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HomeMy WebLinkAboutAU-04/09/2013 Fishers IslandF1SItERS ISLAND FERRY DISTRICT VENDOR 001327 AIRGAS EAST, INC 04/09/2013 CHECK 1071 FUND & ACCOI/NT P.O.~ INVOICE DESCRIPTION AMOUNT SM .5710.4.000.000 9013616554 (2)PROPANE FORKLIFT FUEL 91.29 TOTAL 91.29 Vendor No. Town of Southold, New York - Payment Voucher 1397 Vendor Tax ID Number or Social Security Number Vendor Address P.O. Box 827049 Vendor Name Philadelphia, PA 19182-7049 Airgas East Vendor Telephone Number 860-444-3055 Vendor Contact Invoice Invoice Invoice Net Purchase Order Number Date Total Discount iAmount Claimed Number Description of Goods or Services 9013616554 3/1212013 $91.29 $91.29 Forklift Fuel(~)~ d/~t)~ ;heck No. 10'11 $91.29 Payee Certification $91.29 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 Entered by Audit Date APR 0 9 2013 Town Clerk General Ledger Fund and Account Number 8M5710.4.000.000 Department Certification I hereby certify that thc 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 due and owing, and that taxes from which the Town is exempt are excluded, Signature ~'~'~Title ~ Company Name ffP Date ,.~/ ~t~tot~_~ or discrepancies noted, and payment is approved. Signature ~%~ Title Date PLEASE RETURN THE UPPER PORTION WITH YOUR REMITTANCE. FOR QUESTIONS ON YOUR ACCOUNT PLEASE CALL: 216'642-t 500 8013982738 PR 33A PROPANE INDUS?RIAL 33A CGA 510 Hazmat Flat Rate 2 CL 2 2 41.27 CL (Vol: 64.000 LBS) Sale subtotal: 82.54 N 82.54 8.75 SHIP TO: 2576547 lirgas F,S. RS www. airgas.com FERRY DISTRICT PO BOX H Airgas USA, LLC FISHERS ISLAND NY 06390-0607 6055 Rockside Woods Blvd independence, OH 44131 sEL oo,oo0 Page 1 of 1 Airgas USA, LLC ACT. NO. 8606074318 PNC BANK, ABA NO. 031000053 Airgas SHIPPER: AIRGAS USA, LLC 131 CROSS RD WATERFORD, CT 06385-1204 SHIP "~0:2576547 FISHERS ISLAND FERRY DISTRICT PO BOX H FISHERS ISLAND, NY 06390-0607 US 63%788-7463 DELIVERY ORDER SOLD BY: AIRGAS,USA, LLC 130 CROSS RD WATERFORD, CT 06385-1204 800-962-0285 SOLD TO: 2576547 FISHERS ISLAND FERRY DISTRICT PO BOX H FISHERS ISLAND, NY 06390-0607 US FOR LOCATION NEAREST YOU VISIT WWW.AIRGAS.COM DELIVERY ORDER # 8013982738 PAGE I OF 1 ORDER DATE: 03/12/2013 SCH SHIP DATE: 03/12/2013 PRINTED: 10:01 03/12/2013 SALES ORDER: 1012491371 CUST PO # RELEASE # ORD BY ENT BY GARYDUBATO Order Type Payment Terms Acct Front NET 30 Counter Incoterm Customer Pick Up Route Sales Plant Sales Total Containers, Office Org Ship Return Customer P ck Up N329 N309 NO00 Oty UOM HM Description & Hazard Class Qty Containers Vol Shipped Type Order Ship Ret /Wt 2 : CL X UN1978PROPANE2.1 Line# 10 Materlal#PR33A Stor. Loc, F001 2 2 2 64 PROPANE 32LBS ALUMINUM LB EMERGENCY CONTACT: 1-866-734-3438 II PURCHASER AGREES TO OBTAIN MATERIAL SAFETY DATA SHEETS (MSD$) FROM ONE OF THE ~FOLLOWING SOURCES; POINT OF pURCHASE, AIRGAS WEB SITE AT 4J~[R GAS COI~* OR BY THIS IS TO CERTIFY THAT THE ABOVE NAMED MATERIALS ARE PROPERLY CLASSIFIED DESCRIBED I AIRGAS PERSONNEL DATE T,O,D* PLACARDSOFFERED ACCEPT REJECT CUSTOMER MUST INITIAL CHOICE SEE REVERSE SIDE FOR IMP(~R!Ai~I SAFETY ~N ,FO~ATION. PLEASE PRINT -- INTERNAL USE ONLY Delivery # 8013982738 TERMS AND CONDITIONS WARNING: TRANSPORT AND USE OF COMPRESSED GASES MAY BJr. EXTREMELY DANGEROUS. DO NOT TRANSPORT WITHOUT PROTECTIVE CAPS, IN CONFINED SPACES OR iN ANY OTHER IMPROPER MANNER. ALWAYS TRANSPORT CYLINDERS iN A SECURED UPRIGHT POSITION. BUYER ACKNOWLEDGES THAT IT HAS RECEIVED A SAFETY INSTRUCTION SHEET FROM SELLER, SAFE HANDLING OF COMPRESSED GASES. · EMERGENCYRESPONSEINFORMA~ON PRO~ANE HYDROGEN POTENTIAL HAZARDS AIR NITROUS OXIDE OXYGEN LIQUIDO~ pOTENTIAL HAZARDS ARGON NITROGEN HELIUM FISHERS ISLAND FERRY DISTRICT VENDOR 019500 AT&T 04/09/2013 CHECK 1072 FUND & ACCOUNT P.O. # INVOICE DESCRIPTION AMOUNT SM .5710.4.000.100 SM .5710.4.000.100 86044201650413 NL TERM TEL 3/15-4/14 86044201650413 FINANCE CHARGE 275.19 4.51 TOTAL 279.70 .'OO;O?D,' i:0~05[~'~t,.: 6fl 00~50~ ~.' Town of Southold, New York - Payment Voucher Vendor Tax ID Number or SociaI Securib Number Vendor Name AT&T Vendor Telephone Number 800-321-2000 Vendor Contact Vendor No. Vendor Address I AT&T P.O. Box 5082 Carol Stream, IL 60197- 19500 Check No. i 10'7 , Entered by Audit Date APR 0 9 7013 Town Clerk Invoice Invoice Invoice i ! Net Purchase Order Number Date Total Discount $276.19 General bedger Fund and Account Number Amount Claimed Number Description of Goods or Services 8604420165 3/15/2013 $275.191 NL Terminal Tel SM6710.4.000.100 311512013 $4.51 $4.51 $279.70 $279.70 Payee Certification The undersigned (Claimant) (Acting on behalf of the above named claimant) does hereby certify' that the Ibregoing claim is trac 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 thom which the Town is exempt are excluded 3/15-4114/13 Finance Charge SM5710.4.000.100 Department Certification [ hereby cerdi~ that the materials above specified have been received by Fac in good condition without substitufion thc services properly performed and that the quanfities thereof have been verified with the exceptions or discrepancies noted, and payment is approved at&t FISHERS ISLAND FERRY DISTRICT Page 1 gl ? PO BOX H Account Number 860 442 0165 028 FISHERS ISLE NY 0~390-0607 Billi.g Date Mar 16, 2013 Web Site att.com :, 'thiy otaternen Previous Bill 567.13 Payment Received 2-18 262.86CR Adjustments 4.51 Past Due - Please Pay Immediately 308.78 Current Charges 275.19 Total Amount Due $583.97 * Current Charges Due in Full by Apr 14, 2013 · Thank you for being an ALL DISTANCE® customer. Your ALL DISTANCE® savings includes: Promotions and Discounts 27 O0 Item No D~te DescripiLio!] Adjustments P~vments I 2-18 Payment 262.86 2. 3-15 Late Payment Charge 1,5% 451 Totals 4.51 262.86 Questions? Call: Plans and Services 1 800 32%2000 Repair: 1 800 246-8464 Internet Services: 1 877 722-3755 Total Current Charges Page 1 · PREVENT DISCONNECT · CARRIER INFO · KEEP YOUR DISCOUNT · SPEED CALLING 8 See "News You Can Use" for additional information 275.19 275.19 3 Save Elite® Conn-$27 off 12moterm 27.00CR Monthly Sewice - Mar 15 thru Apr 14 Charges for 860 442-0165 4. Monthly Charges Charges for 860 443-6851 5. MontMy Charges Charges for 860 444-0320 6 MomMy Charges Charges for 860 447-9371 7. Monthly Charges Total Monthly Service 122.60 2835 2835 28.35 207.65 Call Charges Bus Block of Time 700 II 2Y Summary 978 Minutes Used 700 Minutes Allowed Instate Long Distance 4,99 Out of State Long Distance 6.98 Call Plan Summary Total 11.97 8. Bus Block of Time 700 II 2'/ Charges for 866 442-0165 Item No. Date Time Place Number Cod~e Mien Itemized Calls 9. 2-15 218A EISHERSIS NY 631788-5550 2 1:03+ 3000 *BASIC $15352 NON BASIC S430 45 Return bottom portion with your check in the enclosed envelope. Local Services provided by AT&T Connecticut. Services beyond Connecticut provided by AT&T Long Distance East. GO GREEN - Enroll in papedess billing. R at&t FISHERS ISLAND FERRY DISTRICT PO BOX D FISHERS ISLE NY 06390 0607 Page Account Number Billing Oate Web Site 2of7 860 442-oi65 078 Mar 15, 2013 att.com Call Charges - Continued No. ~ Time Place 1. 2-15 720A FISHERSIS 2. 2-15 725A FISHERSIS 3. 2-15 728A FISHERSIS 4. 2-15 728A FISHERSIS 5. 2-15 731A FISHERSIS 6, 2-15 94OA NEWHAVEN 7, 2-15 951A FISHERSIS 8. 2-18 952A FISHERSIS 9. 2-15 953A FISHERSIS 10. 2-15 958A HARTFORD I1. 2-15 1000A RSHERSIS 12, 2-15 1040A FISBERSIS 13. 2-15 1045A NEWYORK 14. 2-15 1128A WlLLIMNTIC 15. 2-15 1207P FISHERS IS 16. 2-15 134P FISHERSIS 17. 2-17 331P FISHERSIS 18. 2-17 414P FISHERSIS 19. 2-17 439P RSHERSIS 20. 2-17 439P FISHERSIS 21. 2-17 507P HAH]FORD 22. 2-18 732A FISHERS IS 23. 2-18 734A BRANEORD Number NY 631 788-5546 NY 631 788-5550 NY 631 788-5550 NY 631 788-5546 NY 631 788-7345 CT 203410-6997 NY 631 788-7744 NY 631 788-7463 NY 631 788-7345 CT 860916-3326 NY 631 788-1149 NY 631 788-7345 NY 917 532-1838 CT 860 428-4860 NY 631 788 7939 NY 631 788-7249 NY 631 788-5563 NY 631 788-5563 NY 631 788-5563 NY 631 788-5686 CT 860916-3326 NY 631 788-7345 CF 203 483-7772 24. 2-18 950A KILLINGWTH CT 860663-2759 25. 2-18 IO37A FISHERS IS NY 631 788-7463 26. 2-18 1131A FISHERSlS NY 631788-7345 27. 2-18 1214P FISHERS iS NY 631788-7463 28, 2-18 320P FISHERSIS NY 63~ 788-7463 29, 2-18 846P MORRISTOWN NJ 201602-2994 30, 2-~9 808A FISHERS IS NY 631 788-7345 31. 2-19 818A GUILFORD CT 203458-4128 32. 