or discrepancies rmtad, and payment is approved. Title ~-'~ Date ~ [earn to pack ~F ~et ~.r pros Pa~k for Ilke a~pro ~tfedeX.com/packag YOU ~ Fe~EX:Off/~ PacE & Ship. Invoice Number 2-012-22227 Invoice Date Sep 10;2012 ~l Account N-mh-r 1206-0334-5 FedExTaxID: 71-0427007 Page 1 of 6 Billinq Address: FISHERS ISLAND FERRY DISTRICT DEB DOUCETTE PO BOX H FISHERS ISLAND NY 06390-0607 Invoice Summary Sep 10, 2012 Shippino Address: FISHERS ISLAND FERRY TERMINAL 6 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 Base Discount Special Handling Charges Total Charges TOTAL THIS INVOICE 200,40 -21.17 35.85 USD $215.08 USD ~\\~,~ You saved $21.17 in discounts t~i$ period[ Other discounts may apply. ................. ~D._e_tailed_de_scri@tions of_s_ur~c, harg_e.~ can be ocated at fedex.com Adjustment Request Fax to (800) 548-3020 Invoice Number '~1 Invoice Date X~I Account Number X~ Page 2-012-22227 Sep 10, 2012 1206-0334-5 2 of 6 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 wvvw.fedex.com or calling 800.622.1147. Please use multiple forms for additional requests, Please complete all fields in black ink. t ;~Phone I I I i-I I I I-I I I I I Fax#l I I I-I I I i-I I I I ] E-mail Address F-lyes, I want to update account contact with the above information. R Tracking Number Bill to Account $ Amount LI ADR-AddressCorrection INW-lncorrectWeight OVS- Oversize Surcharge DVC - Declared Value INS - Incorrect Service RSU - Residential Delivery lAN - invalid Acct # OCF - Grd Pick-up Fee PND - Pwrshp Not Delivered OCS - Exp Pick-up Fee SDR - Saturday Delivery For all Service failures or other surcharges please use our web site www.fedex.com or call (800) 622-1147 !lC? TrackingNumber Code SAmount 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'11 II .... 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°11 II .... ii,iii 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°11 11 .... iiiii!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 I'11 II .... Rerate information only (round to nearest inch LBS L W H I I II I I Ixl I I Ixl I I I I I II I I Ixl I I Ixl ] I I I II I I Ixl I I IxL L I I I II I I Ixl I I Ix1 I I I I II I I I×1 I I Ixl I I I Invoice Number 2-012-22227 FedEx Express Shipment Summary By Payor Type FedEx Express Shipments (Original) Shipper 3 6.0 Recipient 4 9,0 Invoice Date Sep 10, 2012 ~10.10 19.71 90.30 16.14 Account Number '~ Page 1206-0334-5 ~ 3 of 6 -12.14 117,67 -9.03 97.41 Total This Invoice USD $215.08 Invoice Number "~ 2-012-22227 FedEx Express Shipment Detail By Payor Type (Original) Invoice Date '~ Account Number Sop 10, 2012 1206-0334-5 Page 4of6 Fuel Surcharge - FedEx has applied a fuel surcharge of 10,00% to this shipment Bistance Based Pricing, Zone 8 Package sent from: 06360 zip code PackaGe Delivered to Recipient Address - Release Authorized Automation USAB Sender Tracking I0 858871125101 FISHERS ISLAND FERRY TERMINAL Sewice Type FedEx Priority Overnight 5 WATERFRONT PARK Package Type FedEx Box NE~V LONDON CT 06320 US Zone 08 Packages 1 Rated Weight 4,0 lbs, 1.8 kgs Transportahon Charge Delivered Aug 13, 2012 10:04 Fuel Surcharge Svc Area A1 Discount Signed by see above Residential Delivery FedEx Use 022301599/0001618/02 Total Charge ILLEGIBLE ILLEGIBLE SAN FRANCISCO CA94114 US USD 68,50 6.47 6,85 3.00 $71.12 Fuel Surcharge - FedEx has applied a fuel surcharge of 10,00% to this shipment Distance Based Pricing,Zone The package weight exceeds the rnaximurn for the packaging ~pe, therefore, FedEx Pek was rated as FedEx Pak ,/,Automation USAB Sender Tracking ID 875071430198 DEBBIE DOUCETTE Service Type FedEx Priority Overnight FISHERS ISLAND FERRY TERMINAL Package Type FedEx Pek 5 WATERFRONT PARK Zone 02 NEW LONDON CT 06320 US Packages 1 Rated Weight 2.0 lbs, 0.9 kgs Delivered Aug 21, 2012 10:26 Transportation Charge Svc Area AM Discount Signed by D.WHITECAVFGE Fuel Surcharge FedEx Use 023303390/0001486/_ Total Charge Recioient ATTN ACCOUNTING DEPT TOWN OF SOUTHHOLD 54375 MAIN RD SOUTHOLD NY 11971 US 22.85 -2.29 2.06 USD $22~2 · Fuel Surcharge - FedEx has applied a fuel surcharge of 10.00% to this shipment /Automation USAB Sender Tracking iD 899364278102 Service Type FedEx PrioriW Overnight Package Type FedEx Envelope Zone 02 Packages 1 Rated Weight N/A Delivered Aug 29, 2012 10:03 Svc Area A4 Signed by see above FedEx Use 024103597/0000186/02 G S MURPHY FISHERS ISLAND FERRY TERMINAL 5 WATERFRONT PARK NEW LONDON CT 06320 US TransportaOon Charge Discount Residential Oelivery DAS Resi Fuel Surcharge Total Charge _Recinient KENNETH PLEBS 46-2 BECK OF HILL RD OLD LYMECT06371 US USD 18.75 3.00 2,18 Shipper Subtotal USD $117.67 1253 01 O0 0012208 0002 0031801 Invoice Number 2-012-22227 Invoice Date Sep 10, 2012 Account Number '~ Page 1206-0334-5J 5 of 6 Fuel Surcharge - FedEx has applied a fuel surcharge of 1000% 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 Wpe, therefore, FedEx Envelope was rated as FedEx Pek Automation USAB Sender Tracking ID 875366961498 DIANA WHITECAVAGE Service Type FedEx Priori'd/Overnight TOWN OF SOUTHOLD Package Type FedEx Pak 93095 ROUTE 25 Zone 02 SOUTHOLD NY 11971-4642 US Packages 1 Rated Weight 1,0 lbs, 0.5 kgs Delivered Aug 16, 2012 09:37 Transportation Charge Svc Area A4 Fuel Surcharge Signed by N.NICK Discount FedEx Use 022602142/0001486/ Total Charge ~op ~dott ~u 2~20 2 P g Recipient GORDON MURPHY FIFERRY DISTRICT 5WATERFRPNT PK NEW LONDON CT 06320 US USD Fuel Surcharge - FedEx has applied a fuel surcharge of 10 00% to this shipment Distance Based Pricing. Zone6 FedExhas audited this shipment for correct packa§es, weight, and service. Any changes made are reflected in the invoice amount We calculated your charges based on a dimensionalweight of 60 lbs, 18'x 12'x 4', using a dimensional factor of 166 Automation IJSAR Sender Tracking ID 801101810993 ANNE COOK Service Type FedEx Express Saver COOK, ANNE Package Type Customer Packaging 240 S BEACH RD Zone 06 HOBE SOUND FL 33455-2508 US Packages 1 Actual Weight 40 lbs, 1.8 kgs Rated Weight 6.0 lbs, 2.7 kgs Declared Value USO 1,000.00 Transportahon Charge Delivered Aug 24, 2012 09:37 Declared Value Charge Svc Area A4 Discount Signed by M JIM Fuel Surcharge FedEx Use 023504533/0007175/_ Total Charge Recinient ANNE COOK 5 WATER FRONT PK NEWLONDONCT 06320 US USD 22.40 2,02 -2.24 $22.18 23.10 8.00 -2,31 2.08 $3O.87 FueJSurcharge FedExhasappliedafuelsurchargeofl0.00%tothisshipment Distance Based Pricing, Zone 2 FedEx has audited this shipment thr correct packages, weight and service Any chan9es made are reflected in the invoice amount The package weight exceeds the maximum for the packaging type, therefore, FedEx Envelope was rated as FedEx Pak AutomaDon USAB Sender Trackin6 ID 875366961487 JANICE L FOGLIA Service Type FedEx Priorib/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, 05 kgs Delivered Aug 24, 2012 09:37 Transportahon Charge Svc Area PM Fuel Surcharge Signed by M.JIM Discount FedEx Use 023602934/0001486/_ Total Charge Recioient GORDON MURPHY FISHERS ISLAND FERRY DISTRUCT FISHERS ISLAND NY 06390 US USD 22.40 2.02 $22.18 Invoice Number 2-012-22227 Invoice Date Sep 10,2012 Account Number "~ Page 1206-0334-5f 6 of 6 Fuet Surcharge - FedEx has apptied a fuel surcharge of ~0 C(3% to this shipment. Distance Based Pricing, Zone 2 FedExhas audited ff~is shipment for correctpackages, weight~ and service, Any changes made are reflected in the invoice amount. Thepackegeweightexceedsthemaximumf~rthepackagingt~pe~theref~re~FedExEnve~pewasratedasFedExPak~ Automation USAB Sender Tracking ID 875366961476 DIANA WHITECAVAGE Service Type FedEx Priorit~ Overnight TOWN OF SOUTHOLD Package Type FedEx Pak 53095 ROUTE 25 Zone 02 SOUTHOLD NY 11971-4642 US Packages 1 Rated Weight 1.0 lbs, 0.5 kgs Delivered Aug 30, 2012 09:48 Transportation Charge Svc Area M Discount Signed by M,NICK Fuel Surcharge FedEx Use 024203978/0001486/_ Tolal Cha~Je GORDAN MURPHY ~ USD $22.18~ ~ Recipient Subtotal USD $97.41 ~ USD $215.08 -- '""-- Total FedEx Express Terms And Conditions Summary For the current FedEx Service Guide, which contains the complete Terms and Conditions, go to fedex, com. Definitions On this Affbi r 'We ' ' OUB" ' USr' and "FedE×" ~gfer :c Federal Express Corporatron ~ts employees, and agents tou s~d "your" refer to the sender i~s employees and agents Responsibility For Packaging And Completing Airbill Limitations On Our Liability And Liabilities Not Assumed * We wont be aDP Declared Valae Limits · ,~,~,,A,,USAiruill ,,:-",~ 8750 7143 0198 Express N"r~r Address ~ ~c~% cl~ ~ ~ ~,, //~7/ 4a Express Package Sewice 6 Special Handling and Deliveq' Signature Options  Yes Yes ~j Dr,/Ice ~ S~i~,,~¢sDoclar~~ L] ~,.,.,~, o.,.,,,,.,~ 7 Payment Billte: Sender -- Em~ Fe~ ~- P~ °~ Cel~it ~ed Ne' b*V'ew' I ~,~t~m~ ~ Recipient ~ Third P.rly [] CredbCard E-- Cash/Check Terms And Conditions Definitions On this Airbill, "we," 'our," "us," and "FedEx" refer to Fedora', Express Corpora:io~, its emp;oyees, ann agents. "You" and 'your" refer to the sender, its employees, and agents Agreement To Terms By gMng us your package to deliver, yea agree to all the terms on this Airbill and in the current FedEx Sen'ice Guide which is availaPre upon request You ais~ agree to those terms on behalf nf any third party with an interest in the package If there is a conflict between the current FedEx SErvice Guide and ~his Airbill, the current FedEx Service Guide will control No one is authorized to change the terms of our Agreement Reeponsibilit'/For Packagin§ A.d Completing Airbill You are responsible for adequately packaging your goods and properly Riling out this Airbill. if you omit the number of packages and/or weight per package, our bgling will be based on our best estimate of the number of packages we received aud/or aa estimated 'default" weight per package as determined by us Responsibilit'/For Payment Even f you give us different payment instructiOnSr you wiii always be primarily responsible for all delivery costs, as wel! as any cost we incur in either returning your pat;tags to you or warehousing it peuding disposition Limitations ne Oar Linbility Aed Linbilitiee Not Assumed · Our liab iity in connection wkh this shipment is limited to the lesser of your astual damages or $100, unless you declare a nigher value pay an additional charge and document your actual loss in a timely marmot You may pay an additional charge fo~ each additional S100 of declared value. The decia!ed value does not constitute, nor do we provide, cargo liability insurance · In any event, we will riot be liable for any damage, whether dircct inc;dental special, or consequential, in excess of the declared value of a shipment, whether or not FedEx had knowledge that such damages might be incurred, including but not ',ira ged to loss of income or profits · We won't be liable: - for your acts or omissions, including but not limited to improper or insufficient packing, securing, marking, or addressing, or those of the recipient or anyone else with an interest in the package - if you or the recipient violates any o¢ thC terms Of our Agreement - for loss of or damage to Shipments of prohibited items - for loss, damage or delay cadsed by events we cannot control, including but not limited to acts of God, perils of the air, weather conditions, acts of public enemies, war, strikes, civil commotions, or acts of public authorities with actual of apparent autJ/or~ty Declared Value Limits · The highest declared value al!owed for a FedEx Enveiope ~r FedEx Pek shipment is S500 · For other shipments, the highest declared value allowed is S50,000 unless your package contains items af extraordinaw value, in which case the highest declared value allowed is $1 000 · Items of extraordinary value include shipments contaimng such items as artwork, iewelry, furs, precious metals, nego- tiable instruments, and other items listed in the current FedEx Service Guide · You may send more than one package on this Airbill and fill in the total declared value for all packages, not to exceed the $500, $1,000, or S50,000 per package limit described above (Example: 5 packages can have a total declared value of up to $250,000) In that case, our liabdity is limited to the actual value of the package(s) lost or damaged, but may not exceed the maximum allowable declared value(s) or the total declared value, whichever is less You are responsible for proving the actual loss er damage Filing A Claim YOU MUST MAKE ALL CLAIMS IN WRITING and notify us of your claim within strict time limits set out in the current FedEx Service Guide You may cai] our Customer Service department at ~ 800 GoFedEx t 800 463 3339 to report a claim; however, you must sti!! fi!¢ ~ timely ~vdtier~ c;aim We arent obggated to act on any claim until rod have paid all transportation charges and you may not deduct the amount of your claim from those charges If the recipient accepts your package without noting any damage on the delivery record we will assume the package was d¢ivered in good condition For us to process your claim. you must make the original shipping cartons and packing available for inspection Rigfit To Inspect We may, at our option, open and inspect your packages before or after you give them to us to deliver Right Of Rejection We reserve the right to reject a shipment when such shipment would be likely to cause delay or damage to other shipments, equipment, or eersonf~el; or if the shipment is prohibited by [aw; or if the shipment would violate any terms of our Airbill or the current FedEx Service Guide C,O.D. Services on D SERVICE IS NOT AVAILABLEWITH THIS AIRBILL If C OD Service is required, please use a FedEx COD Airbiq Air Transportation Tax Included A Cederal excise tax when required by the Internal Revenue Code on the air transportatron portion of this service, if any, is paid by us Money-Back Guarantee In the event of untimely delivep/, FedEx wgl, at your reguest and with some limitations, refund or credit el! transportation charges See glo current FedEx Service Guide for more information FISHERS ISLAND FERRY DISTRICT VENDOR 006482 PAUL J. FOLEY 10/09/2012 CHECK 751 FUND & ACCOUNT P.O.~ INVOICE DESCRIPTION AMOUNT SM .9060.8.000.000 090112 REIMB.RX-SEP'12 94,41 SM .9060.8.000.000 3225501586 REIMB.4TH QTR STAND ALON 438.05 TOTAL 532.46 i,'000 ? 5 ~"' Vendor No. Town of Southold, New York - Payment Voucher 6482 Vendor Tax ID Number or Social Security Number Vendor Address 690 Williams Street New London, CT 06320 Paul J. Foley Vendor Telephone Number Vendor Contact Invoice Number Invoice Date Total Net Purchase Order Discount Amount Claimed Number 3225501586 9/tl2012 438.05 438.05 I Description of Goods or Services Retiree Stand Alone 90% Reimbursement .486.72 Lees $48.67 Paul Foley Ck # 2208 Quarterly 10101112-12/31111 9/11201; 94.41 94.41 RX Plan- Sept 2012 532.46 532.46 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 Term is exempt are excluded Check No. '151 Entered by Audit Date OCT 0 9 2012 Signature ~ Title ~ CompanyName f~"~ O~te ~ ~ /~.~ 104.90 less $ t0.49 Foley Ck 2207 General Ledger Fund and Account Number ~l~ 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 lhereof have been verified with the exceptions or discrepancies noted, and payment is approved. Signature ~,,,~ Title Date INDIVIDUAL MARKET INVOICE #CTBSA00qRCTi# 000095 091112 091312 PAUL J FOLEY MEMBER NO: MEMBER: INVOICE NO: BILLING ACCT NO: 086~M20101 PAUL J FOLEY 5225501586 701086q920101 ~[ PRODHCT [ CLASS ] PERIOD COVERED [ AMOUNT i MEDIGAP PLAN N,COPAY 820. 1 10/01/2012 12/51/2012 + ~686.72 2208 690 WtLLIANtS ST. NEW LONDON, CT 06320 ,Shield, please call OL through Friday. The 00094416853003 ................................ DETACH AND RETURN THIS PORTION WITH ~,~ME-N~--- lv~-~ PAUL J FOLEY TOTAL AMOUNT DUE BY: 690 WILLIAMS ST NEW LONDON, CT 06520 OCTOBER 1, 20i2 0 9 $486.72 5 MEMBER NUMBER: 0864M20101 INVOICE NUMBER: 5225501586 1 B~LL~ND ACCOUNT: 701086~92010t ~ER~OD COVERED: 10/01/2012 i2/31/20l~ INDICATE ADDRESS CHANGE BELOW: PLEASE DO NOT WRITE BELOW THIS LINE ,,,I,l,l,,,I,, II ,I, II I II I II I hll o Ihl hl llll llll I ANTHEH BLUE CROSS AND BLUE SHIELD PO BOX 1168 NEHARK NJ 0710L-i16B 000944i;-~85300305004000070108649201013003225501586091] :~200109500000~86727 ~ !llIIl IIIII IIII1 Ell IIIII i1111 IIIII I!111111! II1! I%,~,,,I,H,,,.Idq,,d~ill,d,,.I,dtH,,d.f.i,,hllh, PAUL J FOLEY 690 WILLIAMS ST NEW LONDON CT 06320-4132 902640731 G0230330801 Balance Due $104.90 10/01/2012 Please relt/rtt the top pc, rfio// t~/'thi.v fl~/'m n/th your i~aymettt. See reverse side fiw l,ayi~;el/! O/H/OIl& Retai. /he bottom pot/tort qf this fi,/vn.]~.' your /'ecord~ 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 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 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 . . Participant ID: G0230330801 Date: 09/06/2012 Blue UedicareRx*(POP) Transaction Premium Balance Due Date Descriptioq Amount 09/01/20 l 2 September 2012 i 04.90 104.90 PAUL J. FOLEY 2207 690 WILLIAMS ST. eo /' / FlSHERS ISLAND FERRY DISTRICT VENDOR 007317 GNCB CONSULTING ENGINEERS,PC 10/09/2012 CHECK 752 FUND & ACCOUNT P.O.~ INVOICE DESCRIPTION AMOUNT SM .5709.2.000.200 18929 CORNER RAMp REPAIR 500.50 SM .5709.2.000.200 18980 CORNER RAMP REPAIR 1,295.00 TOTAL 1,795.50 Vendor No. Town of Southold, New York- Payment Voucher 7317 Vendor Tax ID Number or Social Security Number 130 Elm Street P.O. Box 802 GNCS Old Saybrook, CT 06475 Vendor Telephone Number Vendor Contact lnv°ic18929 invoice Number Date Invoice Total 1/3112012 $600.50 18980 2/29/2012 $t,295.00 $1,795.50 Discount Net Purchase Order ~.mount Claimed Number $500.50 $t ,295.00 $1,795.50 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 pert has been paid, except ~ 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 Check No. Entered by ~ Audit Date 0CT 0 9 2012 Description of Goods or Services Corner Ramp Repair Corner Ramp Repair General Ledger Fund and Account Number SM5709.2.000.200 SM5709.2.000.200 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 peyment is approved Title & Date Invoice 11003.00 FIFD Ramp 18742 Invoice # 18742 Credit Memo # 1 Invoice # 18929 invoice # 18980 Total for ~11003.00 Total Outstanding 10/31/2011 1/31/2012 2/29/2012 Fishers Island Ferry District Attn: Mark Easter P.O. Drawer H Fishers Island, NY 06390 0-30 31-60 61-90 Over90 Balance $14,125.00 $14,125.00 $14,125.50 $14,125.50 -$.50 -$.50 $500.50 $500.50 $500.50 $500.50 $1,295.00 $1,295.00 $1,295.00 $1,295.00 $16,920.50 $15,920.50 $.00 $.00 $.00 $t5,920.50 $15,920.50 GNCB CONSULTING ENGINEERS, P.C. 130 ELM STREET, POST OFFICE BOX 802 OLD SAYBROOK, CONNECTICUT 06475 PHONE: 860 388 1224 FAX: 860 388 4613 EMAIL: SPENCER@GNCBENGINEERS.COM FISHERS ISLAND FERRY DISTRICT VENDOR 011394 K & S DISTRIBUTORS, INC. 10/09/2012 CHECK 753 FUND & ACCOUNT P.O.# INVOICE DESCRIPTION SM .5710.4.000.600 264630 JANITORIAL SUPPLIES TOTAL .aJqOUNT 170.00 170.00 ONE I~U~I)R.ED OF "'ODD?55,1' ':081,~,05[,~,[,,: &8 00;,508 ~,,,' Town of Southold, New York - Payment Voucher Vendor Tax ID Number or Social Security Number 50 Oakland Avenue East Hartford, CT 06108 K&S Distributors Vendor Telephone Number 860-528-3860 Vendor Contact Invoice Invoice Number Date 264630 9/191201 Total Discount $170.00 $t70.00 Net Purchase Order Amount Claimed Number $170.00 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 pert has been peid, 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 No. 11394 Description of Goods or Services Janitorial Supplies Check No. -tS Entered by ,~ Audit Date OCT O 9 201Z J. Oy7 Clerk ~-, $t70.00 Department Certification Signat u re~.~,.~_~_~.._ Title Company Name~ Date General Ledger Fund and Account Number SM5710.4.000.600 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 ~'off--~'- Date Invoice 264630 Customer FIS02 K & S Distributors 50 Oakland Avenue East Hartford, CT 06108 Telephone: 860/528-3860 Bill To: Fishers Island Ferry District P.O. Box H Fishers Island, NY 06390 Ship To: Fishers Island Ferry District 5 Waterfront Park New London, CT 06320 09/19/12 DELIVERED Net 30 Quanti~ item Numar Des~iption T~ Unit PHm ~ount Req. Ship B.O. 1 0 SS019223 Tape~'~0' Bla~ Slip Resistan~ Tape 1#oll N 165.00 165.00 1 0 FUEL Fuel Sumharge N 5.00 5.00 Thank you for your order; Your Business Is Greatly AppreciatedH~ PLEASE PAY FROM INVOICE-NO STATEMENT ISSUED. You may reach ~s on the web at: ~.KSDISTRIBUTORSINC.COM NonTaxable Subtotal 170.0~ Net due on 10/19/12 Taxable Subtotal 0.0~ Tax 0.0~ Total Invoi~ 170.00 Duplicate Page 1 PACKING SLIP K & S Distributors 50 Oakland Avenue East Hartford, CT 06108 Telephone: 860~528-3860 ship To: FiShe~ Island Ferry District 5 Wa~nt park New LondOn,: CT 06320 Date I Shin Vie I , F.O.B. ~ Invoice I ~l:*~Pe~on I Ctmtom~er ' 09/19/12 I DELIVERE D I I 264630 I JP I FIS02 Terms Purchase Order Number I Order Date Our Order ~ber Net 30 Ver~alI o9/19/12 None C~uantity Item Number Ordered Shippedl Back0rder Deception ' ,, 1 1 0 SS019223 Tape,-4'x60' Black Slip Resistance Tape 1/rcll 1 1 0 FUEL Fuel Surcharge Page FISHERS ISLAND FERRY DISTRICT VENDOR 011056 KARDASLARSON, LLC 10/09/2012 CHECK 754 FUND & ACCOUNT P.O.