2-19 845A OLDSAYGRK CT 860227-2335 33, 2-19 856A SOUTHOLD NY 631 765 3140 34. 2-19 908A FISHERS iS NY 631 788-7528 35. 2-19 1012A FISHERS IS NY 631 788-7311 36. 2-~9 1023A BRIDGEPORT CT 203814-6087 37. 2-19 1039A FISHERS iS NY 631 788-7225 38. 2-19 1103A FISHERS IS NY 631 788-7463 39. 2-19 1104A FISHERS IS NY 631 788-7444 40. 2-19 1128A BRIDGEPORT CT 203814-6087 41. 2-19 1133A BRIDGEPORT CT 203614-6087 42, 2-19 1154A GUILFORD CT 203458-4128 43, 2-19 1249P FISHERS iS NY 631788-7345 44. 2-19 102P BRIDGEPORT CT 203814-6081 45. 2-19 122P FISHERSIS NY 631788-1632 46. 2-19 159P FISHERS IS NY 631788 7463 47. 2-19 305P FISHERSIS NY 63t788-7444 48. 2-19 342P HARTFORD CT 860289-0267 49. 2-19 419P HARTFORD CT 860289-0261 Code Min 0:33+ 1:16+ 0:30+ 1:32+ 0:31+ I:11+ 0:30+ 0:30+ 1:41+ 0:40+ 1:05+ 0:30+ 6:01+ 0:35+ 0:30+ 0:30+ 0:30+ 0:57+ 0:30+ 0:30+ 0:36+ 0:40+ 1:36+ 0:30+ 1:03+ 2:20+ 0:35+ 0:30+ 0:30+ 0:30+ 1:24+ 1:59+ 1:00+ 0:34+ 7:02+ 1:17+ 0:56+ 0:30+ 4:24+ 0:30+ 0:54+ 5:13+ 0:30+ 0:49+ 0:40+ 4:31+ 4:35+ 3:53+ 1:45+ Call Charges - Continued Item No. Date Time Place 50. 2 19 456P FISHERS IS 51. 2-19 459P FISHERSIS 52 2 19 601P FISHERSIS .00 53. 2-20 819A GUILFORD .00 54. 2-20 845A FISHERSIS .00 55. 2-20 918A COCOA .00 56. 2-20 941A FISHERS IS ,00 57. 2-20 1042A FISHERS IS .00 58. 2-20 212P FISHERSIS .00 59. 2-20 3lIP BAITNGHLLW .00 60, 2-20 439P FISHERS IS .00 61. 2-20 454P FISHERS IS .00 62. 2-20 456P GUILFORD .00 63. 2-20 605P FISHERS iS .00 64. 2-20 626P FISHERS IS .00 65. 2-21 830A OLD SAYBRK .00 66. 2 21 1027A DANBURY .00 67. 2 21 1037A FISHERS IS .00 68. 2 21 1039A BAITNGHLLW .0~ 69. 2-21 1124A GAITNGHLLW .00 70. 2-21 1126A FISHERS iS .00 71. 2-21 1127A FISHERSIS .00 72. 2-21 1128A BAITNGHLLW .Od 74. 2 21 132P FISHERS IS .00 75. 2-21 133P FISHERS IS .00 76. 2-21 310P FISHERS IS .00 77. 2-21 358P FISHERSIS .00 78. 2-22 752A FISHERS IS .00 79. 2-22 806A FISHERS IS ,00 80, 2-22 1126A FISHERS IS .C~ 81, 2-22 1134A OLD SAYBRK .0~ 82. 2-22 1188A FISHERS IS .00 83. 2-22 1244P FISHERS iS .00 84, 222 1249P SIMSBURY .00 85. 2 22 127P FISHERS IS ,00 86. 2 22 231P FISHERS IS .00 87. 2-22 234P FISHERS IS .0~ 88, 2-22 328P ROANOKE .00 89 2 23 212P FISHERS IS .00 90. 2-24 137P NATL DA .00 91. 2-24 138P NEWYORK .00 92. 2 25 747A FISHERS IS .00 93. 2 25 952A FISHERSIS .00 94. 2-25 1034A COCOA .0~ 95, 2-25 1210P ESSEX .00 96. 2 25 1211P ESSEX .00 97. 2-25 1236P KILLINGWTH .00 98. 2-25 1243P ESSEX ,00 99. 2-25 147P FISHERS IS .00 100. 2 25 149P RIVERHEAD .0O 101. 2-25 151P FISHERS IS 102. 2-25 258P FISHERS IS Number Cod~e NY 631 788 7463 NY 631 788-7463 NY 631 788-7463 CT 203 458-4128 D NY 631 788-7311 FL 321 482-3786 NY 631 188-7463 NY 631 788-5546 NY 631 188-7463 NY 631 830-1239 NY 631 788-7463 NY 631 788-7463 CT 203458-4128 DM NY 631 788-7463 NY 631 788-1487 CT 860227-2335 CT 203775 1268 NY 631 788-7001 NY 631 830-1239 NY 631 830-1239 NY 631 788-5570 NY 631 788-7226 NY 631 830-1239 NY 631 768-5563 NY 631 788-74~3 NY 631 788-5673 NY 631 788-7463 NY 631 788-7828 NY 631 188 7345 2M NY 631 788-7463 I NY 631 788-5673 1 CT 860 227-2335 D NY 631 788-5673 1 NY 631 788-7345 1 CT 860 653-5095 D NY 631 788-7463 1 NY 631 788-7345 1 NY 631 788-7463 1 VA 540520-6277 1 NY 631 788-5667 2 203 411 NY 212757-2000 2 NY 631 166-7919 2 NY 631 768-7528 1 FL 321 482-3786 1 CT 860662-3013 D CT 860662-3013 D CT 860 663-2759 D CT 860 662-3013 D NY 631 788-7345 1 NY 631 655-2772 1 NY 631 788-7345 1 NY 631 188-7463 I 0:30+ .0~ 0:30+ .00 0:30+ .0~ 2:46+ .0~ 2:21+ .00 1:29+ 0:45+ .0~ 0:30+ ,0~ 0:30+ ,00 0:30+ .00 1:26+ .00 1:56+ .00 5:36+ .00 0:30+ 0:30+ .0~ 0:43+ .00 0:30+ .00 0:49+ .00 O:31+ .00 0:30+ ,00 0:30+ ,00 0:30+ ,00 0:45+ 5:48+ 0:30+ .00 0:35+ .00 0:30+ .00 0:30+ .00 3:14+ .00 2:14+ .00 2:35+ .00 0:30+ .00 1:07+ .00 3:08+ 1:08+ O0 0:30+ .00 1:45+ .00 1:09+ .00 0:30+ .00 0:30+ .00 1 99 9:08+ .00 2:11+ .00 2:30+ .00 3:02+ .00 0:30+ .00 0:30+ 0:30+ .00 0:30+ 1:27+ 1:13+ .00 6:08+ .00 11:25+ .00 2006 AT&T Knowledge Ventures. A9 rights reserved. 7292.007.070128.01.04.0000000 NNNNNNNY 39323.140383 at&t FISHERS ISLAND FERRY DISTRICT PO B OX H FISHERS iSLE NY 06390 0607 Page 3 of 7 Account Number 860442 0165078 Billing Date Mar 16, 2013 Call Charqas - Continued No Bate Time Place Number I 2-25 4OeP NEWHAVEN CT 203710-4410 2. 2-26 937A FISHERS IS NY 631788-2444 3. 2-26 1007A WATERBURY CT 203437-1330 4. 2 26 1127A OLD SAYBRK CT 860399-5266 5. 2-26 114DA OLO SAYBRK CT 860399-5266 6. 2-26 1142A NEWRAVEN CT 203640-6458 7 2-26 1153A RUTLAND VT 802236-4091 8 2 26 336P ALLENTOWN NJ 609 259 8900 9 226 338P BATONROUGE LA 2257068462 10 2 27 922A FISHERS IS NY 631788-7345 II. 2-27 1151A CLAREMONT NH 603543-3669 12. 2-27 1247P ALLENTOWN NJ 609259-89(30 13 2 27 1262P FISHERS IS NY 631 788 7345 14 2-27 1254P ALLENTOWN NJ 609250-8900 15 2-27 135P NEWMILEORD CT 8~03','~-9449 16 2 27 224P BRENTWOOD NY 631 278-5688 17 2 27 343P FISHERSIS NY 631788-7463 18. 2-28 824A SEATTLE WA206390-1965 19 2 28 835A SEARSPORT ME 207548-6302 20 2-28 ~4~A i;U~GHKEP3i NY ~45656q677 21 2 28 846A FISHERS IS 22 2 28 905A HARTFORD 23 2-28 940A ROANOKE 24 2-28 943A TIVERTON 25 2-28 1039A FISHERS1S 26 2 28 1111A SEARSPORT 21 2-28 1210P SEARSPORT 28 2-28 1210P SEARSPORT NY 631 188-7433 CT 860 436 3700 VA 540 620 6277 RI 401 816-5400 NY 631 788-7463 ME 207 548-6302 ME 207 548 O482 ME 207 548-6302 29 2 28 302P SOUTHINGTN CT 860919-335{ 30 2 28 311P SOUTHINGTN CT 860919-335{ 31. 2 28 332P HAMILTON 32. 2-28 342P OSTERViLLE 33. 2-28 345P OSTERVILLE 34. 301 648A FISHERSIS 35 3-01 738A FISHERS IS 36 3-01 750A FISHERSIS 37. 3-01 816A FISHERS IS 38 3-01 823A FISHERSIS 39 3 01 830A WILUMNTIC 40 3-01 838A FISHERS iS 41. 3-01 839A FISHERSI$ 42 301 859A FISRERSIS 43 3-01 920A FISHERS IS 44. 3-01 943A FISHERS IS 45. 3-01 1020A FISHERS IS 46. 3-01 1106A FISHERSlS 47. 301 1130A FISHERSIS 48. 3 01 133P FISHERSIS 49. 3-01 207P FISHERS IS OH 513 863-3300 MA 774 238-0411 MA 774 238-0411 NY 631 78~-7889 NY 631 788-7889 NY 631 788-7345 NY 631 788-5550 NY 631 788-7345 CT 860 428-4860 NY 631 788-7889 NY 631 788 7345 NY 631 188-1899 NY 631 788-7345 NY 631 788-1899 NY 631 788-5673 NY 631 788-7345 NY 631 788-7345 NY 631 788-7857 NY 631 788-5673 Call Charges - Continued Item ~ 0at~ T~im~ Plate 50. 3-01 219P FISHERS IS 51. 3-01 323P FISHERS IS ~ 52 3-02 909A REDFIELD 3:55+ .00 53. 3 03 258P FISHERSIS 0:45+ O0 54. 3-03 337P FISHERS IS 1:43+ .00 55. 3-04 917A MOODUS 3:22+ 00 56 3-04 1013A FISHERS IS 0:30+ .00 57. 3 04 1018A GUILFORD 6:29+ .00 58. 3 04 1137A FISHERS IS 2:17+ 00 59. 3-04 1140A WILUMNTIC 1:28+ .00 60. 3-04 1142A FISHERS IS 0:46+ 00 61. 3-04 1222P HARTFORD 1:17+ OO 62. 3-04 1231P HARTFORD 0:30+ .0O 63. 304 113P FISHERSIS 1:25+ 0O 64. 3 04 126P HARTFORD 0:45+ .0O 65. 3-04 158P ESSEX 1:28+ .OD 66. 3-04 200P FISHERS IS 0:37+ .00 67. 3-04 204P FISHERS IS 0:30+ 00 68. 3-04 235P OLD SAYBRK 5:43+ .00 69. 3-04 239P FISHERS IS 3:10+ .00 lO. 3-04 241P FISHERS IS 3:50+ .00 71. 3-04 302P OLD SAYBRK 0.30, 00 72 3-04 3¢~3P O[OSAYBRK 0:30+ 00 73. 3 04 330P PTCHARLOTT 8:19+ .OO 74. 3-04 406P DANBURY 1:40+ .OD 75. 3-05 812A OLD SAYBRK 3:42+ .00 76. 3-05 959A FISHERS IS 0:30+ .00 77. 3-05 1114A TAMPACEN 4:24+ .00 78, 3 06 1116A HARTFORD 0:30+ .00 79. 3-05 135P HARTFORD 5:47+ .00 80. 3-05 141P COLCHESTER 0:45+ .00 81. 3 05 20~P FISHERSIS 0:30+ .00 82, 3 05 248P FISHERSIS 4:12+ .00 83. 3 05 257P WESTMINSTR 2:03+ 00 84 3-05 301P FISHERSIS 1:30+ 00 85 3 05 322P FISHERS IS 0:30+ (JO 86, 3 05 353P FISHERS iS 0:36+ 0O 87. 3-06 737A NEW HAVEN 3:12+ .00 88. 3-06 938A MILFORD 1:58+ 0(1 89. 3-06 944A FISHERS IS 1:22+ .00 90. 3 06 946A MILFORD 0:42+ 00 91. 3-06 95OA HARTFORD 0:30+ .00 92. 3-06 1123A FISHERS IS 9:13+ .00 93. 3 06 1130A FISHERS IS 0:58+ .OD 94. 3-06 1146A DANBURY 0:34~ .00 95. 3-06 1159A FISHERS IS 1:46+ O0 96. 3-06 1201P JEWETTCITY 1:56+ .00 97. 3-06 1231P FISHERS IS 3:31+ .00 98. 3-06 1231P FISHERS IS 0:53+ .00 99. 3-06 351P WATERBURY 1:09+ .00 100 3-06 357P HARTFORD 2:37+ (10 101. 3-07 725A JEWETTCITY 102. 