# INVOICE DESCRIPTION AMOUNT SM .5710.4.000.000 1250 HUMAN RESOURCE CONSULTNG 5,352.26 TOTAL 5,352.26 FIUE THOUSA~D T~'REE'M~DRE~ FI] "OOD75h,' I:O;:lL, OfL, hhl: ~,P, 00~.50~ l" Town of Southold, New York - Payment Voucher Vendor Tax ID Number or Social Security Number 45-0534566 Vendor No. 11056 B Bronson Street Niantlc, CT 06357 KardasLarson LLC Vendor Telephone Number 860-739-8677 Vendor Contact Invoice Invoice Invoice Number Date lotal Discount Description of Goods or Services $5,352.26 1250 9/27/2012 $8,352.26 $5,352.26 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 parc has been paid, except as therein stated, that the balance therein stated is actually due and owing, and that rexes fi.om which the Town is exempt are excluded Net Purchase Order kmount Claimed Number $5,352.26 Signature ~,~-~ ~Title Company Name Check No. Entered by ~_ Audit Date OCT O 9 2012 Human Resource Consulting General Ledger Fund and Account Number SM5710.4.000.000 Department Certification I hereby certify that the rrmterials 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 ~~f Title Date Invoice KardasLarson LLC 8 Bronson Street, Niantic, CT 06357 Bill To ] Bob Brooks, Chairman Fishers Island Ferry District Town of Soulhhold. Southhold, NY Date Invoice # EIN #4%0534566 9/27/2012 1250 Terms Net 15 Quantity Description Rate Amount 46 ltuman Resource Consulting - Recruiting Project, Organizational Development, 110.00 5,060.00 Background check research and Reference checking. Summary of tasks provided in cover e-mail Candidate Rob MacDougal expense travel reimbursement 292.26 292.26 Total $5,352.26 FISHERS ISLAND FERRY DISTRICT VENDOR 011557 ANN KOWALCZYK-BANKS 10/09/2012 CHECK 755 FUND & ACCOUNT P.O.~ INVOICE DESCRIPTION AMOUNT SM .5710.4.000.600 093012 JANITORIAL-9/12 250.00 TOT~kL 250.00 ~¢~ndor'No, Town of Southold, New York - Payment Voucher [ 1155? Vendor Tax ID Number or Social Se, curi~ Number Vendor Address P.O. Box 384 i Fishers Island, NY 0C390 Vendor Name Ann Kowalczyk Banks Vendor Telephone Number Check No. Entered by ~ _~(-~ Audit Date OCT 0 9 2012 913012012 $25@_00 Description of Goods or Services $250.00 SM$710.4.000.600 $250.00i S250.0(~ Payee Certification The unde~igned (Claimant) (Acting on behalf of the above named claimant) does h~'eby ce~ify that the foregoing claim is true and correct, that no part has Company Name ~'~ Dar e~O~ /,//e~ Department Certification Town of Southold, New York- Payment Voucher Vendor Tax ID Number or Social Security Number Vendor Address Vendor Name Ann Kowalczyk Banks Vendor Telephone Number Vendor Contact Invoice Invoice Number Date 6302012 913012012 Invoice Total Discount P.O. Box 384 Fishers Island, NY 06390 Vendor No. 11557 Company Name '~P Date Payee Certification The undersigned (Claimant) (Acting on behalf of thc above named claimant) does hereby certify that the foregoing claim is true and correct, that no part has been 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 Net Purchase Order Amount Claimed Number 250.00 Check No. Entered by Audit Date OCT 0 9 2012 town Clerk 260.00 250.00 General Ledger Fund and Account Number SM5710.4.000.600 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 vented with the exceptions or discrepancies noted, and payment is approved. Signature ~ Title Date ~/'~ ~ /~ 250.00 Janitorial/August Description of Goods or Services FISHERS 1S~ FERRY D~ICT VENDOR 011564 THOMAS KRAFT 10/09/2012 CHECK 756 FUND & ACCOUNT P.O.# INVOICE DESCRIPTION AMOUNT SM .5710.4.000.300 SM .5710.4.000.300 SM .5710.4.000.300 SM .5710.4.000.300 5218 5218 5218 5218 RP-5213.0 GAL @$3.279300 17,094.99 CT EXCISE TAX-$.5120/GAL 2,669.06 S-F COST RECOVERY .0019 9.90 LUST TAX-$.0010/GAL 5.21 TOTAL 19,779.16 TOTHE DBA DtPIE OIL COMPA/~ ORDER WAT~RBUR~ CT 06703 ~ O0 & 50 2 Town of Southold, New York - Payment Voucher Vendor Tax 1D Number or Social Securit~ Number Thomas Kraft dba Dime Oil Company Vendor Telephone Number 203-754-5334 Vendor Contact P.O. Box 11126 Waterbury, CT 06703 Vendor No. 11564 Check No. Entered by Audit Date Net Purchase Order Amount Claimed Number $t7,094.99 $2,669.06 $9.90 $5.21 $19,779.16 Invoice Invoice Invoice Number Date Total Discount Description of Goods or Services General Ledger Fund and Account Number $17,094.99 9/21/2012 RP-5213.0 Gal. At 3.279300 CT Excise Tax - $.51201gal S-F Coat Recovery .0019 LUST Tax - $.0010/gal $2,669.06 $9.90 $5.21 $19,779.16 Department Certification 5218 SM5710.4.000.300 Payee Certification T~e undersigned (Claimant) (Acting on behalf of the above named claimant) does hereby cerd fy 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 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 '/ff47/~'-~ Date / '~ ~ / ~-- D~me 0~1 LLC PO Box 11125 ~terCury, CT 08703 Phone: 203-75~-533~ Date: 09/21/2012 Re". Fisher's Island Ferry O~str'ict PO Box H Attn Accounts Payable F~sher's Island, NY 06390- F~sher's Island Ferry D~st 5 Water'front Par'k-Race Point, New London ACCOUNT NUNBER: AHOUNT ENCLOSED: ~20165 Page : I Terms: NET 30 Days From Invoice Date Date Invoice Charges and Ct'edits Amount 09/21/12 5218 Fuel Invoice Total 09/21/12 5218 #2OR Off Road D~esel 5213.0 GALS @ 3.279300 1709~.99 Dyed Diesel Fuel for Off Road Use ONLY. S-F Cost Recovery @ 0.0019 9.90 State Exc~se Tax DSL @ 0.5120 2669.06 LUST TAX @ 0,0010 5,21 19779.16 19779, 16 Amount Due **Please include account number' with payment*** Fed ID# ~5~111778 Dime Oil LLC 203-75~-533~ Account: N~20165 - '~.~ 5 ~e~ Park-~ P~ ~ ~1~1 GALLONS DIME ~L COMPANY, LLC ~.'v'" ~ ..x ~ P.O. BOX 11125 TMST' E ~ ~ } WATERBURY, CT 06703 -- ~ "t~"~F~ ~ /203) 754-5~4 ~F~___ '~- ~ ~ ~------~ ....... U C~H ~ CHECK ~ "OO0~5TM ~:0-~05La~: kS 00~50~ 12.Fishers Island/CSEA NegoUations 51946-11 142 $95.02 FISHERS ISLAND FERRY DISTRICT VENDOR 011745 LAND, SEA & AIR CONSULT & TEST 10/09/2012 CHECK 758 FUND & ACCOUNT P.O.~ INVOICE DESCRIPTION AMOUNT SM .5710.4.000.000 237-0812 DRUG TEST-M.EDWkRDS 8/14 57.00 SM .5710.4.000.000 237-0812 DRUG TEST-R.LEFEVRE-8/15 57.00 TOTAL 114.00 ON~ ~UNDI~D POURTm~.N AND 00/'~00 DoLL's 'AY ID FttE ORDER OF ~'O0075a,' ,:O~;,L, OSL, r~L,,: &G OOl, 50~ Town of Southold, New York - Payment Voucher Vendor Tax ID Number or Social Security Number Vendor Address 9t0 Routs 109 North Llndenhurst, NY 11757 Vendor Name Lend Sea and Air Consulting & Testing Vendor Telephone Number 631-225-3060 Vendor Contact Number Invoice Invoice I q~ Total $57.00 .... $57 00 $114.00 Discount Payee Certification l~nc 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 tmxes from which the Town is exempt are excluded. Net Purchase Order ~mount Claimed Number $57.00 $57.00 $114.00 Signature ~ Title Company Name ~d~ Date Vendor Noi 1745 Check No. Entered by ~.~ Audit Date OCT 0 9 2012 Description of Goods or Services Michael Edwards Testihg Raymond Lefevre g/I ~) General Ledger Fund and Account Number SM5710.4.000.000 SM5710.4.000.000 Department Certification I hereby certify that the materials above specified have been received by me in good condition without substitution, the services properly performed and that the quantities thereof have been verified with the exceptions or discrepancies noted, and payment Is approved Signature Title ~-~- Date ~'~ ~ /~-~ 09/04/12 IRS % 27-1482752 FISHER'S, ISLAND FERRY ATT; NINA SCHMIDT PO BOX H FISHER'S ISLAND, CT 06390 Acct: Page: 1 LAND SEA AND AIR CONSULTING &TESTII 910 ROUTE 109 LINDENHURST, NY 11757 Tel: 6312253060 20000328 /CO Tel: 860/442-0165 Date Diag Ref C.P.T Qt Patien~ name AR P1 Amt Bal 08/14/12 RANDOMDS1 129-EDWARDS, MICHAEL O 57.00 57.00 08/15/12 RANDOMDS1 ll0-LEFEVRE,RAYMOND O 57.00 57.00 Regular Total: $ 114.00 Provider: OFFSITE Operator: PP FISHERS ISLAND FERRY DISTRICT VENDOR 012153 LIFE RAFT & SURVIVAL EQUIP,INC 10/09/2012 CHECK 759 FUND & ACCOUNT P.O.~ INVOICE DESCRIPTION AMOUNT SM .5710.2.000.200 44171 RP-LIFE RAFT INSPECTION 3,146.10 TOTAL 3,146.10 SBu THRHE THOUSAND ONE R*UNDRED FORTY SIX AND~ OF D~LLARS Vendor No. Town of Southold, New York - Payment Voucher 12153 Vendor T~x ID Number or Social Security Number Vendor Address 890 Fish Road Vendor Name Tlverton, RI 02878 Life Raft & Survival Equipment, Inc. Vendor Telephone Number 401-816-5400 Vendor Contact Ch~kNo. Entered by Audit Date Number 44171 OCT 0 9 2012 Invoice Invoice Net Purchase Order Date Total Discount Amount Claimed Number Description of Goods or Services ! General Ledger Fund and Account Number I 4/6/2012 3,146.10 3,146.10 RP-Life Raft SM5710.2.000.200 ~ Inspection I 3,t46o10 3,t48olfl Payee Certification The undersigned (Claimant) (Acting on behalf of tbe above named claimant) does hereby cerd fy 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 D~te ~ ~ Compeny Name Department Certification I hereby certi~ that the materials above specified have been received by me in good condition w~thout substitution, the services properly performed and that the quantities thereof have been verified with the exceptions or discrepancies noted, and payment is approved. Title ~7'~'-~ Date ~iic Raft & Survival Equipment, Inc. 590 Fish Road Tiverton, RI 02878 (401) 816-5400 (401) 816-5411 - Fax Invoice Invoice # 44171 LIFE RAFT SURVIVAL EQUIPI~ENT Date 4/6/2012 Work Order 14187 Bill To [:ishcr's Island ForD, District Arm: Mark Easter Box H Fisher's Island, NY 06390 Ship To POC: Mark Easter Fishers Island Ferry District 5 Waterfront Park New London, CT 06320 Customer Phone [ 860-442-0165 I P.O. Number Terms J Rep Via Net 30 OT Boat Name (2) Mfr. SI I Race Point Elliot 50pc & twin 50 R4866 688148 B13-4048 P8678&P8677 SIN Item Code Description Price Each Amount PICK UP & DELIVERY - ACCOUNT PU/DEL ACCI' XLR1501 QRFD99999224 QRFD3RA 15431 QSU06456009 QLR602 QLR618 QRFD3RA 15271 QRFD20883001 LRPMISC 50 PERSON 1BA INSPECTION ELLIOTT/CREWSAVER LiFE RAFT ONLINE CERTIFICATE OF RE-INSPECTION LABEL, USCG SERVICING I YEAR (ELLIOTT/CREWSAVER) BURST DISC 230 BAR "B" CYLINDER HYDRO TEST CYLINDER REFILL 50 & 100 LABEL, ELLIOT LOGO PAINTER LINE, FOAM PLUG. 2" x 2" CONTAINER STRAPS WHITE ON RED 90.00 700.00 120.00 8.50 54.94 48.00 95.00 7.01 12,12 11.95 QRFD06257009 QF192200116 QFI92200120 QF192211052 QBR7520 LRPMISC QRFD2RAI2551 XERI50T TAB, CAP, SAFETY DK88/94/99 BURN CREAM IODINE SWABS EYE WASH D CELL BATTERY, DATED CEMENT TUBES. P/U RAFTS LABEL, CYLINDER ID TWIN 50 INSPECTION 15,96 7.60 4.30 4.50 1.45 29.88 2.28 1,000.00 90.00 700.00 120.00 8,50 109.88 96.00 190.00 14.02 24.24 95.60 31.92 7.60 4.30 4.50 8.70 29.88 4.56 1,000.00 Page 1 Subtotal Sales Tax (0.0%) Total Payments/Credits Balance Due · ~ffe Raft & Survival Equipment, Inc. 590 Fish Road Tiverton, RI 02878 (401) 816-5400 (401) 816-5411 - Fax Bill To Fisher's Island Ferry' District Attn: Mark Easter Box I 1 Fisher's Island. NY 06390 LIFE RAFT SURVIVAL EQUIPMENT Ship To POC: Mark Easter Fishers Island Ferry District 5 Waterfront Park New London, CT 06320 Invoice Invoice # Date Work Order Customer Phone 860-442-0165 44171 4/6/2012 14187 P.O. Number SIN 687433&687434 BI3-4049 & BI3-40... N46222 Terms Net 30 Rep SI Via OT Boat Name Race Point (2) Mfr. Elliot 50pc & twin 50 Item Code Price Each Amount 'RFD99999224 120,00 240.00 'RFD3RA 15431 'SU20883001 'RFDBLACK 100P ATCH3 QCEMENTSOLV LABORREPLR QBR7520 LRPMISC 'HAMMAR Description ELLIOTT/CREWSAVER LIFE RAFT ONLINE CERTIFICATE OF RE-IN SPECTION LABEL, USCG SERV CNG YEAR (ELLIOTT/CREWSAVER) BLOCK, FOAM FOR PAINTER EXIT W/HOLE STRAPS/CRIMPS- WHT ON BLK 'FAB (100P IBA) PATCH, Y' (TOP TUBE) CEMENTS & SOLVENTS LABOR, LR REPAIR, PER HR D CELL BATTERY, DATED CEMENT TUBES, P/U RAFTS HYDROSTATIC RELEASE FOR LIFE RAFT 8.50 12.12 10.00 3.00 25.00 89.00 1.45 29.88 110.00 17.00 24.24 80.00 3.00 25.00 44.50 2.90 59.76 110.00 Page 2 Subtotal $3,146.10 Sales Tax (0.0%) $o.o0 Total $3,146.10 Payments/Credits $o.oo Balance Due $3,146.10 FISHERS ISLAND FERRY DISTRICT VENDOR 011763 MATTHEW LYNCH 10/09/2012 CHECK 760 FUND & ACCOUNT SM .5710.4.000.000 P.O.~ INVOICE DESCRIPTION AMOUNT 092712 REIMB GAS-WHT TRUCK-NL TOTAL 100.00 100.00 ?O T~E O~DE~ OF 22 PRTND]~9II~E AVE WATERFORD CT 06385 ,'000 7 ':O~hOSh~N~: ~8 O0~SO~ Town of Southold, New York - Payment Voucher VeNdor Tax ID Number or Social Security Number Vendor Address Matthew Lynch Vendor Telephone Number Vendor Contact Invoice Number Vendor No. 11'%5 22 Prindivllle Ave Waterford, CT 06386 Date 9127/20t2 Total $100.00 Discount Net Amount Claimec $100.00 Purchase Order Number Payee Certification The undersigned (Claimant) (Acting on behalf of the above named claimant) does hereby certify that the foregoing claim is true and corccct, that no pa~ has been paid, except as therein stated, that the balance therein stated is actually due and owing, and that taxes from which the Town is exempt are excluded. Description of Goods or Services relmbumement for fuel for white truck in NL Check No. Entered by Audit Date OCT O 9 2012 $100.00 $100.00 Department Certification Compan Date General Ledger Fund and Account Number 8M5710.4.000.000 I hereby certify that the materials above specified have been received by me in good condition without subst~Wtion, the services properly performed and that the quantities thereof have been verified with the exceptions or discrepancies noted, and payment is approved Signature ~IC~ SULLIU, 9?54318 # L~D, CT 9/27/2612 92:23:54 PM 995?43362 ;EX XXXXXXIte? ~X IUOICE XUR3118 J~H 526629 MP# 5 ~EL TOTAL 24,644G $~btot~l: $ 166.69 Tax: $ 6,69 Total = $ 196,96 :E~IT $ L66,96 'edit • • FISHERS ISLAND FERRY DISTRICT VENDOR 013054 MAPLE PRINT SERVICES, INC. 10/09/2012 CHECK 761 FUND & ACCOUNT P.O.# INVOICE DESCRIPTION AMOUNT SM .5711.4 .000.000 1702 5200 OFF-PEAK SCHEDULE 515. 00 SM . 5711.4 .000.000 1706 500 LETTERHEAD 127 . 00 TOTAL 642.00 m : 0, vine- THE ORIGINAL CHECK HAS A COLORED BACKGROUND. A VOID COPY FEATURE AND WATERMARK PAPER - H4lta. Y T' +m.T" moi :c m K "'mo tai c.$a w f e. " p a^. n/4i , ti. ,, . i g SOU LG.N1' i71-0958 di' ei,y? .,,; yp, v: .... _. C SU90 CQ1 39 NAL BAI;I,M o- _y .y. X oli f SCS p y µ i +A _ :* m .,f t s la4i" .amu "'P '+T.,t m ce } of m tNimlOil ,VP' r '`- '''bH' L x 1415' ?, ..''e• I. iii i PAY iFL. BRIT E&im IS, 'ttCr - "^ , - w / ui . vl -' i .Wm lu: uyi M. y Th u u !1 ,O/ Itr -. Ili 000 ? 6 LH' 1'0 2 i4054641: GB 00 L 50 2 Lti' Vendor No. Town of Southold, New York - Payment Voucher 13054 Vendor Tax ID Number or Social Security Number 255 Rt. 12, Sulf~ 699 Groton, CT 06340 Maple Print Services, Inc. Vendor Telephone Number 860481-5470 Vendor Contact Invoice Invoice Invoice Net Purchase Order Number Date Total Discount Amount Claimed Number Description of Goods or Services 1702 911912012 $615.00 $5t5.00 Cheek No. Entered by ~ Audit Date OCT 0 9 2012 ..%9O0 Off-Peak Schedule Letterhead General Ledger Fund and Account Number SM5711.4.000.000 t706 9120120t2 $127.00 $127.00 SM$7tl.4.000.000 $642.00 $642,00 Payee Certification The undersigned (Claimant) (Acting on behalf of thc above named claimant) does hereby certi~ that the foregoing claim is true and correct, that no pan has been paid, except as therein stated, that the balance therein stated is actually due and owing, and that taxes from which thc Town is exempt are excluded. Signature ~ Title ~ Company Name F~ Date Department Certification I hereby certi~ that the materials above specified have b~n received by me in good condition without substitution, the services properly performed and that the quantities thereof have been verified with the exceptions or discrepancies noted, and payment is approved. Maple Print Services Inc. 255 Rt. 12 Suite 699 Groton, CT 06340 Date · 9/19/2012 Invoice Invoice # 1702 Bill To Fishers Island Ferry Fishers Island, N.Y. 06390 P.O. No. Terms Rep Item Printing Graphic Prepress Qty 5,200 Off-Peak Schedule File Work Description Amount 485.00 30.00 Thank You!!! Subtotal Sales Tax (0.0%) Total $ 515.00 $0.00 .;515.00 Phone # 860-381-5470 Maple Print Services Inc. 255 Rt. 12 Suite 699 Groton, CT 06340 Date 9/20/2012 Invoice Invoice # 1706 Bill To, Fishers Island Ferry Fishers Island, N.Y. 06390 P.O. No. Terms Rep Item Letterhead AA Qty 500 8.5 x 11 Letterhead Plate Charge Description Amount 107.00 20.00 Thank You!!! Subtotal Sales Tax (0.0%) Total $127.00 $0.00 $127.00 Phone # 860-381-5470 255 Route 12, Suite 699 Gmtm~. CT 06340 (860) 381-5470 ph. (866) 822~3663 fax ~aP~erirenv[ces, (nc. SHIP TO: Delivery Receipt FISHERS ISLAND FERRY DISTRICT VENDOR 013564 MCMASTER-CARR SUPPLY CO. 10/09/2012 CHECK 762 FUND & ACCOUNT P.O.# INVOICE DESCRIPTION AMOUNT SM .5710.2.000.000 36839424 RP,MU-COOLING SYS,EARMUF 197.89 TOTAL 197.89 ~'O00?~D~' ;:OB~[,OS~Q[,~: ~8 O0~50B ~' Town of Southold, New York - Payment Voucher Vendor Tax iD Number or Social Securit~ Number Vendor Address P.O. Box 7690 Vendor Name Chicago, IL 60680-7690 McMaster-Carr Supply Co. Vendor Telephone Number 609-689-3000 Vendor Contact Vendor No. Invoice Number 13564 Invoice Date Total Net ~mount Claimed Purchase Order Number !Check No. Entered by Audit Date OCT 0 9 2012 Discount Description of Goods or Services General Ledger Fund and Account Number 36839424 9/13/2012 197.89 197.89 RP&MUNN Cooling systeff 8M8710.2.000.000 Earmuff 197.89 197.89 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 Tovm is exempt are excluded Compan~ Name ~ Department Certification I hereby certify that the materials abo¥c specified have been received by me m good condition without substitution, thc services property performed and that the quantities thereof have been verified with the exceptions or discrepancies noted, and payment is approved Title Date McMASTER.CARR® 609-689-3000 · 609-259-3575 (fax) nj.sales~mcmaster.com Billed to FISHERS ISLAND FERRY DISTRICT P O DRAWER H FISHERS ISLAND NY 06390-0607 Invoice Purchase Order Total Invoice Invoice Date Payment Terms JOHN $197,89 36839424 9113/12 2% 10, Net 30 Deduct $384 on merchandise if paid by 9/23/12. Shipped to Fishers Island Ferry District 5 Waterfront Park New London CT 063~0 Mail Payment to Your Account McMaster-Carr PO Box 7690 Chicago IL 60680-7690 260910000 Order placed by phone. Line Description Ordered Shipped Balance Unit Price Total 9206T2 2 5296K643 Hearing Protection Earmuff, NRR 30 DB Overhead High-Temperature/Medium-Pressure Coolant Hose, 4-1/2" ID, 4-7/8" OD, 10 PSI, Blue, 3' Length 2 2 0 29.26 Each Each 3 3 0 44.56 Feet Per Foot 58.52 133.68 Merchandise Shipping 192~20 5.69 Total $197.89 Packing List Shipped Weight Carrier Tracking 1557966-01 9/13/12 9lb UPS Ground 1Z0835200340953829 Federal ID 36-1458720 McMaster-Carr Supply Company Page 1 of 1 SP 1165 i cMASTER-CARR 200 New Canton Way F~bbinsville NJ 08691-2343 609-689-3000 nj sales@mcmaster.com 1 9206T2 Fishers island Ferry District 5 Waterfront Park New London CT 06320 2 Each Ordered. Ship~ed 2 Description Hearing Protection Earmuff, NRR 30 DB Overhead High_Temperature/Medium-Pressure Coolant Hose, 5296K643 4-1/2" ID, 4-7/8" OD, 10 PSI, Btue, 3' Length 3 3 Feet Purchase Order JOHN McMaster-Carr Number 1557966-01 AC 8- 27 C Combinable Long ~ 2 DW2~S~ 0911312t 07:34/0'~ 8%2 C¥c{e 24 FISHERS ISLAND FERRY DISTRICT VENDOR 014421 O'CONNOR DAVIES, LLP 10/09/2012 CHECK 763 FUND & ACCOUNT P.O.~ INVOICE DESCRIPTION AMOUNT SM .1310.4.000.000 152147 SVC 7/24-8/29/12,TRL EXP 4,051~25 TOTAL 4,051.25 O0~50B ~,,' Town of Southold, New York - Payment Voucher Vendor Tax ID Number or Social Securiiy Number O'Connor Davies, LLP Vendor Telephone Number 860-257-1870 Vendor Contact Number 152147 Invoice Date 8/31/2012 Invoice Total $4,051.25 Discount $4,051.25 $4,051.25 100 Great Neck Road Suite 401 Wethersfield, CT 06109 Net Purchase Order Amount Claimed Number $4,051.25 !Vendor No. 14421 Description of Goods or Services Services 7/24/12 - 8/29/I 2 and Travel Expenses Check No. Entered by ~ Audit Date 0CT 0 9 2012 Town Clerk for Audit General Ledger Fund and Account Number SM1310.4.000.000 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 thc Town is exempt are excluded. Company Name ~ Department Certification 1 hereby certify that the materials above specified have been received by me tn 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 O'CONNOR DAVIES PKF Date 08/31/2012 Fishers Island Ferry District P.O. Drawer H Fishers Island, NY 06390 For Professional Services Rendered DATE SERVICE STAFF 07/24/2012 Special (describe) Marien T Prepare budget analysis worksheet. Numerous calls with client E.I.N. 27-1728945 HOURS AMOUNT 5.00 $ 1,425.00 08/06/2012 Special (describe) Macione 0.50 87.50 phone call with Tom and Gordon and follow up discussion about project with Tom 08/07/2012 Special (describe) Macione 0.20 35.00 discuss with Tom and send email with contact info to Gordon 08/09/2012 Special (describe) Marien T 0.50 142.50 discussion with Chris Raferty and follow up regarding budget issues 08/10/2012 Special (describe) MarienT 3.00 855.00 Read through budget version July 24, obtain supporting doucments, develop e-mail to answer questions and provide suggestions 08/13/2012 Special (describe) Macione 0.50 87.50 Gordon emailed me about setting up a call to discuss GASB 45. Emails/discussion with MLM and TOM to prepare for his questions 08/13/2012 Special (describe) Marien T 2.00 570.00 100 Great Meadow Road - Suite 401 - Wethersfield - Connecticut - 06109 - ph. 860-257-1870 fax 860-257-1875 O'Connor Davies, LLP Fishers Island Ferry District Invoice No. 152147 Page 2 DATE SERVICE STAFF HOURS AMOUNT Review with Commissioner Chris Rafferty the current version of the budget. Disscuss changes and follow up with new request form Gordon of informaton 08/15/2012 Special (describe) Marien T e-mail to client with additonal data, discussing with Chris Raferty about the budget and how it is constructed 1.50 427.50 08/15/2012 Special (describe) Onion Created vendor report off of Enterprise for expense account in effort to explain a large expense. 