3-07 732A FISHERS IS Number Cod~e NY 631 788-5673 1 1:36+ .00 NY 631 788-7345 I 3:18+ .00 SD 605 475 5950 2 107:37+ .00 NY 631 788-5682 2 0:30+ 00 NY 631 788-5682 2 0:30+ CT 860 873-8687 D 1:41+ 0O NY 631 788-7919 1 0:36+ 00 CT 203 458-4128 D 0:40+ 00 NY 631 788-7444 1 1:49+ CT 860933-3149 D 1:38+ NY 631 788-7463 1 0:30+ ,00 CT 860 289-0267 D 0:54+ .00 CT 860 289-0267 D 2:03+ .00 NY 631 788-7463 1 0:30+ .00 CT 860 9~6-7634 D 7:02+ .00 CT 860761-1768 D 0:30+ .00 NY 631 788-5563 1 0:55+ .00 NY 631 788-7460 I 2:15+ CT 860 227-2335 D 0:30+ .00 NY 631 788-7444 I 1:07+ .00 NY 631 788-7444 1 0:56+ .00 CT 860227-2335 D 1:16+ 00 CT 880 227-2335 O 0:30+ FL 941 979-7607 1 1:06+ .00 CT 203775-t268 D 3:56+ .00 CT 860 227-2335 D 0:37+ .00 NY 631 788-6550 1 1:06+ 00 FL 813288-8006 1 2:18+ .00 CT 860 282 1818 D 4:00+ .00 CT 860 250-3449 D 0:49+ CT 1~60531-1560 D 0:45+ .00 NY 631 788-5673 I 0:58+ .00 NY 631 788-7463 I 0:32+ .00 CA 714893 243~ 1 1:53+ .00 NY 631 788-7463 1 1:23+ .00 NY 631 788 7225 I 2:43+ .00 NY 631 788-5675 I 0:30+ .00 CT 2039150020 N 2:39+ CT 203876-8606 D 5:18+ .00 NY 631 788-7345 1 1:46+ CT 203 876-8606 O 0:30+ 00 CT 860 9~6-7634 D 7:40+ .60 NY 631 788-7463 1 5:15+ .00 NY 631 788-7463 I 0:35+ .00 CT 203 775-1268 D 2:11+ 00 NY 631 788-5563 1 0:30+ .00 CT 860 376 7640 D 1:45+ .00 NY 631 788-5550 I 0:30+ O0 NY 631 788-5563 I 0:30+ .00 CT 203 528 326e D 0:30+ O0 CT 860 528-3~60 O 0:42+ .00 CT 860376-7640 N 1:25+ .00 NY 631 788 7244 2 0:30+ OO FISHERS ISLAND FERRY DISTRICT Page 4 of 7 PO BOX H Account Number 860 442 0165 078 ~ FISHERS ISLE NY 06390 0607 Billing Date Mar 15, 2013 at&t Call Charges - Continued No. Date Time Place I. 3 07 734A FISHERS IS 2 3-07 736A JEWETTC~TY 3 3-07 737A FISHERS IS 4. 3 07 744A FISHERS IS 5. 3 07 932A FISHERS IS 6 3-07 948A FISHERS IS NY 631 788 7429 CT 860 376-7640 NY 631 788-5546 NY 631 788 7463 NY 631 788 7919 NY 631 768-7919 7 3-07 10~6A FARMINGTON CT 860777-5350 8 3 07 1008A OLD SAYBRK CT 860 227 2335 9 3-07 1041A FISHERS IS NY 631 708-7345 10. 3 07 1210P OLD SA¥BRK CT 860 221 2335 II. 307 123P HARTFORD CT 8604363700 12. 3 07 312P PROVIDENCE RI 40[ 463 8300 13. 3 08 849A FISHERS IS NY 631 788 5546 14. 3 08 1034A POUGHKEPSI NY 845656 1677 15. 3 08 1112A FISHERS IS NY 631 788-7463 16. 3-08 108P JEWETTCITY CT 860376-7640 17. 308 207P NEWHAVEN CT 2039150020 18. 308 209P WlLLIMNTIC CT 860371-3286 19 3 06 210P NEW HAVEN 20. 3 08 355P FISHERS IS 21 3-00 358P BRIDGEPORT 22. 311 731A FISHERSIS 23 3 II 752A LINDENHST 24 3-11 807A LINDENHST 25. 3 II 828A LINOENHST 26. 3 11 849A FISHERS IS 27 3-11 950A SPfllNGFLD 28. 3-11 1037A LINDENHST 29 3 11 1047A CAMBRIDGE 30 3 II 1052A FISHERSIS 31 3-11 1057A FISHERS IS 32 3-11 1111A FISHERSIS 33 3 11 1118A FISHERSIS 34 3 11 1150A FISHERSIS 35. 3-11 1247P FISHFRSIS 36. 3-11 1248P FISHERS IS 37. 3 11 242P FISHERS IS 38 3-11 257P F[SHERSIS 39. 311 3OIP FISHI'RSIS 40. 3-11 334P FISHERSIS CT 203915-0020 NY 631 788-7292 CT 203 161 0097 NY 631 788-5673 NY 631 225-3060 NY 631 225 3060 NY 631 225 3060 NY 631 788-7463 MA 413 355-0200 NY 631 225 3060 MA 617 2OI 4375 NY 631 188 7345 NY 631 788 5550 NY 631 788-7345 NY 631 788-7857 NY 631 788-7857 NY 631 788 7343 NY 631 788-7857 NY 631 708-7919 NY 631 788 7345 NY 631 788-7463 NY 631 788 7345 41, 3-12 921A MANCHESTER VT 8026888099 42 3-12 926A FAflMINBTON CT 8607775350 43. 3-12 931A FISHERS IS NY 631 788 7224 44 3-12 103lA FARMINGTON CT 860777 5350 45. 3-12 1034A FISHERS IS NY 631 788 7345 46, 3-12 1040A MANCHESTER VT 802 688 8099 47. 3-12 1202P FAIRFIELD CT 2032549~30 48 3 12 1204P MANCHESTER VT 802680-8099 49, 3 12 102P FISHERS IS NY 631 788-7463 2 N 2 2 I I D D I D D Mien 0:30+ .30 0:30+ .30 0:30+ 1:01+ .00 0:40+ .30 1:00+ .30 0:40+ .(NJ 1:28+ .00 0:30+ .30 2:30+ 30 3:14+ .(30 3:49+ 1:53+ .00 4:30+ .00 5:47+ .00 0:33+ .30 0:58+ 0;52+ ,30 0:46+ ,00 1:57+ .30 0:30+ 1:21+ .30 0:42+ ,30 0:30+ .30 0:30+ .CO 4:45+ 30 5:45+ .30 1:09+ .30 2:35+ .30 0:40+ 1:24+ .00 0:47+ .00 0:41+ .00 Ca Charges- Continued Item No Date Time Place Number 50. 3-12 205P EISHERSIS NY 6317887345 51. 3 12 217P FISHERS IS NY 631 780-7345 52. 3 12 226P BURLINGTON VT 802363-3816 53. 3 12 238P FISHERS IS NY 631 788-7919 54, 3-12 243P FISHERS IS NY 631 788 7919 55. 3-12 255P BRISTOL VT 8024535549 56. 3 12 257P FISHERS IS NY 631788 7343 57 3 [2 301P FISHERS IS NY 631 788-7343 58 312 320P SPRINGFLD MA4133550230 59 3-12 343P FARMINGTON CT 830777 5350 60. 3 12 356P SPRINGFLD MA413355-0200 61. 3-12 ~O4P FISHERS IS NY 831788 7343 62. 3-13 912A FISHERS IS NY 631 788-5673 63 3 13 III1A MANCHESTER VT 802688 8099 64. 3-13 1152A ROANOKE VA 540520 6277 65 3 13 101P HARTFORD CT 860 216 7828 66 3 13 413P HARTFORD CT 830986 7634 67. 3-14 750A FISHERS IS NY 631 788-7463 68. 3-14 817A WlLEIMNTIC CT 860428-4830 69. 314 844AWlLLIMNTIC CT 0304284860 70. 3 14 849A HARTFORD CT 860282 1818 71. 314 1125A FISHERSIS NY 631788 1345 72 3 14 1738P FISHERS IS NY 631 788-7919 73. 3 14 144P FISHERS IS NY 631 788 7255 14 3 14 323P FISHERS IS NY 631 788-5673 75. 3 14 324P FISHERS IS NY 631 788-5673 76 3 14 358P FISHERS IS NY 631 788 7463 77, 3-14 410P FISHERS IS NY 631 788-7463 78. 3-14 4lIP FISHERSIS NY 631788-7345 Total itemized Calls Total Charges for 860 442 0165 Charges for 860 443~8§1 Itemized Calls 79. 2-15 1024A FISHERS IS NY 631 788-5522 80. 2 15 1204P FISHERS iS NY 631 788-5522 81 2 15 309P FISHERS IS NY 631 788-5522 82. 2 16 135P FISHERS IS NY 631 788 5522 83. 2-18 1010A FISHERS IS NY 631 788 5522 84 2-18 304P FISHERS IS NY 631 788 5522 85 2-19 1308A FISHERS IS NY 631 788-5522 86. 2 19 252P FISHERS IS NY 631 788 5522 87. 2-20 10~9A FISHERS iS NY 631 788-5522 88. 2-20 1154A FISHERS IS NY 631 788 7943 89 2 20 306P FISHERS IS NY 631 788 5522 90. 221 1116A FISHERSIS NY 631780-5523 91. 2 2[ 1125A FISHERS IS NY 631 788-5522 92 2 21 247P FISHERS IS NY 631 788-5522 93. 2-21 253P FISHERS IS NY 631 788-5522 94. 2 22 911A HARTFORD CT 830 289-5368 95. 2 22 I012A NEW HAVEN CT 203 468-4445 96 2-22 1041A FISHERS IS NY 631 788 5522 97. 2 22 245P FISHERS IS NY 631 788 5522 Code Min 8:03+ 30 0:49+ .30 0:35+ OD 0:30+ 00 0:31+ 30 1:14+ .30 1:04+ 30 0:58+ 0O 0:42+ .30 O 4:07+ .30 I 0:59+ .30 1 0:30+ 30 1 1:13+ 30 I 1:32+ 30 I 0:42+ .30 D 5:03+ .30 D 4:27+ 30 2 0:30+ 30 O 035+ 00 D 0:40+ .30 D 7:19+ 30 1 2:08+ 30 I 0:3fl+ .30 I TOg+ .30 I 0:30+ .30 1 0:30+ 30 1 2:01+ 00 I 0:30+ 30 1 1:48+ .30 199 199 0:57+ 30 0:30+ 30 0:30+ .30 0:38+ 30 0:32+ 30 0:37+ 30 0:35+ 30 0:30+ .00 031+ .30 106+ 00 1:06+ 30 0:32+ .00 1:47+ 0O 0:34+ 30 1:05+ 30 0:39+ .30 7292.307.070128.02.04.0000000 NNNNNNNY 23855.81691 FiSH ERS ~SLANO FERRY DISTRICT Pa~l 5ot7 at&t ,o,ox, Account Number 860 442-0165 078 FISHERS ISLE NY 06390.0607 8illin~ Date Mar 15, 2013 Call Charges - ConlJnued No. Date ~ Place 1. 2 23 203P EISDERSIS 2. 2-25 1217P FISHERS IS 3. 2-25 1227P FISHERSIS 4 2 25 318P FISHERSlS 5 2 26 18eEA FISHERS IS 6 2 26 257P FISHERS IS I 2 27 1016A FISHERS IS 8 2-27 1017A FISHERSIS 9 227 321P FISDERSIS 10 2 28 1010A FISHERSIS 11 228 258P FISHERSIS 12. 3-01 1107A FISHERSIS 13. 3-01 1206P FISHERS IS 14 301 224P FISHERS IS 15. 3-01 226P FISHERSIS 16. 3-01 303P FISHERSIS 17 3-02 243P FISRERSIS 18 304 943A FISHERS]S 19. 304 1011A FISHERS~S 20 304 151P i~[WIIAVEN 21 3 04 305P FISHERS IS 22. 3-05 IOI1A FISHERS IS 23. 305 1156A EISHERSIS 24 3 06 1201P EISHERS IS 26 3 05 1209P FISHERS IS 26. 3-05 302P FISHERSIS 27 3 06 956A FISHERSIS 28. 306 1211P NEWHAVEN 29. 3-06 312P FISHERSIS 30 307 I101A EISHERSIS 31. 3 07 252P FISHERSIS 32. 3-08 1104A FISHERS IS 33. 3 08 301P FISHERSIS 34 3-11 832A FISHERSIS 35. 3-11 1DI3A FISHERSIS 37 3-11 300P FISHERSIS 38 3-11 304p FISRERSIS 39, 3-11 404P FISHERS~S 40 3-12 1006A FISRERSIS 41 3 12 253P FISHERS IS 42 3 13 952A FISHERS IS 43. 3-13 322P FISHERSIS 44, 3-14 1041A FISHERS IS 45. 3 14 1114A FISHERSIS 4~. 3-14 102P FISHERSIS 47. 3-14 310P FISHERSIS 48. 3-14 410P FISHERS IS Total Itemized Calls Total Charges for 860 443-6851 Number NY 631 788-5522 NY 631 788 5522 NY 631 788-5523 NY 631 788-5522 NY 631 788-5522 NY 631 788-5522 NY 631 788-5522 NY 631 788 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 203 ~9 ~,4~,5 NY 631 788-5522 NY 631 788-5522 NY 631 788-5522 NY 631 788-5522 NY 631 788-5572 NY 631 788-5622 NY 631 788-5522 CT 203891-8858 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 631 288-5522 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 631 788-5523 Code Call Charges - ConlJnued Charges for 860 444-03Z6 Item ~L~ ~q~ Time Plac~ Number Itemized Calls Mi~ 49. 2-18 1211P BILLERICA MA 978671-0446 0:31+ 0~ 50 2 18 1217P BILLERICA MA 978671-0446 0:33+ 0O 51. 2-19 345P FISHERSIS NY 631788-5523 0:36+ 00 52. 2-20 949A FISHERS IS NY 631788 5523 0:31+ 00 53 2-26 459P AUGUSTA ME 207287-6628 0:38+ .00 54 3-05 1002A FISHERS IS NY 631 788-5523 0:30+ .00 55. 3-06 247P EISRERS IS NY 631 788-5523 0:38+ 00 56. 