0.50 57.50 08/17/2012 Client meeting/phone Marien T Follow up e-mail to Chris Rafferty and Gordon Murphy regarding wrap up of the budget process and next steps 0.50 142.50 08/21/2012 Special (describe) Marien T respond to e-mails regarding cleaning up the general ledger and 2012 over expenses line item 0.50 142.50 08/28/2012 Special (describe) Macione emails from Gordon- question on pollworkers. Reading through guidance to send him 0.25 43.75 08/29/2012 Special (describe) Macione call from Gordon with questions on the guidance for poll workers I sent him and GASB 45 0.20 35.00 $ 4.051.25 Client No. 475764.000 Invoice No. 152147 O'Connor Davies, LLP 100 Great Neck Road, Suite 401 Wethersfield, CT 06109 p. 860.257.1870f 860.257.1875 Fishers Island Ferry District P.O. Drawer H Fishers Island, NY 06390 Statement Date 8/31/2012 Client No.475764 Date Description Charge Credit Balance Balance Forward 3,808.75 24134 12/31/2011 Invoice 5,056.52 8,865.27 12/31/2011 Finance Charge 57.13 8,922.40 1/23/2012 Payment 3,808.75 5,113.65 138471 1/31/2012 Invoice 2,477.76 7,591.41 3/23/2012 Payment 7,591.41 0.00 139454 3/31/2012 Invoice 13,976.05 13,976.05 144181 4/30/2012 Invoice 4,850.35 18,826.40 5/10/2012 Payment 13,976.05 4,850.35 146801 5/31/2012 Invoice 4,473.40 9,323.75 6/4/2012 Payment 4,850.35 4,473.40 148047 6/30/2012 Invoice 12,325.00 16,798.40 148426 6/30/2012 Invoice 981.57 17,779.97 7/10/2012 Payment 4,473.40 13,306.57 8/23/2012 Payment 13,306.57 0.00 152147 8/31/2012 Invoice 4,051.25 4,051.25 Current Balance $ 4,051.25 I 0 - 30 31- 60 61 - 90 91 - 120 Over 120 Balance I 4,051.:~5 0.00 0.00 0.00 0.00 $ 4~051~.5 --- 764 FISHERS ISLAND FERRY DISTRICT VENDOR 015887 OXFORD HEALTH PLAN CHECK 764 -...--- 10/09/2012 S AMOUNT DESCRIPTION P.0.4 INVOICE 8, 311.70 FUND & ACCOUNT MEDICAL PREM HIGH-11/12 42150968 3 609. 52 SM .9060.8 .000 . 000 42150972 MEDICAL 9, 203 . 06 000 . 000 42151301 LOW-10/12 SM . 9060.8 . MEDICAL PREM 4,601.53 _ SM . 9060.8. 000 . 000 42151302 MEDICAL PREMPHIGH-10/12LOW3'112 25, 725.81 SM .9060.8 . 000. 000 TOTAL --- <*"2"@NNKR4/140kP!"11P.-. , - . -71.2-t"taA16(1441,41140W474‘r '' '. -r' - ' _.....- ..--- WATERMARK PAPER ,,L, .w,„. ,t7 COLORED BACKGROUND. VCOPY FEATURE AND OID ,"' 7,/ k'\44"P<SY44114r4;`.:14e4-'‘\\,. .„;,,'1/4\tiltm.,,,%.. THE ORIGINALCHE,,,, 1-1A ,f: --: 71s74-'". ?iY14;/.4a# ( 't 74111Z__/,, ,..C21i:, „,,,411174's,,34,110?).;;,/,'",,40,/' \ /, .7,#7',, ., •''..;;\\zN,4:,,, Stasixtril.,7„, ',: -'„'"'<',„ //10,, ,ht, ":',/71.'i'<"7::::.. 7%,/::: ' '‘/'\'-`• '--;\ - - /- ,/ "DU LAIDIN'r"9114r959/ OANK / IIMUNIES7:e t'11r" ' / sunotapiliII?N,' 'NH/ NH H „ , i, !or: ifflo,„,r, : ro, 44,0444\-,,,'\ ”! ,-, :‘,!iiivityt ropt !,, ,,, % ,,,,,issrlii,r.' , ' 14H 14 ——"piiiitillttOPIr.P",',1 'll\N\A A \ \ *zoolA,oi:AiiiA ,w,r)ory '';i1;14::41054:123:44:AW h''It' ?I'LliC4i tt4 S," (, P y-1- -, “' '"'': !:',,, ,„ ,,,,„,, -44i '" ,,"'''ti:, '' ''"" ' g''''''' iii, :i'''''ifil -21±:-Iiirsjiii -,::;'-j''' \ „,, ' ,,, -"::, 7- lif,.., "vit,14sdiii, -n;',,',''- _,,,-- -t, tt).,r, ,'"-ift'l''tk*:p-ffiirr---t-ao' ProAYtits „„Hiso sok 1 97 ' ''• ,H.,,,;41"4,.w, -,,,c4r^."': I :.s:' - - -:- --r.'It-,- ---'' '-,H -ta-'4,1,40•%-j oRpRR :NE:NAR:k tto-0 071011"„„1 /:.:N...'. , t' ; 44;{-"111---;7;- ,11-9:79; 79#44,- ... 4,04, 4?”, ,.._ 502 • ' '3/4 °;14-4,,Yff t ':•(?' / "1 ii 1 a 6 a 00 L ,• "000 76'." .0 2 i 40 5 4 6 Town of $outhold, New York - Payment Voucher Vendor Tax ID Number or Social Security Number Oxford Health Plans Vendor Telephone Number 888-201-4216 Vendor Contact Vendor Address Invoice invoice Date Total 9/1120t2 $3,609.52 911/2012 $9,203.06 911/2012 $8,311.70 9/112012 $4,601.53 PO Box 1697 Newark, NJ 07101-1697 Vendor No. 15887 Check No. Net Purchase Order Amount Claimed Number $3,609.62 / $9,203.06 / $8,31t.70 / $4,601.53 / Entered by ~ Audit Date OCT 0 9 2012 Town Clerk Invoice Number Discount Description of Goods or Services General Ledger Fund and Account Number 42151301 42151302 ~'nq h ? Icu~, Medical Premium for 101t2 /-~ PlO.r-, Medical Premium for 10112 Medical Premium for 1 t 112 SM9060.8.000.000 J SM9060.8.000.000 / 42180968 SM9060.8.000.000 ~ kow PIo~ 42150972 Medical Premium for 11112 SM9060.8.000.000 __ $25,725.81 $25,725.81 Department Certification Payee Certification The undersigned (Claimant) (Acting on behalf of tbe above named claimant) does hereby certify that the foregoing claim is tree and correct, that no part has been paid, except ~s therein stated, that the balance therein stated is actually due and owing, and that taxes from which the Town is exempt are excluded Signature a~/'~ Title ~ Company Name Date 1 hereby certify that the materials above specified have been received by me in good condition without substitmion, 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 /~'/ ~ / ~.~ Unitedttealthcare' OxfOrd INVOICE SUMMARY Fishers Island Ferry District Group Number ] Billing Group FI9458 Ii BG01 Previous Balance $ -4,702 18 Payments Received 0 00 Debit Memos 0 00 (See Memo Details on last page of this invoice.) Credit Memos 000 (See Memo Details on last page of this ~nvoice ) Total Balance Forward ............. $ -4,702.18 Coverage Period 1010112012 - 1013112012 We encourage you to contact your Dedicated Client Service Manager (DCSM) at 888-201-4216 with any questions regarding this invoice. Invoice Number Due Date of Payment 42151301 October 01,2012 $ 0.00 Adjustments to Prior Bills .......... Totals by Contract Type - Current Premium 6 Single 1 Couple 2 Family 9 Total Healthcare Contracts Current Premium ............... 3,458 04 1,267 96 3,585 70 8,311 70 $ 8,311.70 Total Balance Forward ......... Adjustments to Prior Bills ....... + Current Premium ............ Total Amount Due ......... $ -4,702.18 $ o.oo $ 8,311.70 $ 3,609.52 257GBILLLL0015701 JOBINA MILLER FISHERS ISLAND FERRY DISTRICT P O BOX 607 FISHERS iSLAND, NY 06390 Please write your account number on your check when submitting payment. Thank you for choosing Oxford. the total due. Any financial adjustment for Membership activity not displayed in this invoice summary will be reflected in a future invoice. If you would like your payment applied to a specific plan design, you must send the Remittance Advice for that plan design and indicate the amount to be paid in the Amount Remitted field of the Advice. NOTICE Failure to remit payment by the end of the grace period may result in termination of coverage by Oxford.* According to the terms ofyonr Group Polic3r and Group Enrollment Agreement with Oxford, premium payments are due on the first of the month. The purpose of this notice is to advise you that your group coverage may terminate on the last day of the coverage period indicated on page one of this bill (the "Coverage Period") if we do not receive the required premium payment by the end of the grace period specified in your Group Policy and Group Enrollment Agreement. For New York groups, if we do not receive any payment by the end of the grace period, the termination date of coverage will be retroactive to the last paid date of coverage. If we receive a partial payment, the termination process deseribed in the prior paragraph will apply. For all groups, if termination occurs, your employees and their dependents will receive coverage for all claims incurred on or before the last day oftbe Coverage Period or, in the case of a New York employer who has made no payment before the end of the grace period, the last paid date of coverage. No coverage will be provided for claims incurred thereafter. Any employee or dependent who has access to no other health insurance may be able to comTert to an individual policy with Oxford. More information about this conversion option can be obtained by contacting your Oxford group representative directly. FOR NEW YORK EMPLOYERS ONLY In addition to the above, pursuant to section 217 of the New York Labor Law, you are required to inform your employees of the intended termination of their health coverage. This law requires that you do so by either hand-delivcring or mailing to each of your employees, and by posting at conspicuous locations chosen as most likely to give notice to your employees, at least nine days prior to the intended temunation date, a copy of this notice along with your own cover letter advising as to the intended termination of coverage. However, if your premium payment is sent to Oxford on or before the 20th day of the Coverage Period, or if you have arranged for similar replacement coverage for your employees provided by a different carder (and filed affidavim to that effect with the Commission of Labor and Superintendent of Insurance), the law does not require that you provide your employees with notification as described above. The Contract Type on the Invoice Dctails list refers to the Contract Type of the core health care benefit, unless no such benefit exists for the Subscriber. Please refer to the Legend For Invoice Details above for an explanation of Contract Type, Benefit, and Code abbreviations. *Oxford HMO products are underwritten by Oxford Health Plans (NY), Inc., Oxford Health Plans (NJ), Inc. and Oxford Health Plans (CT), Inc. Oxford insurance products are underwritten by Oxford Health Insurance, Inc. Invoice Details may be continued on the other side. OUR GOAL IS HELPING PEOPLE LIVE HEALTHIER LIVES How do we do this? Better information. Better decisions. Better health. We're committed to providing better information to support better decisions that help drive better health for our members. A leading physician network, 24-honr health care guidance with Oxford On-Call®, a wealth of wellness resources, and online access at oxfordhealth.com, are just a few examples of our ongoing efforts to help our members live healthier lives. UnitedJtealthcare' Thank you for choosing Oxford. Page 1 INVOICE DETAILS Fishers Island Ferry District HIGH PLAN Coverage Period: 10101/2012 to 10/31/2012 CURRENT PERIOD ADJUSTMENTS TO PRIOR BILLS TOTALS Social SubBcrlber Contract #of Coverage Current Subscriber Security# Name Type Members Type Benefit Premium Period Code Premium TOTAL 1121732001 Barrett, Fredehck S 1 CSP01S HEALTHCR 57634 1121732601 Easterr Mark S 1 CSP61S HEALTHCR 57634 1121007601 Ford Polly F 3 CSP01 HEALTHCR 179265 1121010001 Hiller, Jonathan S 1 CSP01 HEALTHCR 57634 1121013701 Le Fevre Raymond S 1 CSP01 HEALTHCR 57634 1121011301 Marshall Jesse C 2 CSP01 HEALTHCR 126796 1121078601 Morgan, John F 3 CSP01 HEALTHCR 179255 1121733601 Schmid, Nina S 1 CSP01S HEALTHCR 57634 1121075501 Traub, James S 1 CSP01 HEALTHCR 57634 576 34 57634 1792 85 576 34 57634 126796 179285 576 34 576 34 Total .................................... $ 8,311.?0 ........... $ 0.00 $ 8,31t.70 The Contract Type on the Invoice Details list refers to the Contract Type of the core healthcare benefit, unless no such benefit exists for the Subscriber Please refer to the Legen0 For Invoice Details on the back of the Invoice Summary for an explanation of Contract Type, Benefit, and Code abbreviations Invoice Details may be continued on the other side. UnitedHealthcare' Oxford INVOICE SUMMARY Fishers Island Ferry District We encourage you to contact your Dedicated Client Service Manager (DCSM) at 888-201-4215 with any questions regarding this invoice. Group Number Billing Group FI9458 BG02 Previous Balance $ 4,601 53 Payments Received 0 00 Debit Memos 0 00 (See Memo Details on last page of this mvotce ) Credit Memos 0 00 (See Memo Details on last page of this invotce ) Total Balance Fonvard ............. $ 4,601.55 Coverage Period 1010112012 - 1013112012 Invoice Number Due Date of Payment 42161302 October 01,2012 Adjustments to Prior Bills .......... Totals by Contract Type - Current Premium 5 Single 1 Couple 1 Family 7 Total Healthcare Contracts Current Premium ............... $ 0.00 2,23075 98153 1,389 25 4,60153 4,601.53 Total Balance Forward ......... Adjustments to Prior Bills ....... + Current Premium ............ Total Amount Due ......... $ 4,601.53 $ 0.00 $ 4,601.$3 $ 9,203.06 JOBINA MILLER FISHERS ISLAND FERRY DISTRICT P O BOX 607 FISHERS iSLAND, NY 06390 Please write your account number on your check when submitting payment. MS-12-t39 Thank you for choosing Oxford. the total due. Any financial adjustment for Membership activity not displayed in this invoice summary will be reflected in a f~ture invoice. If you would like your payment applied to a specific plan design, you must send the Remittance Advice for that plan design and indicate the amount to be paid in the Amount Remitted field of the Advice. NOTICE Failure to remit payment by the end of the grace period may result in termination of coverage by Oxford.* According to the terms of your Group Policy and Group Enrollment Agreement with Oxford, premium payments are due on the first of the month. The purpose of this notice is to advise you that your group coverage may terminate on the last day of the coverage period indicated on page one of this bill (the "Coverage Period") if we do not receive the required premium payment by the end of the grace period specified in your Group Policy and Group Enrollment Agreement. For New York groups, if we do not receive any payment by the end of the grace period, the termination date of coverage will be retroactive to the last paid date of coverage. If we receive a partial payment, the termination process described in the prior paragraph will apply. For all groups, if termination occurs, your employees and their dependents will receive coverage for all claims incurred on or before the last day of the Coverage Period or, in the case of a New York employer who has made no pa)anent before the end of the grace period, the last paid date of coverage. No coverage will be provided for claims incurred thereafter. Any employee or dependent who has access to no other health insurance may be able to convert to an individual policy with Oxford. More information about this conversion option can be obtained by contacting your Oxford group representative directly. FOR NEW YORK EMPLOYERS ONLY In addition to the above, pursuant to section 217 of the New York Labor Law, you are required to inform your employees of the intended termination of their health coverage. This law requires that you do so by either hand-delivering nr mailing to each of your employees, and by posting at conspicuous locations chosen as most likely to give notice to your employees, at least nine days prior to the intended termination date, a copy of this notice along with your own cover letter advising as to the intended termination of coverage. However, if your premium payment is sent to Oxford on or before the 20th day of the Coverage Period, or if you have arranged for similar replacement coverage for your employees provided by a different carder (and filed affidavits to that effect with the Commission of Labor and Superintendent of Insurance), the law does not require that you provide your employees with notification as described above. The Contract Type on the Invoice Details list refers to the Contract Type of the core health care benefit, unless no such benefit exists for the Subscriber. Please refer to the I_~gend For Invoice Details above for an explanation of Contract Type, Benefit, and Code abbreviations. *Oxford HMO products are underwritten by Oxford Health Plans (NY), Inc., Oxford Health Plans (NJ), Inc. and Oxford Health Plans (CT), Inc. Oxford insurance products are underwritten by Oxford Health Insurance, Inc. Invoice Details may he continued on the other side. OUR GOAL IS HELPING PEOPLE LIVE HEALTHIErR LIVES How do we do this? Better information. Better decisions. Better health. We're committed to providing better information to support better decisions that help drive better health for our members. A leading physician network, 24-hour health care guidance with Oxford On-Call®, a wealth of wellness ~csourccs, and online access at oxfordhenlth.com, are just a few examples of our ongoing efforts to help our members live healthier lives. I~ UnitedItealtheam' Oxfo~ Thank you for choosing Oxford. INVOICE DETAILS Fishers Island Ferry District HSA SINGLE - LOW PLAN / HSA FAMILY - LOW PLAN Coverage Period: 10/01/2012 to 10/31/2012 Page 1 of 1 CURRENT PERIOD ADJUSTMENTS TO PRIOR BILLS TOTALS Social Subscriber Contract # of Coverage Subscriber Security# Name Type Members Type Benefit Period Code Premium 1121103501 Brown, Donald C 2 CS02F HEALTHCR 1121083801 Burke, Stephen S 1 CSP02 HEALTHCR 1121090301 Flora, Michael S 1 CSP02 HEALTHCR 1121734601 Hoch Richard S 1 CSP02 HEALTHCR 1121093501 Lynch, Matthew S 1 C$P02 HEALTHCR 1121094501 Marks, Jason S 1 CSP02 HEALTHCR 1121096001 Murphy, Gordon F 3 CS02F HEALTHCR TOTAL 98153 44615 44615 44615 44615 44615 138925 98153 446 15 44615 446 15 446 15 446 15 1389 25 Total .................................... $ 4,601.53 $ 0.00 $ 4,601.53 The Contract Type on the Invoice Details list refers to the Contract Type of the core healthcare benefit, unless no such benefit exists for the Subscriber Please refer to the Legend For Invoice Details on the back of the Invoice Summary for an explanation of Contract Typer Benefit, and Code abbreviations Invoice Details may be continued on the other side. Unitedttealthcare' Oxford INVOICE SUMMARY Fishers Island Ferry District We encourage you to contact your Dedicated Client Service Manager (DCSM) at 888-201-4216 with any questions regarding this invoice. Group Number Billing Group FI9458 BG01 Coverage Period 0910112012 - 0913012012 Invoice Number Due Date of Payment 42150968 September 01, 2012 Previous Balance Payments Received Debit Memos (See Memo Details on last page of this invoice.) Credit Memos (See Memo Details on last page of this invoice ) Total Balance Forward ............. $ 000 131013 88 000 0 O0 $ -13,013.88 Adjustments to Prior Bills .......... $ 0.00 Totals by Contract Type - Current Premium 6 Single 3,458 04 1 Couple 1,267 96 2 Family 3,585 70 9 Total Healthcare Contracts 8,311 70 Current Premium ............... S 8,$11,70 Total Balance Forward ......... Adjustments to Prior Bills ....... + Current Premium ............ Total Amount Due ......... $ -13,013.88 $ 0.00 ~ $ 8,,311.7~ $ -4,702.18 JOBINA MILLER FISHERS ISLAND FERRY DISTRICT P O BOX 607 FISHERS ISLAND, NY 06390 Ms_ 2_139 Thank you for choosing Oxford. AH adjustmenls ~ ................. 7 .......... ~' ........... the total due. Any fmancial adjustment for Membership activity not displayed in this invoice summary will be reflected in a future invoice. If you would like your payment applied to a specific plan design, you must send the Remittance Advice for that plan design and indicate the amount to be paid in the Amount Remitted field of the Advice. NOTICE Failure to remit payment by the end of the grace period may result in termination of coverage by Oxford.* ' According to the terms of your Group Policy and Group Enrollment Agreement with Oxford, premium payments are due on the fu-st of the month. The purpose of this notice is to advise you that your group coverage may terminate on the last day of the coverage period indicated on page one of this bill (the "Coverage Period") if we do not receive the required premium payment by the end of the grace period specified in your Group Policy and Group Enrollment Agreement. For New York groups, if we do not receive any payment by the end of the grace period, the termination date of coverage will be retroactive to the last paid date of coverage. If we receive a partial payment, the termination process described in the prior paragraph will apply. For all groups, if termination occurs, your employees and their dependents will receive coverage for all claims incurred on or before the last day of the Coverage Period or, in the case of a New York employer who has made no pas~nent before the end of the grace period, the last paid date of coverage. No coverage will be provided for claims incurred thereafter. Any employee or dependent who has access to no other health insurance may be able to convert to an individual policy with Oxford. More information about this conversion option can be obtained by contacting your Oxford group representative directly. FOR NEW YORK EMPLOYERS ONLY In addition to the above, pursuant to section 217 of the New York Labor Law, you are required to inform your employees of the intended termination of their health coverage. This law requires that you do so by either hand-delivering or mailing to each of your employees, and by posting at conspicuous locations chosen as most likely to give notice to your employees, at least nine days prior to the intended termination date, a copy of this notice along with your own cover letter advising as to the intended termination of coverage. However, if your premium payment is sent to Oxford on or before the 20th day of the Coverage Period, or if you have arranged for similar replacement coverage for your employees provided by a different carder (and filed a~idavits to that effect with the Commission of Labor and Superintendent of Insurance), the law does not require that you provide your employees with notification as described above. The Contract Type on the Invoice Details list refers to the Contract Type of the core health care benefit, unless no such benefit exists for the Subscriber. Please refer to the Lggend For Invoice Details above for an explanation of Contract Type, Benefit, and Code abbreviations. *Oxford HMO products are underwritten by Oxford Health Plans (NY), Inc., Oxford Health Plans (NJ), Inc. and Oxford Health Plans (CT), Inc. Oxford insurance products are underwritten by Oxford Health Insurance, Inc. Invoice Details may be continued on the other side. OUR GOAL IS HELPING PEOPLE LIVE HEALTHIER LIVES ow do we do this? Better information. Better decisions. Better health. We're committed to providing better information to support better decisions that help drive better health for our members. A leading physician network, 24-hour health care guidance with Oxford On-Cal~, a wealth ofwelhaass resources, and online access at oxfnrdhealth.enn~ are just a few examples of our ongoing efforts to help our members live healthier lives, m~ Un tedtte lthca ' Oxford Thank you for choosing Oxford. INVOICE DETAILS Fishers Island Ferry District HIGH PLAN Coverage Period: 09/01/2012 to 09/30/2012 Page 1 of 1 CURRENT PERIOD ADJUSTMENTS TO PRIOR alLLS TOTALS Social Subecrlber Contract #of Coverage Current Subscriber Security # Name Type Members Type Benefit Premium Period Code Premium 1121732001 Barrett, Fredehck S 1 CSP91S HEALTHCR 57634 1121732601 Easter, Mark S 1 CSP01S HEALTHCR 57634 1121007601 Ford, Polly F 3 CSP01 HEALTHCR 179285 1121010001 Hiller, Jonathan S 1 CSP01 HE. ALTHCR 576 34 1121013701 Le Fevre, Raymond S 1 CSP01 HEALTHCR 57634 1121011301 Marshall, Jesse C 2 CSP01 HEALTHCR 126796 1121078601 Morgan John F 3 CSPOl HEALTHCR 179285 1121733601 Schmid, Nina S 1 CSP01S HEALTHCR 57634 1121975501 Traub, James S 1 CSP91 HEALTHCR 576 3 TOTAL 57634 57634 :::::: 179285 57634 57634 126796 179285 576 34 57634 Total .................................... $ 8,$11.7'0 ........... $ 0.00 $ 8,$11.70 The Contract Type on the Invoice Details list refers to the Contract Type of the core healthcare benefit, unless no such benefit exists for the Subscriber Please refer to the Legend For invoice Details on the back of the Invoice Summary for an explanation of Contract Type, Benefit, and Code abbreviations Invoice Details may be continued on the other side. UnitedItealthcare' Oxford INVOICE SUMMARY Fishers Island Ferry District Group Number Billing Group Coverage Period FI9468 BG02 0910112012 - 0913012012 We encourage you to contact your Dedicated Client Service Manager (DCSM) at 888-201-4216 with any questions regarding this invoice. Invoice Number Due Date of Payment 42150972 September 01,2012 Previous Balance Payments Received Debit Memos (See Memo Details on last page of this invoice) Credit Memos (See Memo Details on last page of this invoice.) Total Balance Fonvard ............. $ 000 0 O0 0 O0 0 O0 $ 0.00 Adjustments to Prior Bills .......... $ 0.00 Totals by Contract Type - Currant Premium 5 Single 2,239 75 1 Couple 98153 1 Family 1,389 25 7 Total Healthcare Contracts 4,601 53 Current Premium ............... $ 4,601,53 Total Balance Forward ......... Adjustments to Prior Bills ....... + Current Premium ............ Total Amount Due ......... $ 0.00 $ o.oo $ 4,601.53 JOBINA MILLER FISHERS ISLAND FERRY DISTRICT P O BOX 607 FISHERS ISLAND NY 06390 MS-12-139 Thank you for choosing Oxford. invoice. If you would like your payment applied to a specific plan design, you must send the Remittance Advice for that plan design and indicate the amount to be paid in the Amount Remitted field of the Advice. NOTICE Failure to remit payment by the end of the grace period may result in termination of coverage by Oxford.* According to the terms of your Group Policy and Group Enrollment Agreement with Oxford, premium payments are due on the first of the month. The purpose of this notice is to advise you that your group coverage may terminate on the last day of the coverage period indicated on page one of this hill (the "Coverage Period") if we do not receive the required premium pay~nent by the end of the grace period specified in your Group Policy and Group Enrollment Agreement. For New York groups, if we do not receive any payment by the end of the grace period, the termination date of coverage will be retroactive to the last paid date of enverage. If we receive a partial payment, the termination process described in the prior paragraph will apply. For all groups, if termination occurs, your employees and their dependents will receive coverage for all claims incurred on or before the last day of the Coverage Period or, in the case of a New York employer who has made no pa3anent before the end of the grace period, the last paid date of coverage. No coverage will be provided for claims incurred thereafter. Any employee or dependent who has access to no other health insurance may be able to convert to an individual policy with Oxford. More information about this conversion option can be obtained by contacting your Oxford group representative directly. FOR NEW YORK EMPLOYERS ONLY In addition to the above, pursuant to section 217 of the New York Labor Law, you are required to inform your employees of the intended termination of their health coverage. This law requires that you do so by either hand-delivering or mailing to each of your employees, and by posting at conspicuous locations chosen as most likely to give notice to your employees, at least nine days prior to the intended termination date, a copy of this notice along with your own cover letter advising as to the intended termination of coverage. However, if your premium payment is sent to Oxford on or before the 20th day of the Coverage Period, or if you have arranged for similar replacement coverage for your employees provided by a different carrier (and filed affidavits to that effect with the Commission of Labor and Superintendent of Insurance), the law does not require that you provide your employees with notification as described above. The Contract Type on the Invoice Details list refers to the Contract Type of the core health care benefit, unless no such benefit exists for the Subscriber. Please refer to the Legend For Invoice Details above for an explanation of Contract Type, Benefit, and Code abbreviations. *Oxford HMO products are underwritten by Oxford Health Plans (NY), Inc., Oxford Health Plans (NJ), Inc. and Oxford Health Plans (CT), Inc. Oxford insurance products are underwritten by Oxford Health Insurance, Inc. Invoice Details may be continued on the other side. OUR GOAL IS HELPING PEOPLE LIVE HEALTHIER LIVES How do we do this? Better information. Better decisions. Better health. We're committed to providing better information to support better decisions that help drive better health for our members. A leading physician network, 24-bour health care guidance with Oxford On-Call®, a wealth of wellness resources, and online access at oxfordbealth.com, are just a few examples of our ongoing efforts to help our members live healthier lives. ~ll I lni~t~l~o~l~]noar~' Oxford Thank you for choosing Oxford. INVOICE DETAILS Fishers Island Ferry District Page 1 of 1 HSA SINGLE - LOW PLAN / HSA FAMILY - LOW PLAN Coverage Period: 09/01/2012 to 09/30/2012 CURRENT PERIOD Social Subscriber Contract # of Coverage Current Subscriber Security# Name Type Members Type Benefit Premium 1121103501 Brown, Donald C 2 CS02F HEALTHCR 98153 1121083801 Burke, Stephen S 1 CSP02 HEALTHCR 44615 1121090301 Flora, Michael S 1 CSP02 HEALTHCR 44615 1121734601 Hoch, Richard S 1 CSP02 HEALTHCR 446 15 1121093501 Lynch Mat~ew S 1 CSP02 HEALTHCR 44615 1121094501 Marks, Jason S 1 CSP02 HEALTHCR 446.15 1121096001 Murphy, Gordon F 3 CS02F HEALTHCR 1389.25 ADJUSTMENTS TO PRIOR BILLS Period Code Premium TOTALS TOTAL 98153 446.15 44615 44615 446 15 44615 138925 Total .................................... $ 4,601.53 ........... $ 0.00 $ 4,601.53 The Contract Type on the Invoice Details list refers to the Contract Type of the core healthcare benefit, unless no such benefit exists for the SuPscriber Please refer to the Legend For Invoice Details on the back of the Invoice Summary for an explanation of Contract Type, Benefit, and Code abbreviations Invoice Details may be continued on the other side. FISHERS IS~ND FERRY D1S~ICT VENDOR 016025 PARAMOUNT PICTURES CORP 10/09/2012 CHECK 765 FUND & ACCOUNT P.O.~ INVOICE DESCRIPTION AMOUNT SM .7155.4.000.000 20669 THE DICTATOR 150.00 TOTAL 150.00 Town of Southold, New York - Payment Voucher Vendor No. 16025 Vendor Tax ID Number or Social Security Number Vendor Address P.O. Box 100486 Vendor Name Pasadena, (CA 911894)486 Paramount Pictures Vendor Telephone Number Vendor Contact Invoice Invoice Invoice Net Purchase Order Number Date Total Discount ~.mount Claimed Number Description of Goods or Services 20669 8114/2012 $150.00 $150.00 The Dictator $t 50.00 $150.00 Payee Certification The undersigned (Claimant) (Acting on bebelf of the above named claimant) docs hereby ~erti~ that the foregoing claim is true and correct, that no par~ has been paid, except as therein stated, that the balance therein stated is actually due and owing, and that taxes from which thc Town is exempt are excluded. Check No. Entered by ,,~ Audit Date OCT 0 9 2017. Town Clerk General Ledger Fund and Account Number 8M7t55.4.000.000 Department Certification l hereby certify that the nmterials above specified have been received by me in good coedition withom substitution, the seJ~ices properly performed and that the quantities thereof have been verified with the exceptions or discrepancies noted, and payment is approved Company Na~ne ~~''' ~'~P Date FILM RENTAL STATEMENT Statement Date: Page: I MELROSE AVENUE RN BUILDING, 3RD FLOOR LOS ANGELES, CA 90038 USA FISHER ISLAND FERRY DISTRICT ('19385) RENTAL % RENTAL % TAX % TAX MISC BALANCE Days PERIOD WK GROSS DED HA TERMS BILLED BILLED PAYMENT PAID BILLED BILLED PAID AMOUNT DUE Aged IDICTATOR, THE (18869) ~ 20569 FISHERS ISLAND COMMUNITY THEATER 1 FISHERS ISLANI I, NY (8OSTON) , 08/14-08/14/2012 I 128.00 175 35135 F 150.00 117.19 /'"~")' 150.00 41 [Pay $1 ,~3 ~- --------~° - PICTURE TOTAL: 128.00 160.00 1~0.00 CIRCUIT TOTAL: 128,00 150.00 1 $0.00 REMIT TO: PARAMOUNT PICTURES PO BOX 100486 PASADENA, CA 91189 Contact: Phone: Fax: MAIL TO: FISHER ISLAND FERRY DISTRICT ATTN: GORDON MURPHY 261 TRUMBALL DRIVE FISHERS ISLAND, NY 06390 USA E = BOX OFFICE NOT RECEIVED **- Competitive Theater INCLI~/DE STATEMENT WITH PAYMENT FISHERS ISLAND FERRY DISTRICT VENDOR 016170 H.O. PENN MACHINERY, INC. 10/09/2012 CHECK 766 FUND & ACCOUNT SM .5710.2.000.200 SM .5710.2.000.200 SM .5710.2.000.200 P.O.~ INVOICE DESCRIPTION PSCE4609466 PSCE4611463 PSCE4612353 SHIPPING FOR PARTS RP-PARTS RP-PART TOTAL AMOUNT 26.06 210.07 193.15 429.28 TO THE ORDER OF H.O. P~NIq MACHINERy. 122 NOXON RO~D POU~K~EPSI~ NY 12G03-2~9~0 ]. iim Town of Southold, New York - Payment Voucher Vendor T~x ID Number or Social Security Number Vendor Address Vendor No. 122 Noxon Road Vendor Name Poughkeepsie, NY 12603-2940 H.O. Penn Machinery Co. Vendor Telepbenc Number 845.452-1200 Vendor Contact Invoice Number Invoice Invoice 16170 Net Purchase Order Check No. Number Date Total ~ 826.06 9/17/2012 $210.07 9125/2012 $193.15! $429.28 Discount ~mo~t Claimed $26.06 $210.07 $193.15 $429.28 Description of Goeds or Services Entered by Audit Date OCT n 2012 T Cler - - General Ledger Fund and Account Number PSCE4609466 Shipping for Parts SM6710.2.000.200 PSCE4611463 RP-Part SM5710.2.000.200 PSCE4612363 RP-Part SM6710.2.000.200 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~ 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 Signature_ Z~c'~-~ Title ~/~/4.~.~ Date CUSTOMER INVOICE H. O. PENN MACHINERY COMPANY, INC. BLOOMINGBURG, NY 783 BLOOMINGBURG RD, 12721 845-733-6400 BRONX, NY 699 BRUSH AVENUE, 10465 718-863-3800 HOLTSVlLLE, NY 660 UNION AVENUE, 11742 631-758-7500 NEWING'FON, CT 225 RICHARD STREET, 06111 860-666-8401 POUGHKEEPSIE, NY 122 NOXON ROAD, 12603 845-452-1200 SOLD TO: 000035 * 000035 FISHERS ISLAND FERRY DISTRIC PO BOX H FISHERS ISLAND NY 06390 001 SHIP TO: PSCE4609466 08-27-12 18697 UPS OUT CHARGE 04 C 2 1 04C702654 08-27-12 "i0 3664250 QUANTITY I ITEM PARTS SALES PERSON: HICHELLE L. WAS 'TOTAL PARTS .00 T FREIGHT OUT 24.50 TOTAL HISC CHARGES 24.50 T 04C702~90 UPS OUT CHARGE CONN SALES TAX · NOT RETURNABLE I--",O ~- . 9m(~m "1923 CUSTOMER INVOICE H. O. PENN MACHINERY COMPANY, INC. BLOOMINGBURG, NY 783 BLOOMINGBURG RD, 12721 845-733-6400 BRONX, NY 699 BRUSH AVENUE, 10465 718-863-3800 HOLTSVlLLE, NY 660 UNION AVENUE, 11742 631-758-7500 NEWINGTON, CT 225 RICHARD STREET, 06111 860~66-8401 POUGHKEEPSIE, NY 122 NOXON ROAD, 12603 845-452-1200 SOLD TO: 000044 * 000044 FISHERS ISLAND FERRY DISTRIC PO BOX H FISHERS ISLAND NY 06390 001 SHIP TO: 5 WATERFRONT PARK NEW LONDON, CT. 06 PSCE4611463 09-17-12 18697 JOHN 04 C 2 04C704946 09-13-12 10 10 UPS ~ROUND 3677~82 UOIo~ EQU, IPMEHT Iv.u-=- AA / ~,xx ~ o99zoooo~ I I PARTS SALES PERSON: MARK * BARANSKI 1 9X-1413 *SOLENOID A S 181.62 181.62 2 8L-3873 *GASKET S 2.11 4.22 TOTAL PARTS 185.84 T 1 FREIGHT OUT 11.69 TOTAL MISC CHARGES 11.69 T CONN SALES TAX 12.54 T ' - NOT RETURNABLE H.O. PENN H. O. PENN MACHINERY COMPANY, INC. BLOOMINGBURG, NY BRONX, NY since ~9~ DANBURY, CT HOLTSVILLE, LI NEWINGTON, CT POUGHKEEPSIE, NY CUSTOMER SHIPPING LIST SOLD TO FISHERS ISLAND FERRY DISTRIC PO BOX H FISHERS ISLAND NY 06390 783 BLOOMINGBURG RD 699 BRUSH AVENUE 30 OLD MILL PLAIN RD 660 UNION AVENUE 225 RICHARD STREET 122 NOXON ROAD 845-733-6400 718-863-3800 203-798-8644 631-758-7500 860-666-8401 845-452-1200 CUSTOMER NO. SHIP TO PACKING LIST *CHARGE* 18697 5 WATERFRONT PARK NEW LONDON, CT. 06 STORE 04 FOR INQUIRIES PLEASE REFERENCE THIS NUMBER IDOCUMENT NO. 04C704946 FILLED BY ~WIC LOC. ORDER~ BY T~HONE CUST. ORD~ NO. INSTRUCTIONS O~VERY LOCATION SHIP VIA 631-788-7463 JOHN UPS DIRECT UPS GROUND MAKE PIC MODEL SERIAL NUMB~ ~U~P. NO AR~NG~T NO DATE TfME ~T BY REFER~CE NO. AA Y UNKN 099Z00001 9/13/12 13:33:16 MXB ITEM .... QUANTITY--- PART NUMBER/ GROSS NO. ORDER SHIP B/O DESCRIPTION LOCATION N/R TR SOS WEIGHT UNIT PRICE EXTD PRICE PARTS SALF~S PERSON: MARK *. BARANSKI 1 Z 1 9X-1413 BE 164A * 000 4.3 181.62 181.62 SOLENOID A 2 2 2 8L-3873 DW 1 * 000 .1 2.11 4.22 GASKET TOTAL GROSS WEIGHT OF SHIPPED ITEMS 4.5 SAVE MONEY ON FREIGHT,PLACE STOCK ORDERS[ CALL PARTS MGR FOR DETAILS USD SELL TOTAL £±.~U 197.64 ITEMS MARKED ' *" ARE NOT-RETURNABLE ** S IGNATUR~ REQUIRED** DATE B37FPB0 w/o 04/11/11 'KO. PENN CUSTOMER INVOICE H. O. PENN MACHINERY COMPANY, INC. BLOOMINGBURO, NY 783 BLOOMINGBURG RD, 12721 846-733-6400 BRONX, NY 699 BRUSH AVENUE, 10465 718-863-3800 HOLTSVILLE, NY 660 UNION AVENUE, 11742 631-758-7500 NEWINGTON, CT 225 RICHARD STREET, 06111 860-666-8401 POUGHKEEPSIE, NY 122 NOXON ROAD, 12603 845.452-1200 SOLD TO: 000060 * 000060 FISHERS ISLAND FERRY DISTRIC PO BOX H FISHERS ISLAND NY 06390 001 SHIP TO: 5 WATERRONT DR INVOICE NUMBER INVOICE DATE CUETOMER NO, CUSTOMER PURCHASE ORDER NUMBER STORE OlV SALESMAN TERME PAGE PSCH4612353 09-25-12 18697 dOHN 6}4 C 2 1 04C706560 09-25-12 10 0 UPS COHPLETE 3683221 QUANTITY I ITEM I *NR I DESCRIPTION UNIT PRICE I EXTENSION PARTS SALES PERSON: HICHAEL R. SILVEY ~ 9X 1413 ~SOLENOiD A S 181.62 181.62 TOTAL PAR]o 181.62 T CONN SALES ri'AX 11.53 T · - NOT RETURNABLE ~ ' H. O. PENN MACHINERY COMPANY, INC. ENNI I IP BLOOMINGBURG, NY 783 BLOOMINGBURG RD 845733-6400 H BRONX, NY 699 BRUSH AVENUE 718-863-3800 PACKING LIST · s~ce ~92~ DANBURY, CT 30 OLD MILL PLAIN RD 203-798-8644 HOLTSVlLLE, LI 660 UNION AVENUE 631-758-7500 NEWINGTON, CT POUGHKEEPSIE, NY CUSTOMER SHIPPING LIST SOLD TO FISHERS ISLAND FERRY DISTRIC PO BOX H FISHERS ISLAND NY 06390 225 RICHARD STREET 122 NOXON ROAD CUSTOMER NO. 18697 STORE 04 860-666-8401 845~,52-1200 SHIP TO *CHARGE* 5 WATERRONT DR FOR INQUIRIES PLEASE REFERENCE THIS NUMBER DOCUMENT NO* 04C706560 ORDER~ BY TELEPHONE CUM. ORDER NO. INSTRUCTIONS D~VERY LOCATION SHIP VIA 631-788-7463 JOHN SSI UPS COMPLETE MAKE PR MODEL SERIAL NUMBER EQUIP. NO AflR~G~T NO DATE TIME ~T BY REFER~CE NO. AA Y UNKN 099Z00001 9/25/12 14:05:42 MAS ITEM .... QUANTITY--- PART NUMBER/ GROSS NO. ORDER SHIP B/O DESCRIPTION LOCATION N/R TR SOS WEIGHT UNIT PRICE EXTD PRICE PARTS SALES PERSON: MICHAEL A. SILVEY 1 1 1 9X-1413 BE 164A * 000 4.3 181.62 181.62 SOLENOID A 2 1 1 6N-4241 NON-STK 62 000 .1 39.40 .00 SHAFT 3 4 4 4W-6548 NON- S'I'K 62 000 .3 21.b3 .00 CLAMP A TOTAL GROSS WEIGHT OF SHIPPED ITEMS 4.3 CONN SALES TAX 11.53 ITEMS MARKED "°" ARE NOT-RETURNAbLE **SIGNATURE REQUIRED** DATE FISHERS IS~ FERRY D~ICT VENDOR 016659 PRINCIPAL LIFE GROUP 10/09/2012 CHECK 767 FUND & ACCOUNT P.O.# INVOICE DESCRIPTION AMOUNT SM .9060,8.000.000 H19730-1-1012 LIFE PREM-10/12 177.18 TOTAL 177.18 PAY PRINCIPAL LIFE ~ROUP TO ~ GRAND ISLAND ORDER - OF ~Q BOX ~451~ ~:02~605~61: ~a 00~502 Town of Southold, New York Vendor Tax 1D Number or Social Security Number Principal Life Group Vendor Telephone Number Vendor Contact Vendor No. 16659 Check No. - Payment Voucher Vendor Address P.O. Box 14513 Des Molnes, IA 60306-3513 $t77,18 $177.18 Entered by Audit Date OCT 0 9 2012 Number Description of Goods or Services General Ledger Fund and Account Number Life Prem -~ 10)l~)- 10/11t2-10131112 H 19730-1 -- 9117/2012 Invoice Invoice Date To~ $177.18 $177.18 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. SM9060.8.000,000 Department Certification ! 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 Group Principal Financial Group Des Moines, IA 50392-0001 IPrincipal Life Insurance Company PREMIUM STATEMENT This statement in no way changes the contract or waives any overdue payment Accou~Number H19730-1 Lb. No. 0819730 00001 93 000429 FISHERS ISLAND FERRY ATTN J MILLER 261 TRUMBELL DR BOX 607 FISHERS ISLAND NY 06390 DueDate 10/01/12 StmtDate 09/17/12 BillingPe~iod 10/01/12 - 10/31/12 $ 177.18 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 OF THESE MESSAGES, PLEASE CONTACT US AT THE NUMBER LISTED BELOW. IT IS IMPORTANT TO REPORT NEW ENROLLMENTS, TERMINATIONS, AND CHANGES IN DEPENDENT STATUS PROMPTLY TO OUR WEBSITE AT WWW.PRINCIPAL.COM OR NOTIFY OUR ADMINISTRATION AREA. WEB REPORTING REQUIRES A PIN. IF YOU DO NOT HAVE A PIN, PLEASE CALL B00-621-8280. 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 DF YOUR PLAN, PLEASE BE SURE YOUR $69.t2 BALANCE IS PAID AND RECEIVED IN THIS OFFICE BEFORE THE GRACE PERIOD ENDS ON 09/30/12. 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. "ina#cio/ Group TH'rS ZS YOUR COPY. Principal Financial Group Principal Life Des Moines, IA 50392-0002 Insurance Company PLEASE KEEP FOR YOUR RECORDS. PREMZUM STATEMENT This statement in no way changes the contract or waives any overdue payment ACCOUNT NO. H19730-1 NUMBER NAME FISHERS ISLAND FERRY LB. NO. 08i9730 00001 93 DUE DATE: 10/01/i2 STMT DATE: 09/17/12 CHARGE/ LIFE/AD&D CREDIT BNFT PREM 982693982 PARADIS dO 920098292 TRAUB dAME :UMMARY TOTALS - TOTAL COVERED 17 6.49 B.4g 4.22 0.48 LIFE / AD&D PREMIUM TOTALS $108,05 CHARGES THIS STMT 108.06 TOTAL AMT DUE 177.18 FOR ASS[STANCE, PLEASE CALL TOLL FREE: 1-800-843-1371 F396GP*4 ACCOUNT NO. H18730-1 10/01/2012 000 000000 000000 £GS631622611156043001002 0001064 [302 OF 002 FISHERS ISLAND FERRY DISTRICT VENDOR 014022 RING'S END, INC 10/09/2012 CHECK 768 FUND & ACCOUNT P.O.