3 II 754A FISHERS IS NY 631 788-5523 0:30+ 0O 57. 3-11 1043A FISHERS IS NY 631 788-5523 0:31+ 0O 58. 3-13 318P LINDENHST NY 631 225-3064 0:36+ .00 59. 3 14 550A LINDENHST NY 631 225-3064 0:32+ .(30 60. 3 14 328P LINDENHST NY 631 225-3064 0:39+ OO Total Itemized Calls 0:30+ .00 Total Charges 1or 860 444-0320 0:30+ 00 0:30+ .00 Charges for 860 447-9371 0:31+ .00 Itemized Calls 61. 2-15 II24A FISHERS IS NY 631 788-7876 0:30+ 62. 2-15 117P WlLLIMNTIC CT 860428-4860 0:31+ .00 63 2 18 850A FISHERS IS NY 631788-2919 0:39+ .00 64. 2-19 744A GUILFORD CT 203458-4128 0:57+ 85, 2 19 906A EISHERS iS NY 631 788-7345 0:31+ .00 66. 2 19 1037A FISHERS IS NY 631 788-7311 0:37+ 00 67. 2-20 1037A FISHERS IS NY 631 788-7345 9:43+ .00 68. 2-21 927A NEWHAVEN CT 203468-4501 1:08+ 69. 2-21 928A NEWHAVEN CT 203468-4503 0:40+ .00 70 2 21 932A NEW HAVEN CT 203 934-8644 0:30+ .00 71. 2-21 10~SA HARTFORD CT 860993-5826 0:38+ .00 72. 2-21 1018A EISHERS IS NY 631 288-7463 0:30+ .(X) 73. 2-21 1022A FISHERS IS NY 631 788-74~3 0:30+ .00 74. 2-21 1137A ROANOKE VA 540520-6277 0:54+ 0~ 75. 2-21 1205P FISHERS IS NY 631788-7463 0:31+ 76 2 21 403P FISHERS IS NY 631 788-5623 0:36+ 77. 2-22 818A NEWHAVEN CT 203468-45~6 0:31+ .00 78, 2-22 10OOA STOYSTOWN PA 814893-5701 0:30+ 00 79. 2 22 105lA NEW HAVEN CT 203 468-4509 0:45+ 00 80. 2-22 229P NEW HAVEN CT 203 287 1985 0:30+ 00 81. 2-25 1008A STOYSTOWN PA 814893-5701 0:30+ 82. 2 26 913A FISHERS IS NY 631 788-7345 0:32+ 00 83 2-26 1249P NEWHAVEN CT 2034684503 0:30+ 00 84. 2-26 139P YORK SC 883693-0727 0:39+ .00 85. 2 22 929A NEW HAVEN CT 203 469-6370 0:32+ 86 2 28 839A FISHERS IS NY 631 788-7345 0:37+ 81. 2-28 348P OSTERVlLLE MA774238-0411 0:47+ 00 88 3-01 933A SEARSPORT ME 207 548-6302 0:53+ .00 89 3-01 127P FISHERS IS NY 631788 5563 0:32+ .00 90. 3 01 217P FISHERS IS NY 631 788-7345 1:16+ 00 91. 3-04 9O0A FISHERS IS NY 631 788 5546 0:34+ .00 92. 304 911A MOODUS CT 860873-8687 1:21+ O0 93. 3-04 114P WESTMINSTR CA 714893-2438 .0~ 94. 3-04 159P FISHERS IS NY 631 788 555~ Cod~e ~ 0:3~+ .00 0:30+ .00 0:30+ .00 0:30+ .O0 0:30+ .~ 0:30+ .00 0:30+ .00 0:30+ .00 0:30+ .00 0:31+ .00 0:37+ .00 0:37+ .00 .0O .00 0:37+ .00 0:59+ .00 0:30+ .00 4:17+ .00 0:30+ .00 8:28+ 0:30+ .00 0:30+ .00 1:23+ 6:09+ .02 3:41+ .16 1:57+ .08 3g:06+ 1.68 0:30+ .02 1:11+ .~5 0:30+ .02 37:16+ 1.60 1:24+ .06 1:06+ .31 2:57+ .13 8:20+ .36 0:43+ 4:23+ .19 0:58+ .04 2:46+ .12 0:30+ .02 0:30+ .02 4:45+ .20 0:41+ .03 1:t2+ .05 2:40+ .11 0:39+ .03 19:45+ .85 0:37+ FISHERS ISLAND FERRY DISTRICT Page 6of7 PO BOX H Account Number 860 442 0165 078 FISHERS ISLE NY 06390-0607 Bill[us Date Mar 15, 2013 at&t Call Charqes - Continued No. Date Time Place Number Code Min [. 3-04 215P BATONROUGE LA 2257068462 I 1:06+ .05 2. 3-04 240P OLD SAYBRK CT 860 227-2335 D 0:30+ .02 3. 3 04 246P BATONROUGE LA 225928 1913 I 030+ ~02 4. 3-04 246p BATONROUGE LA 225928-1913 I 4:00+ .17 5. 3-05 730A FISHERS IS NY 631 788 5623 2 0:36+ 03 6. 3 05 llISA WCHICAGO IL 630234.1352 1 3:12+ .14 7. 305 1134A HARIFORD CT 860282-1818 D 4:29+ .19 8. 3-05 1149A FISH[RS IS NY 631 788 7345 1 0:30+ 02 9. 305 1203P HARTFORD CT 860282-1818 D 3:42+ ,16 10 3-05 1246P FISHERS IS NY 631 788 7463 I 2:25+ .32 11. 3 05 1256P FISH[RS 19 NY 631 788 7463 I 0:30+ 02 12. 3-05 136P FISHERS IS NY 63~ 788-7463 I 32:34+ 1.40 13. 3 05 246P FISHERS IS NY 631788 7345 1 0:47+ 03 14 305 313P NEWDAVEN CT 2036729659 O 0:46+ .03 15. 3 06 757A FISHERS IS NY 631788-7345 2 1:38+ 02 [6 3-06 1058A MIDDEEEOWN CT 8606320218 D 2:51+ .13 17. 3-06 158P WESTMINSTR CA 214899-4638 1 1:43+ .07 18. 3 07 745A PROVIDENCE RI 4OI 463-6056 2 0:30+ 02 19, 3 07 746A PROVIDENCE RI 401 463 8300 2 0:30+ .02 20. 3-07 746A PROVIDENCE RI 4Of 463 8300 2 2:25+ .10 21. 3 07 859A PROVIDENCE RI 401463.8300 1 0:30+ .02 22. 3 07 910A PROVIDENCE ti 4OI463-8300 f 3:31+ .15 23. 307 123P NEWHAVEN CT 2036729659 D 0:56+ 04 24 3-01 129P FISHERS IS NY 631 788 7724 1 0:51+ .04 25. 3-11 862A HARZFORD CT 860436-3700 O 14:27+ 62 26. 3 II 1124A FISHFRS IS NY 631 788-7463 I 8:16+ 36 27. 3 II I02P FISHFR9 IS NY 631 788 7463 I 0:30+ .02 28. 3-12 928A ttAR]FORD CT 860436-3700 D 3:48+ .16 29. 3 12 1020A FISHERS IS NY 631 788-7345 f 1:22+ .06 30. 3-~2 IO55A FISHERS IS NY 631 788 7345 I 1:01+ .04 31. 3-12 1157A FISHERS IS NY 631 188 7345 I 0:35+ .03 32. 3 12 312P FISHERSIS NY 631 788 7345 I 1:04+ .05 33. 3-13 947A WATERBURY CT 203754-5334 D 4:51+ 21 34. 3-13 1009A HARTFORD CT 8609~&7634 D 11:25+ .49 35. 3 13 1232P FISHERS IS NY 631 788 7919 1 1:00+ 04 36. 3 13 H2P FISHERS IS NY 631788-7345 1 0:31+ 02 37. 3-13 200P OLDSAYBRK CT 860388-7219 D 0:30+ .02 30. 3-13 204P HARTFORD CT 860986-7634 D 6:18+ 27 39. 3 14 20DP OLD SAYBRK CT 860227 2335 O 1:21+ .06 40. 3-14 210P NEWHAVEN CT 203468-4503 D 0:38+ .03 41. 3-14 212P FISHERS IS NY 631 788-7463 I 0:30+ .02 Total itemized Calls 1197 Total Charges for 860 447 9371 11.97 + Optmual Calling Plan Key to Calling Codes I Peak 2 Off Peak D Day E Evening M Multiple Rate Periods N NighVWeekend Total Call Charges Surcharqes and Other Fees AT&T Connecticut 42. Connecticut E 9-1 1 Surc6arge - 4 Lines 43. Connecticut Service Fund - 4 Lbms 44. Universal Service Fund - Local(4 ~ S1 20) 45 Federal Subscriber Line Charge- 4 Lines Total AT&T Connecticut AT&T LD East 46. Federal Regulatory Fee 47 Universal Service Fund - Interstate Total AT&T Long Distance East Total S.rcharges and Other Fees 160 2O 5.12 2384 30 76 43 337 380 34.56 48 Federal 49. State Sales Tax Tolal Taxes Total Plans and Services 3.47 1255 16.02 275.19 PREVENT [HSCONNE£T 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 ~nonth to keep your account current and avoid cogec6on activities (See Terms and Conditions for lurther infonnatiou). However, to avoid disconnection of local service, Basic Charges MDST be paid. For this account, that amount is: $153.52 for Current Basic Charges SO.O0 for Past Due Basic Charges CARRIERINFO Our records indicate lhat AT&T Connecticut is your carrier for instate calls AT&T Long Distance East is your carrier for interstate and international calls. KEEP YOUR DISCOUNE You receive any discounts, reduced rates, or promotional credits de scribed in the AT&T Bene6ts section of the bill because you subscribe to certain required services, for example, because you are an ALL DISTANCE® customer. If you remove any of the services required for a particular discount, reduced rate, or promotional credit, your effective rate for the associated remain[n9 service will change. Please call your AT&T service representative if you have any ques0ons SPEED CALLING 8 Effective 10/31/13, Speed Call 8 will no longer be available to Business customers Customers with Speed Call 8 will be autmnatically migrated to Speed Call 30 on 10/31/13 R you want to be part of the migration from Speed Call 8 to Speed Call 30, no further action is required at this time. There is no Service and Equipment Charge nor is there a price increase due to this migration If you do not want to be part of this migration, you have the riglrt to cancel your Speed Call 8 service. Additional information will be provided to you prior to tl0s migration If you have questions, please call an AT&T Service Representa6ve at the toll free number on your bill. 7292067,0701280304.0000000 NNNNNNNY 23857.81693 PlSHERS ISLAND FERRY DISTRICT Page ? of 7 PO 80X R Account Number 860 442-0165 078 BASIC CHARGES Basic Charges are charges for Basic Se.ices. Basic Services include local service and in state tall if you are an AT&T Connecticut local service customer Basic Charges include: Monthly Charges for your local line and other services, such as Totelphone and Smar~ink; in-state Calling Charges; in-state Directory Assistance Charges; the Connecticut E 911 Surcharge; the Connecticut Service Fund fee; the Federal Subscriber Uno Charge; and the Universal Se.ice 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 altemahve services providers; Call Charges for in state long distance provided by a company other than AT&T Connecticut; out of state Directory Assistance Charges; ctiarges for telephone equipment and inside wi~e maintenance, AT&T Voice Mail, AT&T Unified Messaging, AT&T High Speed Intemet. Wireless, AT&T I DISH Network, AT&T I DIRECTV, Adve~sing 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 Foxes, Late Payment Charges, Collection Charqes, and Additions and Changes to your service. BILL PAYMENT, LATE PAYMENT CHARGES AND OTHER FEES Failure to pay any porhon of your bill may result in additional cogection action. A~y partial payment made will first he applied to Basic Charges, then to Non-Basic Charges. Failure to pay your Basic Charges will result in interrupbon of your local service. If you fail to pay your Non Basic Charges, your AT&T Connecticut local service will not be interrupted, but all of your Non-Basic services will he terminated. AT&T Connecticut may apply a late payment charge per month on any unpaid balance, excluding the previously assessed late payment charges. Fo avoid a late charge, we must receive payment for the total amount due no later than the date specified on your bill statemenL AT&T Connecticut will apply a $20.00 Collection Charge on an account where a termination nobce has been sent. An explanation of these charges may be obtained by calling AT&T Connecticut at the number shown on your bill or accessing our website: http://www.attcom/cthiliglossary AF&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 0utof state Ion9 distance is provided by AT&T Long Distance East Internet services are provided by AT&T Internet Services. Wireless se.ices are provided by AT&T Mobility. 7292~007.070128.04.04 00OO000 NNNNNNNY 2385981695 FISHERS ISLAND FERRY DISTRICT VENDOR 001781 ATLANTIC DETROIT DIESEL- 04/09/2013 CHECK 1073 FUND & ACCOUNT P.O.~ INVOICE DESCRIPTION ANOI/NT SM .5710.2.000.200 P661840M RP BLOCK HEATERS 433.55 TOTAL 433.55 Vendor No. Town of Southold, New York - Payment Voucher Vendor Tax ID Number or Social Securit) Number Atlantic Detroit Diesel Allison, LLC Vendor Telephone Number 201-489-5800 Vendor Contact Vendor Address j PO Box 950 iLodi, NJ 07644 1781 Check No Entered by ~ Audll Date APR 0 9 2013 Invoice [ Invoice Date Total Discount 211412013! $433.55j Net Purchase Order Amount Claimed Nmnber Description of Goods or Services General Ledger Fund and Account Number P661840M $433.55 RP Block Heaters SM5710.2.000.200 $433.55 $433.55 j Payee Certification Tbe undersigned (Clabnant) (Acting on behalf of the abo~e named claimant} does hereby certil~ that the foregoing claim is true and correct, that no part has been paid, except as therein stated, that the balance therein stated is actuall5 due and owing, and that taxes flora which the Town is cxcmp! are excluded Department Certification I hereby cerbty that the matcrials abovc spccified have been received by me m good condition without substitution, the serMces properly peHBrmcd and that the quantities thereof have been verified with thc exceptions (ir discrepancies noted, and payment is appro~ ed Signature ~1 itle ~ Company, Name / /~) I)atc ~,,~r/' ~ /.~ Signature ATLANTIC _ DETROIT DIESEL ALLISON ,:','f'l...A N T :1: C 562 El...ifi !B"f UN]:T NliJ,~J i.ON!)EIN., (.;t CUSTOMER COPY UN:I:'I ...LI~.LAI..~ I [USTC)i',tlEF;: C(}NTA(]I :: ,.T(]t'IN I I.. ]: I lii]"i i I:{CH:)i i':il:((]tJl-:' }}:]Ji'-,i (;)'i'Y (;:~I Y ET//' I iN]. , I!i.X f li.Nl)lii:D NUfft:81i. F;: DIESCF? ] I::' ¥']:OKt LOC (;}i:;:D SHI::' )3/0 Fq::; iX;ii: F'i:,~ tJ CliL A'I'LANT]:C: :[li~. NOW 'f'i'-lE: ONE ~.f(.)l SI-.iCII::' I::'01:( AI_I... 01::' Y'] .F' F'AI:;ITS AND Slii:RM :[ CE NIEI~!:I),% ...... I..l(::!"l' DE]AI...,(i; (IN ALI.. A :[ t'; COi',I1) :[ 1.1: ON :tZ NI. jj F'~:~t:;:'J S AND S;lii]:~:9 ]]CE ....... Ct~,%l::: AE£)I.J'I' (:)t..}l:;'. I I'd.(.N li:;l::'lliiC]:~i .......... F:'i]R I~JU q. ]]"H::'C) 9.. ,.l.l RIECIE ]ZIJIEi) :( .... GENERAL TERMS AND CONDITIONS I DEFINITIONS. As used in these General Terms and Conditions. the term 'Goods" shall mean the producis, pints and accessories (including flnidst ot'fcred l~r sate by Seller. -ibc · ~'Set~ces' shall mean dm labor lbr diag~osis, repair and maintenance m vehicles and oiher eqmpment provided by Stiles. "Seller" stroll mcan Atlantic Detroit Diesel Allison, 1,LC {also d/h/a Atlantic Power Systems) and "Buyer" shall meall thc customer (person or entity) [o whmn Goods or Selwiccs is s(fld or off, red. 2 ,kCCE~ANCE. Upon acceptance by Se/Ibr. [luyer's request Ik>r quotation and'or pmchase order lk)r Goods or Sera/cea is expressly condition6d upon Buver's abmeement to the Following terms and conditions and no od~er terms tmless authorixed or otherwise supplemented in writing by Seller. All otlkrs by Seller expire 30 days fi'om d~e da~e of ~ssue unless termhmted earlier by Seller belbre ;~cccptatxce or extended by Seller in x~xiting. 3 PRICES AND PAYMENI; All prices arc in [ .S Dollars. Sdlcr reserves thc right to adjust p~es if changes are made in spccifica imps, dclixc~y ot scope of~ork fk>r Goods (>r Services, tin- less otherwise agreed in writing, my Buyer with pre-approved credit terms shall pay the pmchase price Ik}t' Goods or Services wdhin thitly (30) days ol the date of invoice. ( redit lerms ale pm vided only to Buyers whose credit is approved in advallcc by Selier's credil deparm~enL Seller reset; es the righi 1o orange credd lc-ms aid n* requh'e payment in cash or olher lbrm o: immediate payment acceptable to Seller. Buyer will be invoiced ~br thc applicable sales tax or other taxes duc in connectkm with Buyers purchase of Goods and Scrxices tnlless Bayer pr )v~des acceptable tax exemption ce~iticatc. 4 I'MCTORY4UIlIORIZED~iRRINT}'REP~IIRS. ~lheneve~Se/lerprovidt,:>.ataB~O,e~krcq~tc, s;lctc&wyautho:dzcdreTyairse~.w~cs or r?[dacemerJrpm'~sto Good~co~'e~,dbw: IIMRR INIYDISCL.4L*IER, IHE *t:4RRANTIES PROI'IDED tIEREINARE TIlE ONLF ~t54RR~NIIESAPPLI~BLE TO JttE PRODI CTS. t~RTS 45D/OR SI:RI ICt-;S PROVIDED BY SELLER. SELLER M/~KES .%~ OTIIER ~I(4RR,~,%TIES, EXPR~B~S. 131PLIED OR S~4TUTOR} 4.YD SPE(II:IC4ZLY DLS'CI.AfilI~S ,~NY IMPLIED II 4R&INTIES Ok ML'RCII.4N~tBIZlI'Y ()~ FIT, XTSS FOR A P4RTI( UU~R PIJRPOSE. Some xtat{,s do no~ aHm.; the limit~ttio~ o/hem/tm~ t err~u~ ~*~o ~ anties mo¥ h:t r>r / ~ i~orio~ ~ ~' ~ r~ /usio~v o/ certain <l~2ma~;t v so ~ome hmilatio~, may not be tqq;lic'~dffe. Tht' /trotted wam2~ttic.~ give Buverq ~pecific lc,gal ri.ghis which m~O' ~a:v ?om sta~ /o 9. NEG[ 1GENCE DIS( I,AIMER. Buyer understands and agrees dmt Sctler ami Scl/er's oflSccrs, agoras, represc~tati~cs, and employec~ shall n()~ bc I/able ~m ~njury 1<~ property, ~xhed~cr based on negligence, strict liability, ot any olhc~ thcoiV oI'toll liability, for any actioo or lhfilore to act m respect to thc rcpait, replacemen~ of p~rts or workman h~p involved a>~ to ~y Se~x ~ccs I0, DISCI AIMER OF INCll)ENI'AL OR CONSEQUENTIAL LIABILITY. The bruited warranty oP SeIIer and othe~ mam~thclarers' ~im~ted warranlles described hereto do not coxc~ any II. I IMEFATION OE LIABII,II¥. In ar~y and alt events, the limilation of liabilky o~ Sellel or its agents and employees t~r any and al~ losses injuries or damages ~csuhing limn the u~c handling o:any Goods. equipment, pa~% or Services provided o~ pedbrmed by Seller shall be limited lo the purchase price pad by Buyer ihr s~ch Go(~ds or Ser~/ces [2. OTHER REMEDIES OF SELLER. The l lmitcd warraniics provided herein shall not become eflk, ctivc tmless d~e Buyer pay~ Seller lPr thc Good~ or Services when &~c in acctmJancc with agreed tc~rns ol payment. Il thc Bayer thils to pay as agreed, Sdlcr shall have a~l the remedies provided tinder the laws olthc state where the Geods or Services arc provided h xo cos n()t p~d whe~ due are subject to a finance cha~gc oi 1 57a pe~ month t 18% per ama~m). Eqtfipment ~ot picked up by Buyer within 5 busme s days (~ 'c )repletion i~ sal(wct to a S 100 pe~ day sloragc charge FISHERS ISLAND FERRY DIS~IR1CT VENDOR 002241 THE BELL SIMONS COMPANIES 04/09/2013 CHECK 1074 FUND & ACCOUNT P. 0. ~ INVOICE DESCRIPTION AMOUNT SM .5710.2.000.000 SM .5710.2.000.000 SM .5710.2.000.000 SM .5710.2.000.000 SM .5710.2.000.100 S8598393.001 SHOP MAINT 18.37- S8748542.001 CLEAR TUBE FT 2.86 S8790707.001 BLK MAL TEE 9.24 S8984403.001 PUMP FITTINGS 13.37 S8993079.001 MU-HEATING SYSTEM 348.38 TOTAL 355.48 PAY o¢~ CT 06 12 6['?f5~7 Town of Southold, New York - Payment Voucher Vendor No. 2241 Vendor 'ax D Number or Social Securit5r Number Vendor Name The Bell/Simons Companies Vendor Telephone Number Vendor Contact Vendor Address P.O. Box 261567 Hartford, CT 06126-1567 Check No. lO'lq Entered by Audit Date APR 0 9 2013 Town Clerk Invoice Invoice Number Date Description of Goods or Services General Ledger Fund and Account Number Shop maint. 