# INVOICE DESCRIPTION SM .5709.2.000.200 SM .5709.2.000.200 334530 351810 PAINT BUCKETS PAINT AND SUPPLIES TOTAL AMOUNT 40.00 390.59 430.59 PAY RING'S rO rile O " o ~ BOX, II'OOOTh,°,"' ':O;~&[,OSl~,h': [:8 DDt. SD8 Vendor No. Town of Southold, New York - Payment Voucher 14022 Vendor Tax ID Number or Social Securit~ Number Vendor Address PO BOX 714 Niantlc, CT 06357 RING'S END Vendor Telephone Number 860-739-54~t Vendor Contact Invoice Date Total Check No. Entered by Audit Date OCT 0 9 2012 Discount Description of Goods or Services General Ledger Fund and Account Number 334530 91512012 $40.00 Paint Buckets SM5709.2.000.200 $390.69 Net Purchase Order Amount Claim, Number $40.00 $390.59 $430.59 lnvoice Number 912012012 351810 $430.59 Payee Certification The undersigned (Claimant) (Acting on behalf of the above named claimant) does hereby certify that the foregoing claim is teac 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 Paint and Supplies SM5709.2.000.200 Department Certification Signature Title Date 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 308 South Frontage Road New London CT 06385 T: 860-439-0155 F: 860-439-1369 Bethel, CT (203) 797-1212 (800) 797-6511 New London, CT (860) 439-0155 (866) 439-0155 Branford, CT (203) 488-3551 (866) 758-3551 New Milford, CT {860) 355-5566 (888) 350-8966 Darien, CT (203} 655-2525 (800) 390-1000 Nlantic, CT {860) 739-5441 (800) 303-6526 Page # 1 Lewlsboro, NY {914) 533-2517 (888) 533-2517 WlEon, CT {203) 761-1000 (866} 842-7883 TRANSACTION I TYPE Charge Invoice * * * TFOLNK YOU FOR SHOPPING RING'S END * * * London, CT FISHERS ISI2%ND FERRY DIS P.O. BOX H FISHERS ISLAND 860-442-0165 NY 06390 CUSTOMER TRANSACTION CUSTOMER CODE DATE ~MBER TiME PURCHASE ORDER "UMB~ EFIsHIs 09/05/2012 334530 ii:09ISHOP I 104 - Bob Thomas APPLY TO ORDER DATE ORD/QTE NO ~RMS ITEM ORD~ OT¥ ENC41032 25 ENC61086 25 SHiP QTY I 25! 25 ENCORE DESCRIPTION 1 QT MIX-MEASURE ENCORE 2 1/2 QT MIX MEASURE 0 PRICING uNIT PRICING P~R UOM 25 · 000 0 . 600/EACH 25.000 1 . 000/EACH NET AMOUNT 15.00 25.00 RECEIVED IN GOOD CONDITION By: X SEE REVERSE SIDE FOR TERMS AND CONDITIONS 40.0o ] J ~M~IN~NG MIsC SALEs DEPOSIT INVOICE NET AMT C~ARGE FREIGHT TAX TOTAL o.o o.oq 40.00 CUSTOMER COPY The following terms and conditions govern the sales of The Seller, whether pursuant to oral or written orders to its representatives or salespeople. RETURNED GOODS Stock items, in original units or full packages, will be accepted for credit ,~ exchange when returned in good condition. Within 30 days of purchase, AND ACCOMPANIED BY ORIGINAL SALES TICKET. A restocking charge will be assessed by the Seller on ali returned goods. No special orders will be accepted for return or credit. TAXES Buyer shall pay to Seller the amount of any and all taxes, excises or other charges which Seller may be required to pay or to collect for any government, national, state or local, upon, or measured by the production, sare transportation, delivery or use of the merchandise sold hereunder. FORCE MAJEURE Delay in delivery or non-delivery in whole or in part by Seller shall not be a breach of this sale if perf(~rmance is made impracticable by the occurrence of any one or more of the following contingencies, the non-occurrence of which is a basic assumption on which the agreement is made: (a) Fires, Floods, or other casualties; (b} Wars, Riots, Civil Commotion, Embargoes, governmental regulations or martial law; (c) Seller's inability to obtain necessary materials {finished or otherwise) from its usual sources of Supply; (d) Shortage of cars or trucks or delays in transit; (e} Existing or future strikes or other labor troubles affecting production or shipment, whether involving employees of Seller or employees of others and regardless of responsibility or fault on the part of the employer; and (f) Other contingencies of manufacture or shipment, whether or not of a class or kind mentioned herein and not reasonably within Seller's control. WARRANTY Seller agrees that any merchandise delivered hereunder found to be defective in material or workmar~ship will be repaired or replaced by the Seller without additional charge for the merchandise. This warranty is made in lieu of any other warranties or conditions including merchantability or fitness for a particular purpose. The remedies under this warranty are exclusive and by accepting this merchandise the Buyer agrees to these conditions and waives any other warranties conditions expressed or implied. All claims for damaged or defective mater{ar must be made within § days and we are limited to the purchase price of the materials sold or the replacement thereof at our option. We are not responsible for extra costs, indirect damages or consequential damages. Buyer assumes all risk and liability with respect to results obtained by the use of such merchandise whether used alone or in a combination with other products. No claims of any kind whatsoever, whether based on breach of warranty, the alleged negligence of seller, or otherwise, with respect to merchandise delivered or for failure to deliver any merchandise shall be greater in amount than the purchase price hereunder of the merchandise in respect of which damages are claimed; and failure of buyer to give written notice claim within 30 days after delivery of merchandise shall constitute a waiver of buyer of all claims with respect to such merchandise. TERMS AND CONDITIONS TO GOVERN THIS INVOICE CONSTITUTES THE ENTIRE CONTRACT WTH RESPECT TO THE SALE AND PURCHASE OF THE MERCHANDISE SPECIFIED HEREIN. No modification of this sale shall be effected by the acceptance or acknowledgement of purchase order forms specifying different conditions, and no modifications shall be effective unless in writing signed by the party claimed to be bound thereby. STATE OF JURISDICTION This sale shall be deemed to have been made in, and sharl be construed in accordance with the law~ of the State shown in the Seller's address. DELIVERY AND ACCEPTANCE OF TITLE OF GOODS Title to the materials shall pass from the Seller to Buyer upon delivery thereof to Buyer or his agent and thereafter shall be Buyer's risk. Claims for shortages, breakages or for any nonconformance with the terms and conditions of the order shall be noted on the Seller's delivery receipt by the Buyer at the time of delivery, otherwise, the Seller shall not be responsible for any such claims. If delivery is by common carrier, delivery by the Seller to the carrier at point of origin shall constitute delivery to the Buyer and thereafter the shipment shall be at Buyer's risk, and claims for loss or damage must be filed by the Buyer against the carrier. Title to goods loaded onto Buyer's conveyar~ce at Seller's warehouse passes to the buyer at the Seller's loading dock. if upon delivery at job site, there is not present at the job site an employee of the Buyer authorized to accept delivery and sign a delivery document evidencing delivery of materials as listed on this invoice document, then the Seller reserves the right to deposit the material at the delivery area previously designated by the Buyer without obtaining e signed receipt therefore, and the Buyer agrees to liability for payment of this invoice as if it were signed by an authorized employee of the Buyer, unless the Buyer has previ¢)usly instructed the Seller not to deposit material at the designated delivery area without obtaining a signed delivery receipt from an authorized employee of the Buyer. FINANCE All bills are payable on the 15th of the month following billing date and are past due after 30 days. Past due accounts are subject to a FINANCE CHARGE of 1 1/4% PER MONTH on the past due unpaid balance {which is an ANNUAL PERCENTAGE of 15%). MATERIALS SAFETY DATA SHEETS {MSDS) The occupational safety and Health Administration Hazard Communication Standard, the Superfund Amendments and Reauthorization Act of 1986 and many state right-to-know laws require that a material safety data sheet (MSDS) be provided with products containing hazardous chemicals. As a manufacturer, importer or distributor, you are required by law to ascertain which of your products require an accompanying MSDS and provide such. As a condition of this sale, you expressly warrant that you will comply with the provisions of the foregoing right-to-know-laws. HAZARD COMMUNICATION LABEL Alkaline Copper Quaternary (ACQ} Pressure Treated Wood Hazard warnings for treated wood are similar to those for untreated wood. · Airborne wood dust can cause respiratory eye and skin irritation. · Breath ng excess ve amounts of treated or untreated wood dust pr mar y hardwood has been associated with nasal cancer in some industries. · Handling may cause splinters. · High airborne levels of wood dust may burn rapidly in the air when exposed to an ignition source. · Some forms of components of the liquid preservative used to manufacture this product (arsenic and chromium) have caused lung, skin, and possibly other cancers in humans occupationally or environmentally overexposed. SUCH EXPOSURES HAVE NOT OCCURRED WITH TREATED WOOD. NOTE: Consult the Material Safety Data Sheet for additional information on this product. This Information Is designed to address the label requirements of the OSHA Hazard Communication Standard with respect to treated lumber. DELIVERY All deliveries are priced and understood to be on a first floor/tailboard delivery basis.  Page # 1 Bethel, CT Branford, CT Darien, CT Lewisboro, NY (203) 797-1212 (203) 488-3551 (203) 655-2525 (914) 533-2517 308 Sout:h Frontage Road (800) 797-6511 (866) 758-3551 (800) 390-1000 (888) 533-2517 New London CT 06385 New London, CT New Milford, CT Nlnntic, CT Wilton, CT T: 860-439-0155 (860) 439-0155 (860) 355-5566 (860) 739-5441 (203) 761-1000 F: 860-439-1369 (866) 439-0155 (888) 350-8966 (800) 303-6526 (866} 842-7883 TRANSACTION TYPE STORE Charge Invoice * * * THANK YOU FOR sH'6PPING' RING'S END * * * New London, CT BILL ~O= SHiP TOi FISHERS ISLAND FERRY DIS P.O. BOX H FISHERS ISLAND NY 06390 860-442-0165 CUSTOMER TRANSACTION CUSTOMER ITiME PURCHASE OROER NUMBER SA£ESF'ERSON EFISH s 09/20/20i= 518 0'10=53 BOAT 294 - Quibble oRiGiN~ APPLY TO ~ERMS TAX JuRisDIClri0N 0 35i8i0 2% Date Based Discount 6.35% - CT SALES TAX iTEM OkDERCt~ ~HtPOT¥ i~C DES~ION PRIclN~UNi~ NETA~IOUNT P220801 4 4 URETHA/NE ALKYD GLOSS SAFETY WH G 4,000 33.990/EACH 135.96 P749201 2 2 ALIPHATIC ACR/UR/GLS CLEAR BS G 2.000 65,590/EACH 131,18 SAFTEY YELLOW P748404 2 2 ALIPHATIC URETH GLOSS HARDNER QT 2.000 43.860/EACH 87.72 THINNER 1 1 PAINT THINNER GALLON 1 . 000 8 . 090/EACH 8 . 09 ENC45000 2 2 ENCORE 3QT D/W ROLLER TRAY 2.000 3.920/EACH 7.84 ENC00075 20 20 ENCORE 3QT D/W TRAY LINER 20.00~ 0,990/EACH 19.80 RECEivEO IN GOOD CONDiTiON BY: SEE REVERSE SIDE FOR TERMS AND CONDITIONS MiSC SALES REMAINING iNVoicE NET AMT ~RG~, FRE!~T TAX DEPOSIT. ,, ,,~TAI. X 390.5.c 0.0( 0.0( 390*59 CUSTOMER COPY The following torres and conditions govern the sales of The Seller, whether pursuant to oral or written orders to its representatives or solespeop;e. RETURNED GOODS Stock items, in original units or full packages, will be accepted for credit or exchange when returned in good condition. Within 30 days of purchase, AND ACCOMPANIED BY ORIGINAL SALES TICKET. A restocking charge will be assessed by the Seller on all returned goods. No special orders will be accepted for return or credit. TAXES, Buyer shall pay to Seller the amount of any and all taxes, e~'=ises or other charges which Seller may be required to gay or to collect for any government, national, state or local, upon, or measured by the production, sale transportation, delive~y or use of the merchandise sold hereunder. FORCE MAJEURE Delay in delivery or non-delivery in whole or in part by Seller shall not be a breach of this sale if performance is made impracticable by the occurrence of any one or more of the following contingencies, the non-occurrence of which is a basic assumption on which the agreeme.n_t is made: la) Fires, Floods, or other casualties; lb) Wars, Riots, Civil Commotion, Embargoes, governmental regulations or martial law; lc) Seller s inability to obtain necessary materials (finished or otherwise) from its usual sources of Supply; (d) Shortage of cars or 1:tucks or delays in transit; (e) Existing or future strikes or other labor troubles affecting production or shipment, whether involving employees of Seller or employees of others and regardless of responsibility or fault on the part of the employer; and (f) Other contingencies of manufacture or shipment, whether or not of a class or kind mentioned herein and not reasonably within Seller's control. WARRANTY Seller a~rees that any merchandise delivered hereunder found to be defective in material or workmanship will be repaired or replaced by the Seller without additional charge for the merchandise. This warranty is made in lieu of any other warranties or conditions including merchantability or fitness for a particular purpose. The remedies under this warranty are exclusive and by accepting this merchandise the Buyer agrees to these conditions and waives any other warranties conditions expressed or implied. All claims for damaged or defective material must be made within 5 days and we are limited to the purchase price of the materials sold or the replacement thereof at our option. We are not responsible for extra costs, indirect damages or consequential damages. Buyer assumes all risk and liability with respect to results obtained by the use of such merchandise whether used alone or in a combination with other products. No claims of any kind whatsoever, whether based on breach of warranty, the alleged negligence of seller, or otherwise, with respect to merchandise delivered or for failure to deliver any merchandise shall be greater in amount than tho purchase price hereunder of the merchandise in respect of which damages are claimed; and failure of buyer to give written notice claim within 30 days after delivery of merchandise shall constitute a waiver of buyer of all claims with respect to such merchandise. TERMS AND CONDITIONS TO GOVERN THIS INVOICE CONSTITUTES THE ENTIRE CONTRACT WTH RESPECT TO THE SALE AND PURCHASE OF THE MERCHANDISE SPECIFIED HEREIN. No modification of this sale shall be effected by the acceptance or acknowledgement of purchase order forms specifying different conditions, and no modifications shall be effective unless in writing signed by the party claimed to be bound thereby. STATE OF JURISDICTION This sale shall be deemed to have been made in, and shall be construed in accordance with the laws; of the State shown in the Seller's address. DELIVERY AND ACCEPTANCE OF TITLE OF GOODS Title to the materials shall pass from the Seller to Buyer upon delivery thereof to Buyer or his agent rind thereafter shall be Buyer's risk. Claims for shortages, breakages or for any nonconformance with the terms and conditions of the order shall be noted on the Seller's delivery receipt by the Buyer at the time of delivery, otherwise, the Seller sharl not be responsible for any such claims. If delivery is by common carrier, delivery by the Seller to the carrier at point of origin shall constitute delivery to the Buyer and thereafter the shipment shall be at Buyer's risk, and claims for loss or damage must be filed by the Buyer against the carrier. Title to goods loaded onto Buyer's conveyance at Seller's warehouse passes to the buyer at the Seller's loading dock. If upon delivery at job site, there is not present at the job site an employee of the Buyer authorized to accept delivery and sign a delivery document evidencing delivery of materials as listed on this invoice document, then the Seller reserves the right to deposit the material at the delivery area previously designated by the Buyer without obtaining a signed receipt therefore, and the Buyer agrees to liability for payment of this invoice as if it were signed by an authorized employee of the Buyer, unless the Buyer has previously instructed the Seller not to deposit material at the designated delivery area without obtaining a signed delivery receipt from an authorized employee of the Buyer. FINANCE All bills are payable on the 15th of the month following billing date and are past due after 30 days. Past due accounts are subject to a FINANCE CHARGE of 1 114% PER MONTH on the past due unpaid balance (which is an ANNUAL PERCENTAGE of 15%). MATERIALS SAFETY DATA SHEETS (MSDS) The occupational safety and Health Administration Hazard Communication Standard, the Superfund Amendments and Reauthorization Act of 1986 and many state right-to-know laws require that a material safety data sheet (MSDS) be provided with products containing hazardous chemicals. As a manufacturer, importer or distributor, you ars required by law to ascertain which of your products require an accompanying MSDS and provide such. A,s a condition of this sale, you expressly warrant that you will comply with the provisions o! the foregoing right-to-know-laws. HAZARD COMMUNICATION LABEL Alkaline Copper Quaternary (ACQ) Pressure Treated Wood Hazard warnings for treated wood are similar to those for untreated wood. Airborne wood dust can cause respiratory eye, and skin irritation. Breath ng excess ye amounts of treated or untreated wood dust (primarily hardwood) has b~en associated with nasal cancer in some industries. · Handling may cause splinters. · High airborne levels of wood dust may burn rapidly in the air when exposed to an ignition source. · Some forms of components of the liquid preservative used to manufacture this product (arsenic and chromium) have caused lung, skin, and possibly other cancers in humans occupationally or environmentally overexposed. SUCH EXPOSURES HAVE NOT OCCURRED WITH TREATED WOOD. NOTE: Consult the Material Safety Data Sheet for additional information on this product. This Information Is designed to address tho label requirements of the OSHA Hazard Communication Standard with respect to treated lumber. DELIVERY AI~ deliveries ars priced and understood to be on a first floor/tailboard delivery basis. Ch rqe Invoice New ; END) ce  REMIT TO: P. O. Box 714 Niantic, CT 06357 PAYMENTS AND CREDITS RECEIVED ON OR AFTER THE 25TH MAY BE SHOWN ON YOUR NEXT STATEMENT PLEASE RETURN WITH PAYMENT CUSTOMER CODE EFISHIS / 114742 STATEMENT DATE 09/30/2012 FISHERS ISLAND FERRY DIS P.O. BOX H FISHERS ISLAND, NY 06390 FOR BILLING INQUIRIES PLEASE CALL: 860-739-5441 MAKE CHECKS PAYABLE TO: RING'S ENqD, INC. THE NEXT CLOSING WILL BE ON: OCTOBER 31, 2012 STORE TRANS DATE TR3kNS NUMBER TR3~NS TYPE ORIG. TP~S AMT OPEN TR3~NS AMT CUST PO/JOB NAME 7 09/05/2012 334530 INVOICE 40.00 40.00 SHOP 7 09/20/2012 351810 INVOICE 390.59 390.59 BOAT 4 09/29/2012 732 PAYMENT -135.96 0.00 PREVIOUS BALANCE CURRENT CHARGES CURRENT CREDITS CURRENT PAYMENTS FINA/~CE CHARGE ~34OUNT DUE 135 . 96 430 . 59 0 . 00 -135.96 430.59 CURRENT 30 DAYS 60 DAYS 90 + DAYS 430 . 59 0.00 0 . 00 0 . 00 If yOU pay by 10/15/12, Deduct 8.61 Page #: Ail bills are payable on the 15th off the month following billing date and are past due after 30 days. Past due accounts are subject to a FIN/~NCE C~UtRGE off 1 1/4% PER MONTH on the past due unpaid balance. ANNUAL PERCENTAGE RATE OF 15%. FISHERS ISLAND FERRY DISTRICT VENDOR 019153 SCHULTZ LUBRICANTS, INC. 10/09/2012 CHECK 769 FUND & ACCOUNT P.O.# INVOICE DESCRIPTION AMOUNT SM .5710.2.000.000 289169 RP/MU-LUBE OIL 5,782.84 TOTAL 5,782.84 "'OOOTBq"' 1:08~.qOS[,h[,~: Bfl 00;-508 ~,,~' Vendor No. Town of Southoid, New York - Payment Voucher 1 {}153 Vendor Tax ID Number or Social Security Number Vendor Address 164 Shrewsbu~j Street Vendor Name West Boylston, MA 01883-2t t 6 Schultz Lubricants, Inc. Vendor Telephone Number 800-282-3992 Vendor Contact Invoice Invoice Invoice Net Pumha~e Order Number Date Total Discount Amount Claimed Number Description of Goods or Services Check No. Entered by ~ Audit Date OCT 0 9 2012 C, eneml Ledger Fund and Account Number 289169 9/18/2012 $8,782.84 $5,782.84 Lube 011 used for SM6710.2.000.000 both MunnlRP $5,782.84 $5,782.84 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 Department Certification I hereby certify that the materials above spacifiecl 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 due and owing, and that ~xes from which the Town is exempt are excluded. or discrepancies noted, and payment is approved Signature ~.e~~ Title ~ Date ~' /-/ ? Fa3~ed t.0:=631-788-5523 INVOICE UJBRICANT DISTRIBUTORS SINCE 19='8 ~llTo: FISHER ISLAND FERRY DISTRICT P.O, BOX ~ FISHER ISLAND NY 06390 Ship To: FIG~IER iSLAnD FERRY DISTRICT FOOT OF gTAT~ NEW LONDON CT 06320 Co/Oust No. Order No. Customer PO# Ter Sis# Delivered 1/21358100 25105/00 JOMN 1 400 09.17.12 Terms 1.000% 1% 10 DAYS, NET 30 Ship Vi~ Pay Type ACCOUterS RECI~,,I'V~T~.,~ Plea,,e Return Top Portion With Payment Item U/M Ordered ShiRoed Number/D~a'iption Pri~e I~o~e 289169 Date 09/18/12 Re~ Total 113122 Core Charge 55D MOBILGARD 409 NC (R]~PLACES MOBILGARD 450 NC) 55D 6.000 6.000 12.73000 GAT, 101570 Core Charge 55D NUTO H 32 55D 2.000 2.000 9.14000 GAL Core Charges CONNECTICUT PETROLEUM TAX FU~L SURCHARG~ $52.06 4,200.90 1,005.40 1~6.00 392.04 8.50 5,782.84 THIS IS YOUR INVOICE - NO OTHER WILL BE SENT .~UL"IZ BILL OF LADING Page Print SoldTo:FISHER ISLAND ~:ERRY P~ (% BOX H FISHER I SLANO DISTRICT NY 0639~ Co/Cust No 0 ! /003135~i~ ~ ~o ShipTo:FISHER ISt.AND FERRY DISTRICT FOOT 0F- STATE STREET 'F NEW ]NDON CT 06320 Terms: ~,o 10 DAYS, Order No Ter Sis rep Ship Via ;25105/00 1 400 MONDAY O9/17 NET 30 JOHN Date 09,/i2/12 Ref # 11.3I, .... 55D MOBILGARD 409 NC (REPLACES MOBILGARD 450 NC~ 101570 55D NJTO /7 C-~r e Chart]es CONNECTICUT PETROLEUM TAX 6,0~0 ~ a ooo 55D 13 A 06 55D 14 a l 2 3 CUSTOMER COPY RECEiV~-t~'l COMPLETE * FISHERS ISLAND FERRY DISTRICT VENDOR 019719 STAPLES CREDIT PLAN 10/09/2012 CHECK 770 FUND & ACCOUNT P.O.# INVOICE DESCRIPTION AMOUNT SM .5711.4.000,000 SM .5711,4.000.000 SM ,5711.4.000.000 3025049001 FI OFFICE SUPPLIES 64.99 3257000001 FI OFFICE SUPPLIES 109.93 3257000002 FI OFFICE SUPPLIES 39,99 TOTAL 214.91 ,'OOO 770~' I:O~&qOSh~q,: ~6 [Jo~50~ Vendor No. Town of Southold, New York - Payment Voucher 19719 Vendor Tax ID Number or Social Security Number Vendor Address PO Box 414524 Vendor Name Boston, MA 02241-4524 Staples Contract & Commercial, Inc, Vendor Telephone Number 866-996-8t03 Vendor Contact Invoice I Invoice Number Date 3025049001 Total 8/2812012 $39.99! Net Pun:hese Order Check No. '1'10 Entered by Audit Date OCT 0 9 2012 To k Discount Amount ClaimeC $64.99 Number Description of Goods or Services FI Office Supplies SM5711.4.000.000 3267000002 $39.99 FI Office Supplies SM5711.4.000.000 3267000001 8/28/2012 $109.93 $109.93 FIOffice Supplies SM57tt.4.000.000 $214.9t $214.91 Payee Certification The undersigned (Claimant) (Acting on behalf of the above named claimant) does hereby certify that the foregoing claim is true and correct, that no pan has been paid, except as therein stated, that the balance therein stated is actually due and owing, and that taxes from which the Town is exempt are excluded Signature ~ Title Company Name~" ~tP Date 7/, 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 d~''~ 7 / ~ th~ w~s e~ O Customer Sewice: staples.a~countonllne.com I[i Account Inquiries: 1-800-767-1291 Fax 1-801-779-7425 Account Statement FISHER ISLAND FERRY DIST Summary of Account Activin/ Previous Balance $1,249.76 Payments -$988.86 Credits -$0.00 Purchases +$214.91 Debits +$0.00 FINANCE CHARGES +$0.00 Late Fees +$0.00 New Balance $475.81 STAPLES CREDIT PLAN PO Box 790449, St. Louis, MO 63179-0449 Payment Information Current Due Past Due Amount Minimum Payment Due Payment Due Date $25.00 + $0.00 $25.00 10/02/12 ICredit Line Credit Available Closing Date Next Closing Date Days in Billing Period $10,500 $10,024 09/07/12 10/09/12 29 ~qlat's on your new billing statement? Please see enclosed sample for additional information on how to read your statement. TRANSACTIONS Trans Date Locatlon/Oe~criptlon 08/28 ~;e231257000-0~O-Q02 cHAMBERSBURG PA PAYMENTS, CREDITS, FEES AND ADJUSTMENTS F919400KV00OI)~'RL Amount NOTICE: SEE REVERSE SIDE FOR IMPORTANT INFORMATION Page I of 6 This Account is Issued by Citibank, N.A. Information About Your Account. purchases, but not on cash advances. Tbis is called a grace period oo purchases. The grace period is at least 20 days. To ~et the g,ace period on purchases, pay the following amounts by the due date every billing period: the New Balance (subiect to the PIomotional Balance Exceptions), plus the mimmum monthly payments required for your' No Interest and 0% balances. ff you do riel, you will not get a grace period unless you pay those amounts by the due date for two billing periods in a low. The two Promotional Balance Exceptions are: (]) You do not have to pay any NO Interest or 0% balances that do not expire by tile Next Closing Date shown on the billing statement. (2) You can pay any NO interest or 0% balances that do expire by the Next Closing Date shown on the statement by the later of the plomotion's expffation date or tbe statement's payment due date purchases. Other promotional offals, in addition tm No Interest and 0% having to pay all or a portion of the promotional balance by the due date. If either is the case, the plomotiona] offer will describe what happens. Balance Subject to Finance Charge. We calculate periodic finance charges to get a daily balance, we start with the balance as of the end of the payments and make othe~ adjustments. A credit balance is treated as a balance of zero. If the rate on a balance is a dai~y rate we include in the daily results in daily compounding of finance charges.) 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 irl the billing period. The Balance Subiect to Finance Charge is the average of the daily balances during the billing period If you multiplytbis figure for each balance by its daily periodic late and by the number of days in the billing period, the result is the total periodic finance charge on thai Notify Us In Case of Errors or Questions About Your Bill. If you ~hink your transaction on your billing statement, write to us (on a separate sheet) as possible. We must hear from you in writing re later than 60 days after we letter, give us tbe following information: · The dollar amount of the suspected error. · Describe the error and explain, if you can, why you berieve there is an error, If you need more inlormation, describe the item you are unsure about Important Payment Instructions. Crediting Payments. We must receive your payment in proper form at our . processing facility by 5 p.m. local time there, If we do, it will be credited as of that day, A payment receNed at the processing facility in proper forrr~ after that time will be credited as of the next day. Allow 5 fo 7 days for payments by regular mail to reach u_*. There may be a delay of tip to 5 days in crediting a payment we receive that is not in proper form or is not sent to the correct address. The 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 payment 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 Payments Address shown below, Proper Form· For a payment sent by mail or courier to be in proper form, you must: · Enclose a valid check or money orden No cash, gift cards, or foreign currency please. · Include your name and ]ccount number on the front of your check Or money order. If you send an eligible check with this payment coupon, you authorize us to complete your payment by electronic debit. If we do, the checking 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 charge $5 for each copy of a billing statement that dates back 3 months or more. We add the fee to the regular revolve credit plan balance. We waive the fee if your request for the copy relates to a billing error o~ disputed purchase. Payment Options Other Than Regular Uail. Online Payments. Visit the web address on the front and sign up for online payments. Enrollment may take a few days, If we receive your request to make an online paynlent by 5 p.m, Eastern time, we will credit your payment as of that day. if we receive your request to make an online payment after that time we will credit your payment on the next day, For security reasons, you may be unabie to pay your entire New Balance with your first online payment, Pay by Phone Service, You may use ttlis service any fime ~o make a payment by phone. You wilt be charged $14,95 to use this service. Cail by 5 p,m. Eastern time to have your payment c~edited as of tbat day. If you call after that time, your payment will be credited as of the next day. We may process your payment electronically after we verify your identity. Express Payments. YOU can send payment by courier or express mail to the Express Payments address: Customer Service Car}far, Dept, CCS 922, 4740 12tst Street, Ur'bandale, IA 50323. Payment must be received in proper form, at the proper address, by 5 p.m. Centrai time in order to be credited as of that day. Ail payments received in proper form, at the proper address, after that time will be credited as of the next day. Report a Lost or Stolen Card Immediately. You may call Customer Service 24 hours a dayr 7 days a week. Account: **** **** **** 7673 PURCHASES REGULAR REVOLv NG cRE9 T PLAN Your Annual Percentage Rate (APR) b the annual Interest rate on your account. 0.00% 0.00000% $0,00 $0.00 Page 3 of 6 1-800-767-1291 staples .accountonline.com Account: **** **** **** 7673 Clear. Statements show you exactly how much ~u've spent, how much you owe, when you owe it and your available credit. Plus our newformat provides you with more offers and product irr;ormetion, all highlighted in color. Concise. . . The informa~on is bucketed into sections that make it simDre to find what you're looking for and is written in normal, everyday language. Simple to read. Not only are the words themselves c~ear ~ncl concise, they're in large and simple to read type face. Summary 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 Spells 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 Page 4 of 6 CRC JUL12 1-800-767-1291 staples.a(xx~ntooline.eom INVOICE DETAIL m m BILL TO: Acc'f; 6035 5178 2065 7673 SHIP TO: DEB DOUCETi'E FISHERS ISLAND FERRY 261 'IRUMBULL DR FISHERS ~SLAND, NY PRODUCT SKU # FILE RECY LTR/LGL CTN12 000587169 Purchased by: DEB DOUCE1TE SHIPTO: 261TRUMBU~DR BiLL TO: Ac, ct: 6035517820657673 PRODUCT FISHERS ISLAND, NY 00000-0000 SKU # BROTHER P-TOUCH 1290 LABE 000796620 IPO '99 I I 10/02/12 I Invoice #: 3O25O49OO1 Store: 100088887, PUTNAM QUAN'nTY UNIT PRICE TOTAL PRICE BILLTO: Acc't: 6035 5178 2065 7673 1.0000 CT $64.99 $64.99 SUBTOTAL $64.99 TAX $0.00 SHIPPING $0.00 TOTAL $64.99 Purchased by: DEB DOUCE ~ i ~ SHIP TO: DEB DOUCETTE FISHERS ISLAND FERRY 261 TRUIdt~JLL DR 08/28/12 10/02/12 ~ I Store: 100099887, PUTNAM QUANTITY UNIT PRICE TOTAL PRICE 1.(X)00 EA $39.99 $39.99 SUBTOTAL $39.99 TAX $0.99 SHIPPING $0.00 TOTAL $39.99 PRODUCT FISHERS E~LAND, NY SKU QUANTITY UNIT PRICE TOTAL PRICE PEN ROLLER OPTIFLOW BLUE 000486574 EXPANDABLE WALL PKT LTR B 000889187 BROTHER IZb-231 12MM BLK 000917860 Purchased by: DEB DOUCE3TE 1.0000 DZ $I 1.49 $11.49 5.0000 ST $1529 $76.45 1.0000 EA $2i .99 $21.99 SUBTOTAL $109.93 TAX $0.0O SHIPPING $0.00 TOTAL $109.93 Page 5 of 6 1-800-767-1291 staples .accountonline.com This page intentionally left blank. Page 6 of 6 1-800-767-1291 staples.ec~3mmt3nllne.com , Stap;es.com® ] Printable Order Summary Page 1 of 2 that wa~ easy.® Printable Order Summary Thank You for Your Order For complete details of your order, including estimated tax and delivery info, be sure to check for an email from Staples at the address below. Order confirmation will be sent to: ddoucette@fiferry.com Order number 1:9231025049 Order date: August 21, 2012 You'll also find complete details of this order in the Order Status section of My Account. Shipping Address Deb Doucette Fishers Island Ferry District 261 Trumbull Dr Drawer H Fishers Island, NY, 06390-8021 (631) 788-7463 Not going to be around to receive or sign for your order? Please fill out a Driver Release Agreement: http://www.staples.com/sbd/content/help/$hipping/nothome_popup.html Billing Address Gordon Hurphy 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: 9231025049 item ]'g;nl~er; Bo)~® SYSTEHATIC® Basic-Duty Expected 587169 i 100% Recycled Storage Boxes Letter/Legal delivery: Thu 08/23 at $64.99 ~$64.99 Size 12/Pack i Subtotah $64.99 Estimated Tax: Tax Exempt Delwer¥: $0.00 'Total: $64.99 Ii Remaining Balance! $64,99 https://www.staples.com/office/supplies/orderconfprnt?catalogId= 10051 &orderld= 154487... 8/21/2012 · Staples.com® I Printable Order Summary Page 2 of 2 Remaining Balance will be applied to following: I~ta~le~ ~dit Card ending in 5882 Hold on Lo 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 au pport@orders.staples.com 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 International 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 Map I RSS Feed I AdChoices https://www.staples.com/office/supplies/orderconfprnt?catalogId=10051 &orderld=154487... 8/21/2012 Staples.corn® I Printable Order Summary that was oasy;~ Printable Order Summary Thank You for Your Order Page 1 of 2 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 1:923:[257000 Order date: August 28, 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 Hurphy Fishers Island ferry District 261 Trumbull Dr Fishers Island, NY, 06390-0607 (63:[) 788-7463 Your order may be sent in different shipments. If it is, no additional charges will apply. Order number: 9231257000 Item Staples® Expandable Wall Pocket, Expected bus~ness-day Qty: 5 Price: 889187 Letter-Size, Black delivery: Thu 08/30 at $15.29 4 $76.45 ! Pockets Item Brother® P-touch® PT-1290 Label Expected business-day Qty: 1 Price: 796620 Haker delivery: Thu 08/30 at $39.99 $39.99 Each Item Brother® TZe-231 P-Touch® Label Expected business-day Qty: i :Price: 917860 'Tape, :[/2" Black on White delivery: Thu 08/30 at $21.99 $2'1.99 Each : Item Staples® OptiFIowTM Rollerball Pens, Expected business-day ~Qty: 1 i Price: 486574 Fine Point, Blue, Dozen delivery: Thu 08/30 at $11.49 Dozen https://www.staples.com/office/supplies/orderconfprnt?catalogld= 10051 &orderId=155024... 8/28/2012 Staples.com® I Printable Order Summary Page 2 of 2 I Coupons: i$O.O0 ~ Estimated Tax: iTax Exempt i Delivery: i $O.OO i Total: $:t49,92 Remaining Balance; $149.92 Remaining Balance will be applied to following: I Staples Credit Card ending in 5882 Hold on to your Staples Rebate Visa Cards and Prepaid Gift Cards until your order has been received If you have any questions or concerns about your order, please call 1-800-STAPLE$ (1-800-782-7537) or email su pportL~orders.staples.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 International 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 IViap I RSS Feed I i AdChoices https://www.staples.com/office/supplies/orderconfprnt?catalogld--10051 &orderld= 155024... 8/28/2012 that was easy: For Customer Service, call 1 800 333-3330, or email at support@orders.staples.com. Order online, by phone or by fax 24 hours a day, 7 days a week. STAPLES that was easy REFER TO THIS ORDER NO. FOR ALL INOUIRIES 4051825224 8/29/12 9231257000-000002 SHIPPING LOCATION:Chambersburg, PA FC CARRIER ROUTE:UPS/UPS /U1 FISHERS ISLAND FERRY DISTRICT DEB DOUCETTE TOTAL PACKAGES: 1 Floor: 1 261 TRUMBULL DR FISHERS ISLAND, NY 063908021 Contact: (631) 788-7463 DEB DOUCETTE PAGE: Order Date: 08/28/2012 Coupons and other adjm tments are deducted after the Merchandise Total. 796620 BROTHER P-TOUCH 1290 LkBELER /PT1290 EA 1 1 39.99 39.99 ~ /~ M. !roi ~andise Total ........ 39.99 T, ux ..................... 00 Check your order statu! online by going to www. Staples.com and clicking on "My Orders". ~ Need to return something? Please call Customer Service to process TOTAL VALUE oo~ Thank You For Your Order! Staples, Inc. THIS IS NOT AN INVOICE 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, ? days a week. that was easy: ~F~ FO THIS ORDER NO. FOR ALL INOUIRIES 4081828224 I 8/29~12 I 9281257000-000001 STAPLES that was easy FISHERS ISLAND FERRY DISTRICT DEB DOUCETTE Floor: 1 261 TRUMBULL DR FISHERS ISiJ~ND, NY 063908021 Contact: (631) 788-7463 - DEB DOUCETTE SHIPPING LOCATION: Putnam, CT FC CARRIER ROUTS:UPS/UPS /U2 PAGE: 1 Order Date: 08/28/2012 ::::::::::::::::::::::::::::::::::: ::ii ?i :. ::: :: ~i~ :. i ?. i :: :: i ~ ~ ~::~ii~ ~ ~ :. :: :. :~ ~ Coupons and other adju: ments are deducted after the Merchandise Total. On large orders some b< ~es may be arriving in separate shipments, i~ / 486574 P.EN ROLLER OPTIFLOW BLUE /11528 DZ 1 11.49 11.49 889187 EXPANDABLE WALL PKT LTR BL~CK /20221-CC ST 5 15.29 76.45 917860 BROTHER TZE-231 12~ BLK ON WT/TZe-231 EA 1 21.99 21.99 Material Safety Data SI 9ets (MSDS) may be found by visiting http://msds ce:.p.com/ms~s/91786¢.pdf The following are ship~-=d from an alternate warehouse via UPS. They should arrive no later than 08/31/12 796620 BROTHER P-TOUCH 1290 LABELER /PT1290 EA 1 0 39.99 .00 M~rc andise Iotal ....... 109.93 D ~li ery ................. 00 T ~x ..................... 00 Check your order status online by going to www. Staples.com and clicking on "My Orders". ~ Need to return something? Please ~a~.~s~ call Customer Service to process TOTAL VA~UE · ~ev~.ew, a return. OF ORDER: 109.93 Thank You For Your Order! Staples, Inc. THIS IS NOT AN INVOICE FISHERS ISLAND FERRY DISTRICT VENDOR 020151 TECHNICOLOR, INC. 10/09/2012 CHECK 771 FUND & ACCOUNT P.O.~ INVOICE DESCRIPTION SM ,7155,4.000.000 85661500 FILM DEL/PU FEES TOTAL 100.00 100.00 P~¥ ,1'00077~,' ~:02~qOSq~6,: ~8 00~502 ~' Vendor No. Town of Southold, New York- Payment Voucher 20151 Vendor Tax ID Number or Social Security Number Vendor Address Oepanment 848498 Los Angeles, CA 90084-8498 TECHNICOLOR, INC. Vendor Telephone 800-0634667 Vendor Contact Check No. -1-ii Entered by ..~ Audit Date OCT 0 9 2012 Number 85661500 invoice Date 9/10~201 Invoice Total $100.00 Discount Net Amount Claimed $100.00 $100.00 $100.00 Payee Certification The undersigned (Claimant) (Acting on behalf o£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 ,~_~ D~te ~ ~ /'J Purchase Order Number Film DeI/PU Fees Description of Goods or Services T~ ?~.~lerk ~ . General Ledger Fund and Account Number SM7t88.4.000.000 Department Certification I hereby certify that the materials above specified have been received by me in go~ 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 -~-----~ e h i I .ec, .n.co.or T~s: ~T ~4 D*~ Page: i of l INVOICE TO: Shipped To: 1000448 Community Thtr New London, CT 06320 Community Thtr Po Box 607 iircuit or Fishers Island, NY 06390 Dwner 1000448 09/10/12 I 85661500 09/24/12 PRINT MANAGEMENT DIARY OFA WIMPY KID 3:DOG D 35 ma t±lm 1 25.00 8175944 08/24/12 1ZSFYl150323259022 ICE AGE 4: CONTINENTAL DRIF Print Return 1 25~00 8183355 08/27/12 1Z8RTY657823228666 SNOW WHITE AND THE HUNTS~N Print Return 1 25.00 8183356 08/29/12 1Z8R7Y657823275829 MOONRISE KINGDOM Prln~ Return 1 25~00 8176827 08/31/12 1ZSR7Y657823306465 (PM) S~totals: 0 00 0.0 S.00 130.00 100.00 Packag: ng Material 5 Sales 2ax Shi >ping Subtotal FOR ADDRESS CORRECTIONS: 0100 0:0C 0100 10O}0C 100.00 TECHNICOLOR, INC. Department 848498, LOS ANGELES, CA 90084-8498 U~ ~S~ ~ ~ ~FE~RING ~ TH~ ~ I P A Y FOR ~LL.I_.N.~ i l i oo.oo FISHERS ISLAND FERRY DISTRICT VENDOR 020167 TERMINIX PROCESSING CENTER 10/09/2012 CHECK 772 FUND & ACCOUNT SM .5709.2.000.200 P.O.# INVOICE DESCRIPTION 317867360 PEST CONTROL-NL- 9/4/12 TOTAL AMOUNT 49.98 49.98 ~'OOO??;h~' ':OBi,~,OS[,~,t,~: ~,8 00;,508 l,~' Vendor No. Town of Southold, New York- Payment Voucher 20167 Vendor Tax ID Number or Social Security Number Vendor Address P.O. Box 742592 Vendor Name Cincinnati, OH 45274-2592 Terminix Processing Center Vendor Telephone Number 860483-0012 Vendor Contact Invoice Check No. Date Total 915/2012 49.98 $49.98 Net Purchase Order Amount Claimed Number 49.98 Entered by ,~ Audit Date OCT 0 9 2012 Discount Description &Goods or Services Cmneral Ledger Fund and Account Number 317867360 Past ContmI-NL 914/12 SM5709.2.000.200 $49.98 Payee Certification The u~tersigned (Claimant) (Acting on behalf of the above named claimant) dces hereby certify that the foregoing claim is true and correct, that no pan has been paid, except as therein stated, that the balance therein stated is actually due and owing, and that taxes from which the Tovm is exempt are excluded. Department Certification I hereby certify that the materials above specified have been received by me in good condition without substiiution, the services properly performed and that thc quantities thereof have been verified with the exceptions or discrepancies noted, and payment is approved. ~N~X ACCOUNT INVOICE PO. BOX 17167 MEMPHIS, TN $81B7 · ?$3" g~,UO NO RP ~,l] O'l~O2i]i2 yNNNNNNN I]C]~,a~?q ~ TS? Please Pay By: 09/24/2012 12279 1 MM 0.401 Total Due: $49.98 FISHER'S ISLAND FERRY* " ~.:ATTN: DEBRA DOUCETTE 0 PO BOX H PAY ONLINE Ter minixCommerciel corn FISHERS ISLAND NY 06390-0607 H"lll"l'dll'dh'm'll'~HhqHhhhIHqlH'ql 01.800.TERNltNIxPAY BY PHONE  QUESTIONS · Local Office: 860.683.0012 EASY WAYS TO PAY YOUR TERMINIX® INVOICE · Toll Free: 1.800 TERNIlNIX · Online: TerminixCommercial corn Paying your bill Is easy, especiaJly online Just visit the "Nlanage ~4y Account" portal at TerminixCommercial.com anc~ sign up with your Customer Number: 4067525 and phone number to start paying bills online 09/05/2012 Pest Control Work Order 11066952001 Tax Charge Location: 5 STATE ST/DOCK OFFICE, NEW LONDON CT 06320 317867360 $47.OO $2 98 $4998 DUE DATE: 09/24/2012 TOTAL DUE: $49.98 BUSINESS REFER & SAVE REFER COLLEAGUES AND FRIENDS, SAVE ON YOUR TERMINIX SERVICE. For each person or t~usiness you recommend who purchases an annual Terminix commercial or residential serwce, you'll Save $150 or more. To learn more about Business Refer & Save, visit TermlnlxCommerclal.com or ask your Termlnlx Commercial representative. OPERATOR'S NAME & CERTIFICATION # ~Yr-~~ ; r.q3' ~'--' $'?