8M6710.2.000.000 invoice Total Discount 88598393.001 4/30/2012 37) S8748642.001 8/30/2012 10/4/2012 S8790707.001 S8984403.001 3/11/2013 2.86 9.24 13.37 S8993079.001 3/19/2013 348.38 Net Purchase Order Amount Claimec Number ( 2.86 9.24 13.37 348.38 355.48 Payee Certification The undersigned (Claimant) (Acting on behalf of the above named claimant) does hereby ceftin, that the foregoing claim is true and correct, that no pan has 355.48 been paid except as therein Stated, that the balance therein stated is actually, due and ex, lng, and that taxes lhom ~hich the Tox~n is exempt are excluded Clear Tube FT BIK Mai Tee Pump Fittings SM5710.2.000.000 SM5710.2.000.000 MUNN Heating System SM5710.2.000.000 Department Certification I hereby certif~r that thc materials above specified have been received bv me in good condition without substitution, the sen, ices properly perfonned and that the quantities thereof have been verified with the except*ohs or discrepancies noted, and pa5 ment ~s approved SM5710.2.000.100 The Bell~Simons Companies Vi,it ~ on the .eh at http://~..be[[simons.com or e-mail ~s at i~fo@bo[[simo~s.com INVOICE Customer Account Date In¥oice Number 41845 04/30/12 S8598393 . 001 Sold To: Ship To: FISHERS ISLAND FERRY DIST. FISHERS ISLAND FERRY DIST. P·O. BOX H P.O. BOX H FISHERS ISLAND, NY 06390 FISHERS ISLAND, NY 06390 Page 1 Writer Customer PO Number uroer ua[e SIlip Da~e Batch EZOLDE 04/30/12 04/30/12 Quantity Stock Number Unit Description Net 30 days Unit Price Extended 276934 EA LENOX 21191 TCW158P2 CUT WHEEL 17.267 17.27 ** Original Sale : S8595365.001 ** Non Taxable Mdse Taxable Mdse 0.00 Sales Tax Shippin9 Handling Invoice Total -17.27 1.10 0.00 0.00 -18.37 PLEASE REMIT TO: 41845 04/30/12 S8598393. 001 The Bell/Simons Companies, P. O. Box 261567, Hartford, CT 06126-1567, A Service Charge of 1.5% per month (APR of 18%) wilt be added to all past due balances. Please direct any questions concerning this invoice to the Branch of purchase. Customer will be Liable for all collection costs including att attorney's fees. *** NO RETURNS AFTER 90 DAYS. *** Items purchased at: The Bell Ptunp Company, New London, CT - Phone (800) 647-5916 BellSimons COMPANIES SoLd To: FISHERS ISLAND FERRY DIST. P. O. BOX H FISHERS ISLAND, NY 06390 INVOICE Date Invoice Number 08/30/12 S8748542.001 41845 Ship To: FISHERS ISLAND FERRY DIST. P. 0. BOX H FISHERS ISLAND, NY 06390 Writer Customer PO Number Release Number Order Date Ship Date Terms SEA~TD M~intenar, ce 0.~/30/~!2 08/30/12 Net 30 days Quantity Stock Number Unit Description Unit Price 10 75459 EA MARS 79133 1/2" CLEAR TUBE FT 0.269 Extended 2.69 Non TaxabLe Mdse Taxable Mdse Sales Tax Shipping Handling 0.00 2.69 0.17 0.00 0.00 2.86 41845 08/30/12 S8748542.001 PLEASE REMIT TO: The Bell/Simons Companies, P. O. Box 261567, Hartford, CT 06126-1567, A Service Charge of 1.5% per month (APR of 18%) wiJ[ be added to aLJ past due balances. PLease direct any questions concerning this invoice to the Branch of purchase. Customer will be Liable for all collection costs including all attorney's fees. *** NO RETURNS AFTER 90 DAYS. *** Visit us on the web at http://www.beLLsimons.com or e mail us at info@be[[simons.corn Items purchased at: The Bell Pu~p Company, New London, CT - Phone (800) 647-5916 THE BELL/SIMONS COMPANIES Ship Ticket S8748542.001 Page ~ 1 Bill FISHERS ISLAND FERRY DIST. To : P.O. BOX H FISHERS ISLAND, NY 06390 ship To : FISHERS ISLAND FERRY DIST. P.O. BOX H FISHERS ISLAND, NY 06390 Customer PO~ Maintenance Order Date 08/30/2012 Customer Rel~ Writer SEAND Ship Date 08/30/12 Batch Number Payment Terms Net 30 days Ship Via PU PICK-UP Salesman Customer Phone 516 788-7463 Quantity Stock ~ 10 75459 Item Description MARS 79133 1/2" CLEAR TUBE FT Total Sales tax Invoice Amount Unit Prc NeE 0.269 2.69 2.69 0.17 2.86 Reprint . . Reprint . . Reprint . . Reprint . . Customer Signature Items on this order were purchased at: The Bell Pump Company, New London, CT Phone (800) 647-5916 BellSimons COMPANIES HVAC · REFRIGERATION · PLUMBING Gold TO: FISHERS ISLAND FERRY DIST. P.O. BOX H FISHERS ISLAND, NY 06390 INVOICE Date Invoice Number PaNe 10/04/12 S8790707 . 001 1 41845 Ship To: FISHERS ISLAND FERRY DIST. P. O. BOX H FISHERS ISLAND, NY 06390 Writer Customer PO Number Release Number Order Date _Ship Date Terms 10/04/12 10/04/12 Net 30 days Quantity Stock Number Unit Descri~tlon Unit Price Extended 1 78914 EA 1 1/2 BLK MAL TEE 8.694 8.69 Non Taxabte Mdse Taxable Mdse Sales Tax Shipp~_r~N Hand[ inN Invoice Total 0.00 8.69 0.55 0.00 0.00 9.24 41845 10/04/12 S8790707.001 PLEASE REMIT TO: The Bell/Simons Companies, P. O. Box 261567, Hartford, CT 06126-1567, A Service Charge of 1.5% per' ~Tionth (APR of 18%) will be added to ali past due balances. Please direct any questions concerning this invoice to the Branch of purchase. Customer will be liable for alt collection costs ir~cluding att attorney's fees. *** NO RETUR/qS AFTER 90 DAYS. *** Visit us on the web at http://www.beLLsimons.com o~ e mail us at info@beLLsimons,com Items purchased at: The Bell Pump Company, New London, CT - Phone (800) 647-5916 BellSimons Sold To: FISHERS ISLAND FERRY DIST. P.O. BOX H FISHERS ISLAND, NY 06390 INVOICE Date Invoice Number S8984403.00t 41845 03/11/13 Ship To: FISHERS ISLAND P.O. BOX H FISHERS ISLAND, FERRY DIST. NY 06390 Writer Customer PO Number Release Number Order Date SEAND Maintenance 03/11/13 Ship Date 03/11/13 Net 30 days Unit Price Extended 3 80988 EA 1/2 X 2-1/2 BLACK NIPPLE 3 88466 EA GFI 2006 2A-710 REPL CARTRIDGE 1.453 4.36 2.738 8.21 Non Taxable Hdse Tax~bLe Mdse Sales Tax _Shipping Handlin~ Invoice lotaL 0. 80 0. 00 0 . 00 13 . 37 0 . 00 12 . 57 41845 03/11/13 S8984403 . PLEASE REMIT TO: The Bell/Simons Companies, P. O. Box 261567, Hartford, CT 06126-1567, A Service Charge of 1.5% per month (APR of 18%) will be added to all past due balances. Please direct any questions concerning this invoice to the Branch of purchase. Customer will be ~iabLe for all collection costs including all attorney's fees. *** NO RETURATS AFTER 90 DAYS. *** Visit us on the web at http://www.bellsimons.com or e-mail us at info@bellsimons.com Items purchased at: The Bell Pump Company, New London, CT - Phone (800) 647-5916 BellSimons COMPANIES HVAC · REt'RIGERATION · PLUMBING Servingfhelndus~ryst,~c~I~40 SoLd To: P. O. BOX H FISHERS ISLAND, NY 06390 INVOICE Date Invoice Number Page 03/11/13 S8984403. 001 1 41845 Ship To: P.O. BOX H FISHERS ISLAND, NY 06390 Customer PO Number Release Number Order Date SEAND Maintenance 03/11/13 Quantity Stock Number Unit Description Ship Date 03/11/13 Net 30 days Unit Price Extended 3 80988 EA 1/2 X 2-1/2 BLACK NIPPLE 3 88466 EA GFI 2006 2A-710 REPL CARTRIDGE 1.453 4.36 2.738 8.21 Non Taxable Mdse Taxable Mdse Sales Tax Shipping HandLinu Invoice Total 0.80 0.00 0.00 13.37 0.00 12.57 41845 03/11/13 S8984403. 001 PLEASE REMIT TO: The Bell/Simons Companies, P. O. Box 261567, Hartford, CT 06126-1567, A Service Charge of 1.5% per month (APR of 18%) will be added to all past due balances. Please direct any questions concerning this invoice to the Branch of purchase. Customer will be liable for all collection costs including all attorney's fees. *** NO RETUR/~S AFTER 90 DAYS. *** Visit us on the web at http://www.be[[simons.com or e-mail us at info@beltsimons.com Items purchased at: The Bell Pump Company, New London, CT - Phone (800) 647-5916 BellSimons COMPANIES HVAC · REFRIGERATION · PLUMBING Sold To: FISHERS ISLAND FERRY DIST. P.O. BOX 607 FISHERS ISLAND, NY 06390 INVOICE Date Invoice Number 03/19/13 S8993079. 001 41845 5hLp To: FISHERS ISLAND FERRY DIST. P.O. BOX H FISHERS ISLAND, NY 06390 1 ._.C__qg~tg_m~_r pO Numb_e.r _ _~q~eage. Number .... _Or_d_~.r__D.p_te ........ Shi~ Date Maintenance 03/19/13 03/19/13 Quantity Stock Number Unit Description 1 331867 EA BG 189105LF BEARING ASSY 1 331870 EA BG 189134LF S/S BEARING ASSY W/PLASTIC IMPELLER 1 22479 EA SSC 779 COUPLER 118705 2 22471 EA SSC-790 SPRING-FLEX COUPLER Terms Net 30 days Unit Price 218.380 86.636 7.160 7.700 Extended 218.38 86.64 7.16 15.40 Non Taxable Mdse Taxable Mdse Sa[es Tax Shippin9 Handling Invoice Total 20.80 0 . 00 0. 00 348 . 38 0.00 327.58 Customer Account Date Invoice Number 41845 03/19/13 S8993079 . 