~ TEIIMI IX TERMITE and PEST CONTROL SERVICE PROPERTY AT P~OOUOTION [ TIME IN I TIME OUT ~;51 eM 7.;10 SERVICE CENTER S Sidle sf/r~c,2R OFFICE TARGET PESt SERVICE INSTRUCTIONS BOILEB ¢30M 02411-6 02263< 15028--S ,.¢~.,~',"'~'-~'. BASEMENT - .E~l 024~,~-u 02263-C FO0~ CREF:S C.O'.'J;j=~-~ 022~3-C 15028--S 0233~-C OFFICES 024I!-C 02263-C I~0z8-$ 0~332-E P~¢~E]:~' ~024!1-6 15028-S~ PUBLIC AREAS ~ 02263-C 15028-8 02332-6 ~EST ~O]~S ¢,24il-C 02263-C 15023-S 02332-C TRASH AREA 02263--C 02~I1-C 15028-S VEND!~G ARB~S 024H-6 02263-C 15028-$ 02332-C 02411 rri-Die Bulk Dust 02263 565 PLUS XtO FORM,II t5~28 S~p 02332 M~¢orce FC Select PFRETHRINSl~,PBOtOT,SILIC 4~-427 PYRETHRINS,5~ PIPERONYL B 499-2¢0 FIRRONIL ,01~ ~32-125¢ CYFLUFH~IN 0,05% 4f7--3,~4 BAYER oK SUPERVISOR'S COMMENTS: ~Treat for Infestation/Prevention or Inspect areas indicated· TREATED INSPECTED L _] C _2 [_] [_] £_] £_] E_] [_] [_] [ _] L_] AMOUNT EQUIP TREATMENT CODES: EQUIPMENT CODES: C = Crack & Crevice S =',Spot B = 3' Band A = Aerosol B&G = Comp. Air F = Fogger G = General T = SpaceTreatment HD = Hand Dust T = Trap B = Bait Stat. AMOUNT PAID Pri~r O~];~nc~,: 4.998 FISHERS ISLAND FERRY DISTRICT VENDOR 020230 THAMES SHIPYARD & REPAIR CO. 10/09/2012 CHECK 773 FUND & ACCOUNT IN-VOICE DESCRIPTION SM .5710.2.000.200 7694 RP AIR CONTROL VALVE TOTAL AMOUNT 9.21 9.21 NINE~A~ID 21;100 CO. NEW LONDON CT 06320-079~ ~"OOO~?5~' ':OSI, l~OSL, l~l~: ~6 00;,508 Town of Southold, New York - Payment Voucher Vendor Tax ID Number or Social Security Number Vendor Name Thames Shipyard & Repair Co. Vendor Telephone Number 860-442-5349 Vendor Contact Invoice Number Invoice Date Vendor Address 2 Ferry Street Inv°ice$9.21 Total Discount New London, CT 06320 Amount Claimed Purchase Order Number Vendor No. 20230 Check No. Entered by Audit Date OCT 0 9 2012 Description of Goods or Services General Ledger Fund and Account Number 7694 911012012 $9.21 RP Air Control Valve 8M$710.2.000.200 $9.21 $9.21 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 Comp nyName Dete 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 ?RAM~S SHIPYARD & REPAIR CO. 2 FERRY STREET NE,W LONDON, CT 06320 Voice: 860-442-5349 Fax: 860-440-3492 INVOICE Invoice Number: 7694 Invoice Date: Sep 10, 2012 Page: 1 FISHERS ISLAND P.O. BOX H FISHERS ISLAND, NY 06390 FISHERS ISLAND P.O. BOX H FISHERS ISLAND, NY 06390 FISHERS Couder Net Due 9/10/12 SALES-MATERiAL 8.66 Check/Credit Memo No: Subtotal Sales Tax Total Invoice Amount Payment/Credit Applied 8.66 0,55 9.21 CHARGE TO: THAMES SHIPYARD AND REPAIR CO. P.O. Box 791 New London, CT 06320-0791 (860) 442-5349 Material DATE: QUAN. DESCRIPTION QG;O'ZI 5 - SELLING FISHERS ISLAND FERRY DISTRICT VENDOR 020331 TIMES-REVIEW NEWSPAPERS 10/09/2012 CHECK 774 FUND & ACCOUNT P.O.~ INVOICE DESCRIPTION SM .5710.4.000.000 111947 L/N~10857-HNG FIS AFFR TOTI~L ~40UNT 16.08 16.08 Vendor No. Town of Southold, New York- Payment Voucher 20331 Vendor Tax ID Number or Social Security Number Vendor Address P.O. Box 1500 Vendor Name Mattituck, NY 11952 Times/Review Newspapers Vendor Telephone Number 631.296.3200 Karen Kine Check No. Entered by .~ Audit Date OCT 0 9 2012 Town Clerk . 111947 9120/2012 $16.08 $16.08 Legal Ad SM5710.4.000.000 $16.08 $16.08 Payee Certification The undersigned (Claimant) (Acting on behalf of the above named claimant) does h~reby eerfi fy that the foregoing claim is t~u¢ and correct, that no pert has be~n peid, except ss 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 Department Certification l hereby certify that the materials above specified have been r~c~ived by me in good condition without substitution, the services properly performed and that the quantities the~of have been verified with the exceptions PLEASE DETACH AND RETURN UPPER PORTION WITH YOUR REMITTANCE 09120/12 Affidavit Fee 1567320 10857-HNG FIS AFFR 2013-15L-iX 1 SUFF TIMES Legal Ad 1.000 10.00 6.08 16.08 STATEMENT OF ACCOUNT AgDI6 01, pAST TIMES / REVIEW NEWSPAPERS 77861dainlbad, P.O. Bex 15es MattHuck, NY11es2 The NmNs-Revievv Tho Suffolk Times The North Shore Sun Shelter Inland Reporter Wine Press Pay this amount~;~ I 16.08 111947 09/20/2012 139579 139579 FISHERS ISL. FERRY -LEGAL #10857 STATE OF NEW YORK) ) SS: COUNTY OF SUFFOLK) Karen Kine of Mattituck, in said county, being duly sworn, says that she is Principal Clerk of THE SUFFOLK TIMES, a weekly newspaper, published at Mattituck, in the Town of Southold, County of Suffolk and State of New York, and that the Notice of which the annexed is a printed copy, has been regularly published in said Newspaper once each week for ! week(s), successfully commencing on the 6th 20th day of September, 2012. Principal Clerk Sworn tobeforemethis L.~ day of &~(, '_ . _ 2012. LEGAL NOT~CE NOTICE is be~l~ given that the Board of Commissioners of the F~- er/Island Ferry District~ F~shers Island. New York will hold a public hearing mi S~turday, OcWber 6th, 2012 at 5:30pm at the l~shers Island Community Center, Second Floor, Fisbel~island, New York on the e~timated reve~tues and expendi- tures of the fiscal p~Fi(~ beginning Jatlu- aty 1, 2013 and encl~g December 2013. At such hea~in~ any person may be heard in favor or a~inst any item or items contained therein. Board of Commissioners Fishers Island Ferry District 10.857-11 9/20 NOTARy PUBLIC*STATE OF NEW YORK No. 0tYO610~080 QuaLfflecl In Suffolk County My Coml'M4~lofl i~iOitfll Fel~uarV 28, 2016 FISHERS ISLAND FERRY DISTRICT VENDOR 020820 TWENTIETH CENTURY FOX FLM CORP 10/09/2012 CHECK 775 FUND & ACCOUNT SM .7155.4.000.000 SM .7155.4.000.000 SM .7155.4.000.000 SM .7155.4.000.000 P.O.# INVOICE 080512 081212 082212 082912 DESCRIPTION FILM MIN-PROMETHEUS FILM MIN-BST EXOT.MRGLD FILM MIN-ICE AGE-CONT DT FILM MIN-DIARy WIMPY KID AMOUNT 250.00 250.00 278.00 250,00 TOTAL 1,028.00 ONE THOUSAND TWE~NTy ~ EIGHT AND O0/1~ DOSLARS Town of Southold, New York - Payment Voucher Vendor No. 20820 Vendor Tax ID Number or Social Security Number Vendor Name Twentieth Century Fox Film Corporation Vendor Telephone Number 818-87fl-7225 Vendor Contact Invoice Number Date 815/2012 8/12/2012 Toml $280.00 $280.00 Discount Vendor Address Bank of America 5863 Collection Center Drive Chicago, IL 60693 Net ~mount Claimed $250.00 $250.00 Purchase Order Number Description of Goods or Services I Film Min/Percentages: Prometheus Film MIn/Percentages: Check No. Entered by ~ Audit Date 0CT 0 9 2012 General Ledger Fund and Account Number SM7165.4.000.000 SM7155.4.000.000 Best Exotic Marigold Hotel 8122/2012 $278.00 $278.00 Film MinlPementages: SM7t65.4.000.000 Ice Age: Continental Drift 8/29/2012 $250.00 $260.00 Film Min/Percentages: SM7155.4.000.000 Diary of A Wimpy Kid $1,028.00 $1,028.00 Payee Certification Thc undersigned (Claimant) (Acting on behalf of the above named claimant) does hereby certify that the foregoing claim is tree and correct, that no part has been paid, except as therein stated, that the balance therein stated is actually due and owing, and that taxes from which the Town is exempt are excluded Signature ~~1~ Title ~ Company Name Date ~ ~'~ ~f* in good condition without substitution, the services properly performed and that the quantities thereof have been verified with the exceptions or discrepancies noted, and payment ~s approved Signature ~~ Title Date Twentieth C~mtur~ Fox Film Co~. Statement of Account - Detail Circuit: Independent USA I NomClrcult Payer: Fisher's Island Fe~j District Pa~le 2 of 2 Atlantic Division - New York Branch 000000000 - Fishers island Community Theater Fishers Island, NY I 08/1208/18/12 I 35.00 Diary of A Wlml~ Kl~: Dog Oay~ I 08/05-08/05/12 I 40.00 Temm: Pemeat ~ ~ 420.00 L~r FR 250.00 0.00 0.00 250,00 FR-MIN 103.00 Total VVk I 420,00 250.00 0.00 Total Film 250.00 0.O0 Terma: Per~e~t ~ 275.00 [E-S~ FR 250.00 0,00 FR-MIN 140.00 Total Wk I 2'[5.00 250.00 0.00 Total Fllm 2SO, O0 0.00 Terms: Pem~lt 556.00 (F~S) FR 278.00 0.00 Total~'R'~ 278,00 0.00 Terms: Perce~t 250.0~ E-$~ FR 250.00 0.00 FFI-MIN 150.00 Total IAtk I 25000 250.00 0.00 Total Film 250.00 0.00 Total Theater 1,028.00 0.00 31 0.00 200.00 20 0.00 278.00 27 278.00 1,028.90 Grand Total 1,028.00 0,00 1,028.00 Tuesday 9/18/2012 9:25AM Gordon Murphy From: Sent: To: Cc: Subject: Attachments: Analisa Rojas <Analisa. Rojas@fox.com> Tuesday, September 18, 2012 12:58 PM staleysed@gmail.com; Gordon Murphy Lawrence Piller, Anna Osso; Derval Whelan FW: Scan from a Xerox WorkCentre Pro Scan001.PDF The attached statement is for film rental due to Fox Studios Box offi¢.e, reports have not been received please have them emailed or faxed. ~~~ Prom~ast-'~ due please respond back to this email to let me know when payment will be sent. Thankyou Analisa Rojas 20th Century Fox Ph: (818)876-7225 Fx: (818)876-7289 Analisa.Roias~fox.com Twentieth Century Fox Film Corp. Independent USA/Non-Circuit Fishers Island Community Theater 510 Whistler Avenue Fishers Island, NY 06390 USA Fishers Island Ferry District 261 Drumball Drive Drawer H Fishers Island, NY 06390 USA Booking Confirmation August 7, 2012 Prometheus I123m41s I I Booking Summary Screen Detail House Allowance No. Days Playing Full Day % Scm % Adjusted Seats Twentieth Century Fox Film Corp.-NY Attn: Bank of America 5863 Collection Center Drive Chicago, L 60693 USA Sound Language Caption Type English I Caption Lanai Schedule of Weekly Terms I 40.00% Box Office 250 If Held 35.00% Box Office Floor 35.00% Box Office Holdover If Friday through Sunday Gross of Week 1 or any subsequent week is over $800, exhibitor agrees to hold Film at terms provided in Schedule of Weekly Terms. Adult Child Senior Per Capita Royalty Base L5.00 } 3.00 3.00 J For each performance of the Film which commences at or after 5:30 p.m., Exhibitor shall pay the greater of (a) the applicable stated weekly percentage term of each picture sold, or (b) the minimum per capita royalty for each patron entering the theater, to be calculated as follows: the applicable weekly percentage term, multiplied by the per capita royalty base indicated above for adults (patrons 12 years of age or older), children (patrons under 12 years of age), and senior citizens. Exhibitor retains the right to charge any price it desires for admissions, and the per capita is in no way a requirement that Exhibitor charge any particular price. Additional Terms This Booking Confirmation Sheet incorporates by reference all of the terms set forth in the Master Contract between Twentieth Century Fox Film Corp. and Exhibitor, and superoedes any pdor Booking Confirmation Sheet. In the event the Master Contract is not executed, Exhibitor agrees that the exhibition of the Film shall constitute Exhibitor's acceptance of all terms set forth on the Master Contract and in this Booking Confirmation Page 1 of I Fox Searchlight Pictures Booking Confirmation Independent USA / Non-Circuit Fishers Island Community Theater 510 Whistler Avenue Fishers Island, NY 06390 USA Fishers Island Ferry District 261 Drumball Drive Drawer H Fishers Island, NY 06390 USA August 14, 2012 PG-13 Best Exotic Marigold Hotel l 23m40s ] SCOPE I 7 Booking Summary 250 Screen Detail No. Days Playing Full House Allowance Day % Scrn % Adjusted Seats Sound Language I I 15001 Qu^D Eng,sh Caption Type Caption Lang Schedule of Weekly Terms 1 35.00% Box Office 250 If Held 35.00% Box Office Floor 35.00% Box Office Holdover If Friday through Sunday Gross of Week 1 or any subsequent week is over $1,600, exhibitor agrees to hold Film at terms provided in Schedule of Weekly Terms, Adult Child Senior Per Capita Royalty Base I 5.00 I 3.00 3.00 I For each performance of the Film which commences at or after 5:30 p.m., Exhibitor shall pay the greater of (a) the applicable stated weekly percentage term of each picture sold, or (b) the minimum per capita royalty for each patron entering the theater, to be calculated as follows: the applicable weekly percentage term, multiplied by the per capita royalty base indicated above for adults (patrons 12 years of age or older), children (patrons under 12 years of age), and senior citizens. Exhibitor retains the right to charge any price it desires for admissions, and the per capita is in no way a requirement that Exhibitor charge any particular price. Additional Terms This Booking Confirmation Sheet incorporates by reference all of the terms set forth in the Master Contract between Fox Searchlight Pictures and Exhibitor, and supercedes any prior Booking Confirmation Sheet. In the event the Master Contract is not executed, Exhibitor agrees that the exhibition of the Film shall constitute Exhibitor's acceptance of all terms set forth on the Master Contract and in this Booking Confirmation Sheet. Page 1 of I Twentieth Century Fox Film Corp. Independent USA I Non-Circuit Fishers Island Community Theater 510 Whistler Avenue Fishers Island, NY 06390 USA Fishers Island Ferry District 261 Drumball Drive Drawer H Fishers Island, NY 06390 USA Booking Confirmation August 21, 2012 Ice Age: Continental Drift PG I92m34s t sCOPE Booking Summary Screen Detail NO. Days Playing Full House Allowance Day % Scrn % Adjusted Language Caption Type Caption Lanai Seats Sound 5001Qu^D Schedule of Weekly Terms I 50.00% Box Office 250 If Held 50.00% Box Office Floor 5000% Box Office Holdover If Friday through Sunday Gross of Week 1 or any subsequent week is over $400, exhibitor agrees to hold Film at terms provided in Schedule of Weekly Terms Adult Child Senior Per Capita Royalty Base I 5.00 3.00 I 3.O0 For each performance of the Film which commences at or after 5:30 p.m., Exhibitor shall pay the greater of (a) the applicable stated weekly percentage term of each picture sold, or (b) the minimum per capita royalty for each patron entering the theater, to be calculated as follows: the applicable weekly pementage term, multiplied by the per capita royalty base indicated above for adults (patrons 12 years of age or older), children (patrons under 12 years of age), and senior citizens. Exhibitor retains the right to charge any price it desires for admissions, and the per capita is in no way a requirement that Exhibitor charge any particular price. Additional Terms This Booking Confirmation Sheet incorporates by reference all of the terms set forth in the Master Contract between Twentieth Century Fox Film Corp and Exhibitor, and supercedes any prior Booking Confirmation Sheet. In the event the Master Contract is not executed, Exhibitor agrees that the exhibition of the Film shall constitute Exhibitor's acceptance of ali terms set forth on the Master Contract and in this Booking Confirmation Page 1 of I Twentieth Century Fox Film Corp. Independent USA I Non-Circuit Fishers island Community Theater 510 Whistler Avenue Fishers Island, NY 06390 USA Fishers Island Ferry District 261 Drumball Drive Drawer H Fishers Island, NY 06390 USA Screen Detail Booking Confirmation August 28, 2012 Diary of A Wimpy Kid: Dog Days J 93m52s J SCOPE I 5 Booking Summary Twentieth Century Fox Film Corp.-NY Attn: Bank of America 5863 Collection Center Drive Chicago, IL 60693 USA House Allowance No. Days Playing Full Day % Scrn % Adjusted Seats Sound Language Caption Type Caption Lan~ Schedule of Weekly Terms 40.00% Box Office 40.00% Box Office Holdover If Friday through Sunday Gross of Week I or any subsequent week is over $400, exhibitor agrees to hold Film at terms provided in Schedule of Weekly Terms. Per Capita Royalty Base Adult Child Senior 5.00 3.00 3.00 For each pedormance of the Film which commences at or after 5:30 p.m., Exhibitor shall pay the greater of (a) the applicable stated weekly percentage term of each picture sold, or (b) the minimum per capita royalty for each patron entering the theater, to be calculated as follows: the applicable weekly percentage term, multiplied by the per capita royalty base indicated above for adults (patrons 12 years of age or older), children (patrons under 12 years of age), and senior citizens. Exhibitor retains the right to charge any price it desires for admissions, and the per capita is in no way a requirement that Exhibitor charge any particular price. Additional Terms This Booking Confirmation Sheet incorporates by reference all of the terms set forth in the Master Contract between Twentieth Century Fox Film Corp and Exhibitor, and supercedes any prior Booking Confirmation Sheet. In the event the Master Contract is not executed, Exhibitor agrees that the exhibition of the Film shall constitute Exhibitor's acceptance of all terms set forth on the Master Contract and in this Booking Confirmation Page 1 of I FISHERS ISLAM FERRY D~ICT VENDOR 021506 UNITED PARCEL SERVICE 10/09/2012 CHECK 776 FUND & ACCOUNT P.O.# INVOICE DESCRIPTION AMOUNT SM .5710.4.000.700 SM .5710.4.000.700 SM .5710.4.000.700 26639372 W/E 9/15/12-(3)PKG 118.93 26639382 W/E 9/22/12-(8)PKG 206.82 26639392 W/E 9/29/12-(8)PKG 194.68 TOTAL 520.43 FIVE HUNDREU TWENTY AND 45/:100 DOLL~ Town of Southold, New York - Payment Voucher Vendor T~x ID Number or Social Security Number Vendor No. 21506 United Parcel Service Vendor Telephor~ Number 800-81'1-1648 Vendor Contact Vendor Address P.O. Box 7247-0244 Philadelphia, PA 19170-000t Check No. Audit Date ~ OCT 0 9 2012 $118.93 Invoice Invoice Purchase Order Number Date Number Description of Goods or Services General Ledger Fund and Account Number 26639372 9115/2012 Net $118.93 $206.82 $194.68 26639382 9122/2012 $206.82 26639392 9129/2012 $194.68 $520,43 $520.43 Payee Certification I The undersigned (Claimant) (Acting on behalf of the above named claimant) does hereby certify ha he foregoing claim is true and correct, that no Ixart has SM57'10.4.000.700 SM5710.4.000.700 SM5710.4.000.700 ~en 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. Department Certification 1 hereby cerli~ 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 discreptmcies noted, and payment is approved. Signature ~~- Title ~-~- Date . ~ Delivery Service Invoice Invoice date September 15, 2012 · - Shipped from: Invoice number 0000026639372 FISHERS ISLAND FERRY Shipper number 026639 1 STATE ST Control iD 43T1 NEW LONDON, CT 06320 Page 1 of 3 0720A00000266392 77366300012350 FP 01 076851 37211G239 A**3DGT For queetions aboul your invoice, cell: ,1111111h ]~ (800)811-1648 tlt"lt"l"lqllh'lll'lhh'l Ill"t ttll'll'flt'll Monday-Friday FISHER ISLAND FERRY ,~ , 8:OOa. m.