001 PLEASE REMIT TO: The Bell/Simons Companies, P. O. Box 261567, Hartford, CT 06126-1567, A Service Charge of 1.5% per month (APR of 18%) will be added to all past due balances, Please direct any questions concerning this invoice to the Branch of purchase, Customer will be liable for all collection costs including all attorney's fees. *** NO RETURNS AFTER 90 DAYS. *** Visit us on the web at http://www.bel[simons.com or e mail us at info@be[[sLmons.com It~m~ ?~rchased at: The Bell Pump Company, New London, CT - Phone (800) 647-5916 THE BELL/SIMONS COMPANIES ** Ship Ticket ** S8993079.001 Page ~ 1 Bill FISHERS ISLAND FERRY DIST. To : P.O. BOX H FISHERS ISLA/~D, NY 06390 Ship To : FISHERS ISL~kND FERRY DIST. P.O. BOX H FISHERS ISL]kND, NY 06390 CusTomer PO~ Order Uate 03/ [9/20!3 Customer Rel# Writer SEAND Ship Date 03/19/13 Batch Number Payment Terms Nez 30 days Ship Via PU PICK-UP Customer Phone 516 788-7463 Quaxtity Stock # 1 331867 i 331870 22479 22471 Item Description BG 189105LF BEARING ASSY BG 189134LF S/S BEARING ASSY W/PLASTiC IMPELLER SSC 779 COUPLER 118785 SSC-790 SPRING FLEX COUPLER Total Sales tax Invoice Amount Unit Prc 218.380 86.636 7.160 7.700 Net 218.38 86.64 7.16 15.40 327.58 20.80 348.38 . . Reprint . . ReP~ci Items on this order were purchased at: The Bell Pump New !,ondon, CT Phone {800) 647 5916 eprint.. .. Reprint Dmpany, FISHERS ISLAND FERRY DISTRICT VENDOR 002433 WILLI~Jq BLOETHE 04/09/2013 CHECK 1075 FUND & ACCOUNT P.O.~ IArVOICE DESCRIPTION AMOUNT SM .5713.4.000.000 033113 MAIL TRANSPORT-1ST QTR 2,250.00 TOT~fL 2,250.00 Town of Southold, New York - Payment Voucher Vendor Tax ID Nu nber or Soc a Secur y Number i Vendor Address P.O. Box 446 i Vendor No. ' 2433 William Bloethe Vendor Telephone Number Vendor Contact Fishers Island, NY 06390 Check No. 1075 Enteredby Audit Date APR 0 9 2013 Tow. a~lerk .-, .. Invoice In¥oice Number Date 313112013 Invoice Net Total Discount !Amount Claimec $2,250.00 $2,250.00 $2,250.00 $2,250.00 Payee Certification ']'he undersigned (Claimant) (Acting on behalf oCthc above named claimant) does hereby certil~ 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 Purchase Order Number Description of Goods or Ser¥ices General Ledger Fund and Account Number Mail Transport SM5713.4.000.000 1st Quarter 2013 Department Certification I hereby ccrti~ that the materials above specified have been received by me m good condition without substitution, the ser~'ices properly performed and that the quantities thereof have been verified with the exceptions or discrepancies noted, and payment ~s approved Sent: To: Cc: Subject: GSMurphy <gmurphy@fifemJ.com> Wednesday, March 07, 2012 5:27 PM Debbie Doucette Margaret Dougherty (W) Mail Contract Debbie, Please be advised that Bill BIoethe has been given the island mail delivery contract effective 1 April 20:[2 for two years terminatm§ on 31March 2014' For services rendered Mr. Bioethe will be paid quarterly in arrears °n an annuai rate °f $9,000.00. he will not be invoicing the District. Would Peggy and you please set QB up to handle the next two years. I do not know how the current payment structure works, but recommend that we keep it in effect until the new contract goes live. Gordon 5. Murphy Assistant Manager +1 631 788 7463 FISHERS ISLAND FERRY DISTRICT VENDOR 002487 BOCA SYSTEMS, INC. 04/09/2013 CHECK 1076 FUND & ACCOUNT P.O.~ INVOICE DESCRIPTION AMOUNT SM .5710.4.000.400 1029361 BOCA BOARDING TICKETS 1,255.38 TOTAL 1,255.38 487 OD I, 50 ~ 1' III Vendor No. Check No. Town of Southold, New York - Payment Voucher Vendor Tax ID Number or Social Securit~ Number Vendor Name Boca Systems, inc. Vendor Address 1065 S. Rogers Circle Boca Raton, FL 33487 Vendor Telephone Number 561-998-9600 Vendor Contact 2487 Audit Date APR 0 9 2013 Town Clerk Invoice Invoice Invoice Net Purchase Order Number Date Total Discount Amount Claimed Number Description of Goods or Services General Ledger Fund and Account Number 1029361 311812013 $1,255.38 $1,255.38 Boca Boarding Tickets SM5710.4.000.400 $1,25S.381 Payee Certification ['he undersigned (Claimant) (Acting on behalf ol'thc above named claimant) does hereby cerlii~ 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 t¥om which the Town ~s exempt are excluded $1,258.38 Department Certification I hereby cerd f~ that the materials above specified have been received by me in good condition without substitutiom the set,rices properly performed and that the quantities thereof'have been verified with the exceptmns or discrepancies noted, and payment is approved Signature_ Compun, Name Invoice Boca Systems Inc. 1065 S. Rogers Circle Boca Raton, FL 33487 (561) 998-9600 cathy@bocasystems.com INVOICE NUMBER: 1029361 INVOICE DATE: 3/18/2013 The paper used to produce these tickets is certified to meet the standards set forLh in the Sustainable Forest initiative (SFI) Program for Fiber Sourcing and Chain of Cuslody (15% certified forest content and 85% fiber sourcing). Cedificate #BV-SFICOC-US003863-1 BILL TO: SHIP TO: Fishers Island Ferry District 261 Trumbull Drive Attn: Accounts Payable Fishers Island, NY 06390-0607 Fishers Island Ferry District 261 Trumbull Drive Attn: Receiving Fishers Island, NY 06390-0607 Boca Systems will close for our summer vacation on July 4. We will re-open on July 22. PO Number: email-2/26/13 Customer Name: fishers island ferry Release: 0 Order Date: Phone: 631 788 7463 Quote Num: AG157891A Ship Via: ground Terms: Net 30 Contact: Gordon Murphy Email: gmurphy@fiferry,com Quantity Description Unit Price Net Price 100 K Ticket (HS7.2.x3.25, :3 colors) $ 11.4 0 0 $ 1,14 0.0 0 Special Instructions Repeat Order std blackmark at 1188 Reference #316C NEW front colors Attn: Deb Doucette Order Complete SUBTOTAL $ 1,140.00 SHIPPING $ 115.38 SALES TAX TOTAL $ 1,255.38 PREPAID BALANCE $ 1,255.38 USA Origin, Commercial Invoice. All prices are in US dollars. All this information is true and correct. For complete terms and conditions, refer, to our website, www.bocasystems.com FISHERS ISLAND FERRY DISTRICT VENDOR 002665 ROBERT R. BROOKS II 04/09/2013 CHECK 1077 FI/ND & ACCOUNT P.O.~ INVOICE DESCRIPTION AMOUNT SM .5712.4.000.000 123112 '12 COMM MTG OCT-DEC(8) 400.00 TOTAL 400.00 ,i'O0~O ? ?,,' Town of Southold, New York - Payment Voucher Vendor No. 2665 Vendor Tax [D Number or Social SecuriD Number Robert R. Brooks, II Vendor Telephone Nmnber Vendor Contact Vendor Address P.O. Box 305 Fishers Island, NY 06390 Check No. Entered by Audit Date APR 0 9 2013 [ I'own Clerk i ~,...~:7 ~ ,..'/!~ Invoice Net ~ Purchase Order Nu]Ilber Discount Amount Claimed Number Description of Goods or Services General Ledger Fund and Account Number Invoice Invoice Date Total 12~3112012 $400.00! $400.00 $400.00 I Payee Certification The undersigned (Claimant) (Acting on behalf of the above named claimant) does hereby certi~ that the foregoing clahn is true and correct, that no paC. bas 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 $400.00 Commission Meeting SM5712.4.000.000 October- December 12 Mtgs @ $50/mtg Department Certification I hereby certi~ that the materials above specified have been received bv me in good condition without substitution, the services properly pcrlbrmcd and that the quantities thereof have been verified with the exceptmns or discrepancies noted, and payment ts approved Signature .. ?' ~ ~it)e '~ ~'~-: Dale eeting Date 04/03/12 04/09/12 04/17/12 05~01112 05/15/12 06/05/12 06/19/12 07/03/12 07/11/12 07/17/12 07/18/12 07/19/12 07/21/12 07/24/12 07/30/12 08/07/12 08/11/12 08/17/12 08/28/12 09/06/12 09/17/12 Brooks, Robert 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Burnham, David 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Edwards, Christopher Herrick, Lucinda 1 Rafferty, Christopher 1 1 1V 1 1 1 1V 1 1V 1 1 1 1 1 1V 1 1 1 1 1 1 1 1 1 I 1 1 1 1V 1 1 Rugg, Peter Wall, Robert 1 1 1 1 1 1 1 1 1 3tal 18 15 19 16 20 2 3 10/2/2012 10/2/2012 0/15/2012 0/24/2012 111612012 1/20/2012 12/4/2012 2/18/2026 2/26/2012 1 1 1 1 1 1 1 1 I 1 1 1 1 1 1 1 1 I 1 1 I 1 1 1 4Q12 8 $400 0 $- ~ 9 $45O 0 9 $450 6 $300 9 $450 FISHERS ISLAND FERRY DISTRICT VENDOR 005288 CATHERINE EDWARDS 04/09/2013 CHECK 1078 FUND & ACCOUNT P.O.