-g:OOp.m.E.T. PO BOX 607 FISHERS ISLAND, NY 06,%90 0~./ UpS P.O. Box '~247-0244 Philadeiphia, PA 19170-0001 Account Status Summary Weekly Payment Plan Amount Due This Period $118.93 Amount Outstanding (prior invoices) $1,686.73 Total Amount Outstanding $1,805.66 Please include the Return Portion of each outstanding invoice with your payment. See Account Status for details. Questions about your charges? To get a better understanding of the charges on your invoice, visit our invoice guide and glossary of billing charges at ups.com/invoiceguide. Sign up for electronic billing today! Visit ups.corn/billing Thank you for using UPS. Summary of Charges Page Chmge Outbound 3 UPS WorldShip $ 69.71 3 Ad'luetmenls & Other Charges $ -1.53 3 Fees $ 30.75 Service Charges $ 20.00 Amount due this period $118.93 UPS payment terms require payment of this invoice by September 26, 2012. Payments not received by October 10, 2012 are subject to a late fee of 6% of the Amount Due This Period. (Details in UPS Tariff, available at upe.cem) Note: This invoice may contain a fuel surcharge as described at ups. com. The published fuel surcharge is 7,0% for UPS Ground Services end 11.5% for UPS Air Services, UPS 3 Day Select, end International services. For more information, vioit ups.com. Delivery Service Invoice Invoice date September 15, 2012 Invoice number 0000026639372 Shipper number 026639 Page 2 of 3 Account Status Weekly Payment Plan Payments Applied Invoice Number Invoice Date 0000026639302 07/28/2012 0000026639312 08/04/2012 0000026639322 08/11/2012 Account Status Weekly Payment Plan Amount Paid $ 619.24 $473.11 $ 704.32 Amount Outstanding (prior invoices): Please include the Return Portion of each outstanding invoice with your payment. Balance Invoice Number Invoice Date Due 0000026639332 08/18/2012 $ 512.51 0000026639342 08/25/2012 $ 734.85 0000026639352 09/01/2012 $108.38 0000026639362 09/08/2012 $ 330.99 Total $1,686.73 Outstanding balances reflect any payments received as of 09/14/2012. Please ignore this message if a recent payment has been made for any outstanding invoices. Delivery Service Invoice invoice date September 15, 2012 Invoice number 0000026639372 Shipper number 026639 Page 3of3 Outbound uPs WorldShip Pickup Pickup Number of Billed Date Record Message Codes Packages Charge 99/13 9121173530 1 15,88 09/14 9121173541 r 2 53.83 Total UPS WoridShip 3 Package(e) 69.71 Total Outbound 3 Package(a) 69.71 Adjustments & Other Charges Miscellaneous Billed Explanation Charge WEEKLY PRINTER SERVICE FEE 2.00 FOR 1 PRINTERS AT $2~00 EACH FOR 14-SEP-2012 Total Miscellaneous 2.00 Residential/Commercial Adjustments UPS WoridShin Shipped PickulY Recorded Billed Adjustment Date Record Entry Tracking Number ColTacted Charge Amount 09/t3 9121173530 1 lZ0266390340913601 Residential -9.54 Residential Sumharge -2,55 Commercial 9.54 Delivery Ama Surcharge -0.75 Fuel Surcharge -0.23 -3.53 1st ret: Paul Vartanian FINY 06390 2nd ref: 631 788 7770 Total UPS WorldShip 1 Package(s) -3.53 Total Residential/Commercial Adjustments 1 Package(s) -3.53 Total Adjustments & Other Charges -1.53 Fees WeekEnding Unpaid Billed Date Balance Rate Charge 08/18 Late Payment Fee 512.51 6.00 % 30.75 Pursuant to the UPS Tariff, a late payment fee has been assessed. Total Fees 30.75 Invoice Messagin~l Code Message r Dimensional weight applied 076851 2/2 Shipped from: FISHERS ISLAND FERRY I STATE ST NEW LONDON, CT 06320 Delivery Service Invoice Invoice date September 22, 2012 Invoice number 0000026639382 Shipper number 026639 Control ID 08S8 Page 1 of 3 0720A00000266392 77366400011419 FP 01 071078 41067[228 A**3DGT iHH,IhMl,',,lidli,llllll,l,ll~ll~ll,lid'lhhllhlhl FZSHER ISLAND FERRY PO BOX 607 FISHERS ISLAND, NY 06590 Account Status Summary Weekly Payment Plan Amount Due 1~i8 Period $ 206.82 Amount Outstanding (prior invoices) $1,293.15 Total Amount Outstanding $1,499.97 Please include the Return Portion of each outstanding invoice with your payment. See Account Status for details. Questions about your charges? To get a better understanding of the charges on your invoice, visit our invoice guide and glossary of billing charges at upe.con~invoiceguide. ISign up for electronic billing todayl Visit upe.com/billing For questions about your invoice, call: (800) 811-1648 Monday - Friday 8:00 a.m. - 9:00 p.m.E.T. or write: P.O. Box 7247-O244 Philadelphia, PA 19170-0001 Thank you for using UPS. Summary of Charges Page Charge Outbound 3 UPS WoddShip $136.13 3 Adjustments & Other Charges $16.60 3 Fees $ 44~09 Service Charges $10.00 Amount due this period $ 206.82 UPS payment terms require payment of this invoice by October 3, 2012. Payments not received by October 17, 2012 are subject to a late fee of 6% of the Amount Due This Period. (Details in UPS Tariff, available at ups, corn) Nots: This invoice may oonteln · fuel surcharge as described at ups. com. The published fuel surcharge is 7.0% for UPS Ground Services and 11.5% for UPS Air Services, UPS 3 Day Select, end International services. For more information, visit ups.com. Delivery Service Invoice Invoice date September 22, 2012 Invoice number 0000026639382 Shipper number 026639 Page 2 of 3 Account Status Weekly Payment Plan Payments Applied Amount Invoice Number Invoice Date Paid 0000026639332 08/18/2012 $ 512.51 Account Status Weekly Payment Plan Amount Outstandin~l (prior invoices): please include the Return Portion of each outstanding invoice with your payment. Balance Invoice Number Invoice Date Due 0000026639342 08/25/2012 $ 734.85 0000026639352 09/01/2012 $108.38 0000026639362 09/08/2012 $ 330.99 0000026639372 09/15/2012 $118.93 Total $1,293.15 Outstanding balances reflect any payments received as of 09/21/2012. Please ignore this message il a recent payment has been mede tar any outstanding invoices. Delivery Service Invoice Invoice date September 22, 2012 Invoice number 00000266;39382 Shipper number 026639 Page 3 of 3 Outbound ups WorldShip Pickup Pickup Number of Billed Date Record Message Codes Packages Charge 09/17 9121173552 2 32.7q 09/18 9121173563 I 18.75 09/20 9121173574 1 20~33 09/21 9121173585 4 64.24 Total UPS WorldShip 8 Package{e) 136.13 Total Outbound 8 Package(e) 136.13 Adjustments & Other Charges Undeliverable Returns Retum Pickup ZIP Billed Date Record Entry Tracking Number Service Code Zone Weight Charge 09/18 9121173541 1 1Z0266390342683017 Ground Undeliverable 06320 8 15 1620 Return Fuel Sumharge 1.13 Total 17.33 Reason for Return: Receiver did not want 1si ret: Mason Hum 30 Amherst Court 2nd ret: Mystic Conn. 06355 Returned From: Returned To: FISHERS ISLAND FERRY 1427 LOVE WAY 1 STATE ST AUBURN CA 95603 NEW LONDON CT 06320 Total Undeliverable Returns 1 Package(a) 17.33 ~-. Miscellaneous '" Explanation Cha~ge WEEKLY PRINTER SERVICE FEE 2~00 FOR 1 PRINTERS AT $2.00 EACH FOR 21 -SEP-2012 Total Miscellaneous 2.00 Residential/Commercial Adjustments UPS WorldShip Shipped Pickup Recorded Billed Adjustment Date Record Entry Tracking Number Corrected Charge Amount 09/21 9121173585 1 1Z0266390341979870 Residential -8.52 Residential Surcharge -2.55 Commercial 8,52 Fuel Surcharge ~18 -2.73 let ret: The Beach Plum FINY 06390 2nd ret: 631 788 7731 Total UPS WorldShip 1 Package(s) -2.73 Total Residential/Commercial Adjustments 1 Package(s) -2.73 Total Adjustments & Other Charges 16.60 Fees WeekEnding Unpaid Billed Date Balance Rate Charge 08/25 Late Payment Fee 734.85 6.00 % 44.09 Pursuant to the UPS Tariff, a late payment fee has been assessed. Total Fees 44.09 071078 2/2 Shipped from: FISHERS ISLAND FERRY 1 STATE ST NEW LONDON, CT 06320 Delivery Service Invoice Invoice date September 29, 2012 Invoice number 0000026639392 Shipper number 026639 Control ID N593 Page 1 of 4 0720A00000266392 77366500011118 FP 01 068879 45191[221A**3DGT FISHER ISLAND FERRY PO BOX 407 FISHERS ISLAND, NY o~$go 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: UPS P.O. Box 7247-0244 Philadelphia, PA 19170-0001 Account Status Summary Weekly Payment Plan Amount Due ~tis Period $194.68 Amount Outstanding (prior invoices) $1,499.97 Total Amount Outstanding $1,694.65 Please include the Relurn Portion of each outstanding invoice with your payment. See Account Status for detalia. Questions about your charoes? To get a better understanding of the charges on your invoice, visit our invoice guide and glossary of billing charges at ups.corn/invoiceguide. Thank you for using UPS. Summary of Charges Page Charge Outbound 3 UPS WoHdShip $150.18 3 Adjustments & Other Charges $ 28.00 4 Fees $ 6.50 Service Charges $10.00 Amount due this period $194.68 UPS payment terms require payment of this invoice by October 10, 2012. Payments not received by Octobe~ 24, 2012 are subject to a late fee of 6% of the Amount Due This Period. (Details in UPS Tariff, available at ups.cem) Note: This invoice may contain a fuel surcharge as desctfbed at ups.com. The pubtished fuet surcharge is 7.0% for UPS Ground Services and 11.5% for UPS Air Services, UPS 3 Day Select, and International services. For more information, visit ups. com. m Delivery Service Invoice Invoice date September 29, 2012 invoice number 0000026639392 Shipper number 026639 Page 2of4 Account Status Weekly Payment Plan Amount Outstandin¢J (prior invoices): Please include the Return Portion of each outstanding invoice with your payment. Balance Invoice Numbe~ Invoice Date Due 0000026639342 08/25/2012 $ 734.85 0000026639352 09/01/2012 $108.38 0000026639362 09~)8/2012 $ 330.99 0000026639372 09/15/2012 $118.93 0000026639382 09/22/2012 $ 206.82 Told $1,499.97 Outstanding balances reflect any payments received as of 09/28/2012. Please ignore this message il a recent payment has been made for any outstanding invoices. Delivery Service Invoice Invoice date September 29, 2012 Invoice number 0000026639392 Shipper number 026639 Page 3 of 4 Outbound UPS WoridShip Number of Bill~,l Pickup Pickup Charge Date Record Message Codes Packages 09/24 9121173596 1 19.10 9121173600 2 55.4 I 09/25 9121173611 1 24.13 09/26 9121173622 2 20.43 09/27 9121173633 2 31.11 Total UPS WoridShip 8 Packa~e(e) 150.18 Total Outbound 8 package(s) 150.18 Adjustments & Other Charges Miscellaneous Billed Explanation Charge WEEKLY PRINTER SERVICE FEE 2.0u FOR 1 PRtNTERS AT $2.00 EACH FOR 28-SEP-2012 2.00 Total Miscellaneous Residential/Commercial Adjustments UPS WorldShi~) Billed Adjustme,,[ Shipped Pickup Recorded Date Record Entry Tracking Number Corrected Charge Amount 09/24 9121173600 I 1Z0266390341244921 Commercial -12.05 Residential 12.05 Residential Sumharge 2.55 Delivery Area Sumharge - Extended 1.25 Fuel Surcharge 0.27 4.07 1st ref: TW Cashel FINY 06390 2nd tel: 631 788 7419 2 1Z0266390342659133 Commemial -28.26 Residential 28.26 Residential Surcharge 2.55 Delivery Area Surcharge - Extended 1.25 Fuel Sumharge 0.27 4.07 1st ref: TW Ceshel FINY 06390 2nd ref: SAME 09/27 9121173633 2 1Z0266390342416181 Commercial -11.59 Residential 11.59 Residential Surcharge 2.55 Fuel Surcharge O. 18 2.73 15t ref: Roberta Elwell FINY 06390 Total UPS WorldShip 3 Package(e) 10.8/ Total Residential/Commercial Adjustments 3 Package(e) 10.87 Delivery Service Invoice Invoice date September 29, 2012 Invoice number 0000026639392 Shipper number 026639 Page 4 of 4 Adjustments & Other Charges Shipping Charge Corrections Learn how to avoid future shipping charge correcbens. Visit www.ups.comJavoidcharges. Pickup Tracking Original Service/ ZiP Date Number Corrected Service Code Zone Weight Billed Adjuslment Charge Amount 2nd ref: SAME Receiver: T. w. Cashel LAKE WALES FL 33898 09/24 1Z0266390342659133 Ground 33898 6 42 28.26 Ground 33898 6 58.8 34.46 Dimensions = 31 x 21 x 15 in Additional Handling - Not encased in cardboard 8.50 Fuel Sumharge 0.43 15.13 1st ref: TW Cashel FINY 06390 Sender : FISHERS ISLAND FERRY NEW LONDON CT 06320 Total Shipping Charge Corrections 1 P=~,,.~.e(s) 15.1R Total Adjustments & Other Charges 28.00 Fees WeekEnding Unpaid Billed Date Balance Rate Charge 09/01 Late Payment Fee 108.38 6.00 % 6.50 Pursuant to the UPS Tariff, a late payment fee has been assessed. Total Fees 6.50 FISHERS ISLAND FERRY DISTRICT VENDOR 024539 W.B. MASON CO.INC 10/09/2012 CHECK 777 FUND & ACCOUNT P.O.~ INVOICE DESCRIPTION AMOUNT SM .5711.4.000.000 I07313968 OFFICE SUPPLIES-NL 39.34 TOT3~L 39.34 &8 OD ;,SD 8 Vendor No. Check No. Town of Southold, New York - Payment Voucher 24539 Vendor Tax ID Number or Social Security Number PO Box 981101 W.B. Mason Boston, MA 02298-1101 Vendor Telephone Number 888-WB-Mason Vendor Contact Entered b~ Audit Date OCT 0 9 2012 Town Clerk Invoice Invoice Net Purchase Order Number Date Amount Claimed Number Description of Goeds or Services General Ledger Fund and Account Number Total Discount $39.34 $39.34 $39.34 Office Supplles-NL 107313968 91t 8/201 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 Town is exempt are excluded Company Name Date $39.34 Department Certification SM8711.4.000.000 I hereby certify that the materials above specified have be~n 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 Title . W.B. MASON CO., INC. 59 Centre St - Brocldon, MA 02301 Address Service Requested 888-WB-MASON www.wbmason.com *1RO31117 i*H0***********ALL*FOR*AADC* 0 6 0 FISHERS ISLAND FERRY DISTRICT PO BOX H FISHERS ISLAND, NY 06390-0607 (Page 1) PM Delivery Address Invoice Number: 107313968 Fishers Island Ferry Distdct 5 Waterfront Park New London, CT 06320 Customer Number: C2024302 Reference Number: 107313968 Invoice Date: 09/18/2012 Due Date: 10/18/2012 Order Date: 09/17/2012 Order Number: S007418277 Order Method: PHONE W.B. Mason Federal ID #: 04-2455641 Important Messsages J.Solomon Incorporated and W.B. Mason have joined forces!! The new J.Solomon Incorporated/W.B. Mason team looks forward to continuing to provide the outstanding products and service you have become accustomed to over the years with J.Solomon Incorporated. All future payments should be sent to the remittance address noted above. ITEM NUMBER DESCRIPTION WBM21200 PAPER,XERO/DU P,WE,LTR,20# QTY ORDERED QTY UCTRa I 36.99 UNIT PRICE EXT PRICE SHIPPED 1 36.99 SUBTOTAL: 36.99 TAX & DEPOSITS TOTAL: 2.35 ORDER TOTAL: 39.34 To ensure proper credit, please detach and return below por~ion with your payment How to Reach W.B. Mason Customer Service · By Phone: 1-888-WB-Mason · For inquires by mail: PO Box 111 Brockton MA 02303-0111 · For payments by check: PO Box 981101 Boston MA 02298-1101 HOW TO READ YOUR INVOICE Customer Number - Your account number. It will be helpful to reference this number when calling customer service or in any other correspondence. Terms - Invoice must be paid within the terms period before becoming past due. Amount Enclosed - Please indicate the payment amount included with your remittance. Important Messages - Special notes from W,B. Mason about your account. Invoice Detail - Information pertaining to your order. Invoice Date - Date your invoice was printed. Total Due - Amount of this order to be remitted for payment. Remittance Address - Send your payment to this address with your remittance slip for proper credit to your account, wbm-103717 Packing Slip W.B. Mason PO Box 111 59 CENTRE ST BROCKTON, MA 02303 1-888-WBMASON www.wbmason.com Page: 5 Route ........ : 00140 Warehouse: ..... : NLO-CT Packing Slip~ ...: 07237036ARPACK Customer # ..... : C2024302 Sales Rep ....... : Russell Sheikowitz Bill To: FISHERS ISLAND FERRY DISTRICT P O BOX H Fishers Isle, NY 06390 ,Special Instructions: Ship To: Fishers Island Ferry District 5 Waterfront Park New London, CT 06320 Ship Date 9/18/2012 P.O. Number Sales Order # S007418277 Delivery Instructions: ITEM NUMBER Qty Order Qty Ship WBM21200 1 1 Bk Ord U/M Descrip!ion CT PAPER,XERO/DU P,WE,LTR,20# Facility NLO-CT FISHERS ISLAND FERRY DISTRICT VENDOR .02520 WADSWORTH ATHENEUM MUSEUM OF 10/09/2012 CHECK 778 FUND & ACCOUNT P.O.# INVOICE DESCRIPTION AMOUNT SM .1765.00 091812 REIM,OVER PYMT CH;kRTER 839.00 TOTAL 839.00 O0 ;, SO ~ Town of Southold, New York - Payment Voucher Vendor Tax ID Number or Social Security Number 06-0653111 Vendor Address 800 Main Street V~dorS~e Hartford, CT 06103 Wadsworth Atheneum Museum of Art Vendor Telephone Number 860-838-4096 Vendor Contact Hila~ A. Burral, Membership Manager Number Invoice Date 9118/2012 Invoice Total $839.00 $83g.00 Discount Payee Certification Tiae undersigned (Claimant) (Acting on behalf of the above named claimant) does hereby ce~ify 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. N~ ~mhase Order Amount Claimee Number $839.00 $839.00 Company Name ~/d Vendor No. Check No. Entered by Audit Date ~)- 0¢1 0 9 2012 Description of Goods or Services overpaid on a charter On 9/18112 this should be lut to the charter income account General Ledger Fund and Account Number SMt76~. o~ 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 bsve been verified with the exceptions or discrepancies noted, and payment is approved. Signature ~'~ Title ,/~L..~ Date 05/0§/2010 00:16 8604436851 FI-NL OFFICE PAGE 81/83 Fishers Island Ferry District Transaction Confirmation Transaction ID: 272093 Customer Info: Date: 9/18/2012 3:46:02 WADSWORTH ANTHENEUM Trans Price: $1,100.00 Trans Discount: $0.00 Trans Total: $1,100.00 Travel DetlNTime: 9/19/2012 9:30:00 AM Oligin: NL De~Unatlon: Ticket I Seq Description 641281 1 Truck(s)- Chader Price $1,100, Failure of automobile to be at dockside 25 minutes before scheduled sailing time will result in forfeiture of reservation. Residents must show proof of residence at Ticket terminal and boat ramp or reservation and payment will be FORFEITED. See www.fiter~.com for full Ter~s and Conditions of travel. $1,100. O0 M H SGount $0.00 S0,00 85/85/2810 89:16 860~36851 FI-NL OFFIOE PAGE 82/83 Fishers Island Ferry District Transaction Confirmation Transaction ID: 272094 Customer Info: Date; 9/18/2012 3:46:49 I WADSWORTH ANTHENEUM Trans P~ice: $117.00 Trans Di~ount: $0.00 Trans Total: $117.00 Travel Date/Time: 9119/2012 7:00:00 AM Tlck~ 1 8eq Description Origin: NL De~tinMIon: I Price D 641282 1 Aclult Round Trip $19.00 641283 1 Adu~ RoundTrip $19.00 641284 1 Adult Round Tdp $19.00 641285 I A~u~ Round Trip $19.00 641286 1 Auto Round Trip Failure of automobile to be at clocl(side 25 minutes before schecluled sailing time will result in forfeiture of reservation. Residents must show proof of residence at Ticket terminal and boat ramp or reservation and payment will be FORFEITED. See www,fifarty.com for full Terms and ConditmOns of travel. $38.00 $t14.~0 M ;CouRt $0.00 $0.00 ~.00 $0.00 85/85/2818 89:16 868~d36851 FI-NL OFFICE PAGE 83/83 Fishers Island Ferry District Transaction Confirmation Transaction ID: 272094 Trane Price: Trans Discount: Trane Total: Travel Date/Time: Cuetomerlnfo: $117.00 $0.00 $117.00 9/19/2012 7:00:00 PM Ticket I ~eq Description 641286 2 Au~Round Trip Date: 9/18/2012 3:46:49 l WADSWORTH ANTHENEUM Origin: FI Failure of automobile to be at dockside 25 minutes before scheduled seiting time will result in forfeiture of reservation. Residents must show proof of residence at Ticket terminal and boat ramp er reservation and payment will be FORFEITED, See www.f'der~y.com for full Terms and Conditions of travel. Destination: Price $2.00 ~ount $0.00 $0.00 From:860 527 0803 09/20/2012 10:53 #873 P.001/002 Wadsworth Atheneum Museum OFFICE 600 OF INSTITUIONAL ADVANCEMENT MAIN STREET HARTFORD CT 06103 860-838-4095 (P) 860-527-0803 (F) FACSIMILE TRANSMITTAL SHEET TO: FROM: Debbie Hilxty B.rvall~ Membenhip Mamge. r F/shem Island Ferry District SEPTMEBER 20, 2012 631-788 5523 2 6M-788-7744 RE: Wadswmxh Atheneum 9/19 C~ Feny URGENT [] FOR REVIEW [] PLEASE COMMENT [--1 PLEASE REPLY [] PLEASE RECYCLE NOTE.q/COMMENTS: Debbiq Attached pleam find the W-9 ~r &e Wadsworth Atheneum- Please let me know ff you need mydaing d~ Thank yOU to the eatite Fishexs Island Fea'y team for maldng out eveat a success. You guys are so eaay to work with and make my job easter. THANK YOU! ! & A. Butrall Membership Wadsworth Atheneum (p) 860.838.409S (¢) hilary.bmxalll~wadswor th~th~eum- o~g WWW.WADSWORTHATHENEUM.ORG FISHERS ISLAND FERRY DISTRICT VENDOR 025182 ZURICH 10/09/2012 CHECK 779 FUND & ACCOUNT P.O.~ INVOICE DESCRIPTION AMOUNT SM .1910.4.000.300 4686248-9/12 WORKERS COMP-9/12 6,617.60 TOTAL 6,617.60 $~x TBOUSAI~D'~ ,'OOO??q,' ,:08~05~q,: ~;% O0 ~ 50 ~ ~,' Town of Southold, New York- Pa' Vendor Tax ID Number or Social Security Number 36-4233459 Vendor Name ZURICH NORTH AMERICA Vendor Telephone Number 800-332-6641 4686248 9/19/2012 $6,617.60 $6,617.60 ~ment Voucher Vendor Address PO BOX 4664 Vendor No. CAROL STREAM, IL 60197-4664 Net Purchase Order Amount Claimed Number $6,617.60 $6,617.60 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 ~ Compeny Name ~ Date 25182 Cheek No. Entered 2% Audit Date OCT 0 9 2012 To Q. Description of Goeds or Services Workem Compensation Insurance General Ledger 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 w~thout substitution, the services properly performed and that thc quantities thereof have been verified with the exceptions or discrepancies noted, and payment is approved. P.O. BOX 5387 Invoice Jacksonville, FL 32247-5387 Agency: ALL RISKS, LTD Account Name: FISHERS ISLAND FERRY DISTRICT Account Number: M020619054-001-00001 Invoice Date: 09-19-12 Due Date: 10-09-12 Durrent Balance: $6,617.60 Minimum Due: $20.00 Please see reverse side for other messages and important billing information. PAYOR NAME AND ADDRESS ZURICH FISHERS ISLAND FERRY DISTRICT PO BOX H FISHERS ISLAND NY 06390 ZURICH AMERICAN INSURANCE CO., AMERICAN ZURICH INS CO, AMERICAN GUARANTEE & I~ABILITY, STEADFAST INSURANCE, ZURICH AMERICAN OF )LLINO~S, MARYLAND CASUALTY COMPANY, NORTHERN INSURANCE COMPANY OF NEW YORK, ASSURANCE COMPANY OF AMER+CA, FIDELtTY AND DEPOSIT MARYLAND SUMMARY OF ACTIVITY SINCE YOUR LAST INVOICE POLICY EFFECTIVE ACTIVITY TRANSACTION MINIMUM NUMBER DATE AMOUNT DUE PREVZOUS STATEMENT BALANCE 18,500.00 09-19-12 PAYMENT - THANK YOU 9,902.40C LATE FEE 20.00 0.00 WC 4686248 08-01-12 WORKERS COMP 20.00 FUTURE SEMI-ANNUAL INSTALLMENTS Please note that changes to your policy coverage may change your installment schedule. ] Due Bate Premium Fee Amount Due Due Date Premium Fee Amount Due / I 02-01-13 8,597.60 6.00 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 1-803-332-$641. PLEASE SEND ANY WRITTEN CORRESPONDENCE ViA TOLL FREE FAX TO 1-866-301-0306. iNCLUDE YOUR ZURICH ACCOUNT 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 tssued after the date that coverage began, your first invoice for those policies may include more than one installment~ We reserve the right to withdraw payment by installments Jn 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, your 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 (2~J) 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 installment(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 ZURICH EZPAY AND PAY ON-LINE. XT'S EASY AND EFFXCZENT. SET UP YOUR RE-OCCURRiNG, AUTOMATIC PAYMENT TODAY. LOG ON TO OUR NEB SETE "ZURICHNA.[NETBILLER.COM". NEN PAYMENT OPTIONS ARE NON AVAILABLE. CALL 866-350-7599 TO HAKE AN ELECTRONIC CHECK PAYMENT BY PHONE. A CONVENEENCE FEE OF $1.95 WELL BE CHARGED FOR EACH ELECTRONIC CHECK PAYMENT. ALL OTHER PAYMENT OPTIONS REMAIN AVAILABLE AT NO COST. HON TO REPORT A WORKERS~ COMP CLAIM : TZMELY CLAZM REPORTING HELPS HANAGE YOUR LOSS COSTS . FOR YOUR CONVENIENCE, ZURICH PROVIDES ACCESS TO NORKERS' COMP CLAIMS REPORTING - 24 HOURS A DAY , SEVEN DAYS A WEEK . PHONE : t-800-987-3373 ; ONLZNE : WNW.ZURECHNA,COM AND CLICK ON THE CLAIMS TAB ; FAX : 1-877-962-2567 ; OR BY HAIL : P.O. BOX 49547 , COLORADO SPRINGS , CO 80949 .