~ INVOICE DESCRIPTION AMOUNT SM .1930.4.000.000 SM .1930.4.000.000 031413 031413 DMG CLAIM-CAR MIRROR,CVR 489.11 REIMB.FERRY TICKET 22.00 TOTAL 511.11 Town of Southold, New York - Payment Voucher Vendor No. 5288 Vendor Tax ID Number or Social SecuriiT Number Catherine Edwards Vendor Telephone Number 631-788-7318 Vendor Contact Invoice Invoice Invoice Number Date Total Discount P.O. Box 693 Fishers Island, NY 06390 $489.11 Ncr I Purchase Order $489.11 $22.00 $22.00 Description of Goods or Services Damage on her car suffered on the ferry ferry ticket reimbursement 4 Check No. Entered by Audit Date APR 0 9 2013 Town Clerk General Ledger Fund and Account Number SM1930.4.000.000 SM1930.4.000.000 Payee Certification The undersigned (Claimant) (Acting on behalf of the above named claimant) does hereby, certil~ that the lbregoing claim is truc 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 lhom which the Iown is exempt are excluded Department Certification I hereby ccrti[}~ that the materials above specified have been received b3 me In good condition without substitution, the services properl,, performed and that the quantities thereof have been verified %~ith thc exceptions or discrepancies noted and payment ~s approved Signamre ' - Idle .'(4L)' ~'- Date ' 0-,~ ,- .~'.. Catherine H. Edwards 8ox 693 Fishers Island, NV 06390 14 March 2013 Dear Mr. Murphy, Attached is a copy of the invoice for the repair of the damage to my vehicle that occurred on the Munnatawket ferry on February 8, 2013. The entire driver's side mirror and cover were replaced which cost $489.11. I would also like to be reimbursed $22.00 for the ferry ticket for myself and the vehicle on the day of the repair. The total reimbursement due is $511.11. Thank you Catherine H. Edwards ~BOiB VALENTI AUTO MALL BOB VALENTI CHEVROLET-OLDSMOBILE, Inc. VALENTI FORD, Inc, MYSTIC, CT 06355 VALENTI CHRYSLER-PLYMOUTH DODGE-JEEP, Inc. 13042 .............. EATHERZNE EDWARDS BOX 693 FZSHERS ISLAND, NY 06390 6~1~88'7318 ia~e~-614s ,~$5471~9- ~ I 51FOZ BODY ELECTRICAL HOURS: 0.80 TECH(S):336 C/S DRIVERS SIDE VIEW MIRROR ASSEMBLY NEEDS REPLACING REPLACE DRIVER SIDE VIEW HIRROR ASSEMBLY 71.20 PARTS ...... QTY---FP-NUMBER ............... DESCRIPTION ......... LIST PRICE-UNIT PRICE- i 8A8Z-17683-CA MIRROR 360002 222.88 222.88 222.88 i 8A8Z-17D743-BAPTM COVER 359996 53.33 53.33 53.33 TOTAL - PARTS 276.21 SUBLET ..... PO// ........VEND INV#-INV.DATE-DESCRIPTION ............................... 547169 547171 02/20/13 PAINT MIRROR COVER 112.50 TOTAL - SUBLET 112.50 i TOTALS ............................................................ LABOR PARTS SUBLET 71.20 276.21 112,50 JOB~ 1 JOURNAL PREFIX FOCS JOB~ 1 TOTAL 459.91 TOTALS .......................................................................................... *********************************************** TOTAL LABOR .... 71.20 * TOTAL PARTS .... 276.21 [ ] CASH [ ] CHECK CK NO. [ ] * TOTAL SUBLET... 112.50 * TOTAL G,O.G .... [ ] VISA [ ] I't&STERCARD [ ] DISCOVER * TOTAL MISC CNG, 0,00 * TOTAL MISC DISC 0.00 [ ] OTHER [ ] CHARGE * TOTAL TAX ...... 29.20 *********************************************** TOTAL INVOICE $ 489.11 'HANK YOU FOR YOUR BUSINESS!! CUSTDMER SIGNA1URE PAGE 1 OF 1 CH~TOMERCOPY [ END OF INVOICE ] 10:22am ALL PARTS NEW EXCEPT AS NOTED FISHERS ISLAND FERRY DISTRICT DAMAGE/ACCIDENT REPORT ~DateofOccurance: OZ -O~-- 15 RTimeofOccumnce: Trip: C~tain: ~. Mor3e.~ Weather and Sea Conditions: ~Vehicle Description: Manufacturer: Year: '7-0 Model: Color: B Owner Identification: Name: Cc~-~ Address: City: F~¢'C~ ~ Phone: FI Phone: Provide detailed account of incidem including accurate description of damage, how it occurred, burden of blame, witnesses, etc.. FISHERS ISLAND FERRY DISTRICT VENDOR 005289 CHRISTOPHER EDWARDS 04/09/2013 CHECK 1079 FUND & ACCOUNT P.O.# INVOICE DESCRIPTION AMOUNT SM .5712.4.000.000 123112 12 COMM MTG OCT-DEC(9) 450.00 TOTAL 450.00 Town of Southold, New York - Payment Voucher Vendor No. 5289 Vendor Tax D Number or Soc a Secur ~ Number Christopher I. Edwards Vendor Telephone Number Vendor Contact Vendor Address P.O. Box 167 Fishers Island, NY 06390 Check No. Entered by ' -x Audit Date APR 0 9 2013 [ Tovm,C[erk . Number Invoice Date 12131/2012 Invoice Net Total Discount Amount Claimec $450.00 $450.00 = ~ $450.001 $450.00 Payee Certification Ihc undersigned (Claimant) (Acting on behalf of the above narqed claimant) does bereby cerlit\ that the foregoblg clad'n 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 Purchase Order Number Description of Goods or geYx~rices General Ledger Fund and Account Number Commission Meeting SM5712.4.000.000 October- December 12 9 Mtgs @ $50/mtg Department Certification [ hereby certi~ that the materials above specified have been received b~ me in good condition without substitutiom the services proper}y perlbrmed and that the quantities thereof have been verified with the excepbons or discrepancies noted, and payment is approved ~eting Date 04t03tl 2 04/09/12 04/17/12 05/01/12 05/15/12 06/05/12 06/19/12 07/03/12 07/11/12 07/17/12 07118/12 07/19/12 07/21112 07/24/12 07/30/12 08/07/12 08/11/12 08/17/12 08/28/12 09/06/12 09/17/12 10~2~2012 10~2/2012 )/15~2O 12 )/24/2012 1/6/2012 /20/2012 2~4~2012 ~/18/2026 !/26/2012 Brooks, Robert 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 18 Burnham, David 1 1 1 1 1 1 1 1 ! 1 1 1 1 1 1 15 Edwards, Christopher 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 19 Herrick, Lucinda 1 16 Rafferty, Christopher 1 1 1V 1 I 1 1V 1 1V 1 I 1 1 1 1V 1 1 1 I I 1 1 1 1 1 1 1 1V 1 1 20 Rugg, Peter Wall, Robert 3 4Q12 8 0 9 0 9 6 9 $400 $- g~ $450 $- $450 $300 $450 FISHERS ISLAND FERRY DISTRICT VENDOR 005442 EMPIRE DENTAL 04/09/2013 CHECK 1080 FUND & ACCOUNT P.O.~ INVOICE DESCRIPTION AMOUNT SM .9060.8.000.000 5085830 DENTAL PREMIUN-4/13 1,017.69 TOTAL 1,017.69 Sis .'OO~OBO"' ~:08 ~8 O0 ~ 50 B Town of Southold, New York - Payment Voucher Vendor Tax ID Number or Social Security Number Empire Beffcaf Vendor Telephone Number 800-928-6459 Vendor Contact Invoice Invoice Number Date 5085830 3/14/2013 Total P.O. BOX 202837 Department 83703 i Dallas, TX 76320-2837 $1,017.69 Discount Net Amount Claimer $1,017.69 Purchase Order Number $1,017.69 $1,017.69 Vendor No. ' 5442 Description of Goods or Services Check No. Entered by .... . Audit Date APR 0 9 2013 Town Clerk General Ledger Fund and Account Number SM9060.8.000.000 Payee Certification Thc undersigned (Claimant) (Acting on behalf of the above named claimant) does hereby certit~~ 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 _~-"'"'"'-~ Fitle Com a,, Name Dat ?, /? Department Certification [ hereby certif5 that the materials above specified have been received by mc m good condition without substitution, thc services properl3 performed and that the quantities thereof have been verified with the exceptions or discrepancies noted, and payment is approved . .mlgire, STATEMENT pACE EMPIRE PO BOX 856 MINNEAPOLIS MN 55440-O856 ACCOUNT NAME ACCOUNT # BILLING DATE BILL/PYMT ENROLLMENT FISHERS ISLAND FERRY DISTRICT ENY4561251 03/14/2013 877-506-3408 800-928-6459 FISHERS ISLAND FERRY DISTRICT ATTN: ASSISTANT MANAGER DEBBIE DOUCE 261 TRUMBULL DR PO BOX 607 FISHERS ISLAND NY 06390 REMIT TO: EMPIRE DENTAL PO BOX 202837 DEPARTMENT 83703 DALLAS TX 75320-2837 INVOICE TRANSACTION TRANSACTION DUE REFERENCE TRANSACTION AMOUNT NOMBER DATE DATE AMOUNT DUE 5085830 03/14/2013 INVOICE 04/01/2013 O1/APR/13 30/APR/13PREMIU 1,017.G9 1,017.69 CURRFN7 [DUE PAST DUE TOTAL AMOUNT DUE 1 30 DAYS 31 - 60 DAYS 61 90 DAYS OVER 90 DAYS 1,017.69 0.00 O.O0 0.00 0.00 1,017.69 AMOUNT REMITTED YOUR BALANCE IS DUE BY THE FIRST OF THE MONTH. PLEASE INCLUDE A STATEMENT COPY WITH YOUR PAYMENT s Empire INVOICE EMPIRE PO BOX 856 MINNEAPOLIS MN 55440-0858 ACCOUNT NAME ACCOUNT # BILLING DATE BILLING/PYMT FISHERS ISLAND FERRY DISTRICT ENY4561251 INVOICE# 5085830 03/14/2012 SUBSCRIBER PERIOD 04/01/2013 04/30/2013 877-606-3409 CLAIM PERIOD FISHERS ISLAND FERRY DISTRICT ATTN: ASSISTANT MANAGER DEBBIE DOUCETTE 261 TRUMBULL DR PO BOX 607 FISHERS ISLAND NY 06390 REMIT TO: EMPIRE DENTAL PO BOX 202837 DEPARTMENT 83703 DALLAS TX 75320-2837 CUSTOMER NUMBER OF CURRENT NUMBER OF CLAIM ADJU$?MENT RATE TOTAL REPORTING NUMBER EMPLOYEES CLAIMS AMOUNT AMOUNT AMOUNT AMOUNT 456125-0001-0001-550 17 338.22 3?.58/ER/MO 383.40 76.68/EE/MO 91.89 279.34 139.6?/RE/MO -75.16/RETRO 1.017.69 INVOICE TOTAL 17 0 $0.00 $0.00 $1,017.69 $1,017.69 YOUR BALANCE IS DUE BY THE FIRST OF THE MONTH. PLEASE INCLUDE A STATEMENT COPY WITH YOUR PAYMENT. SUBSCRIBER LISTING EMPIRE PD BOX 856 MINNEAPOLIS MN 55440-0856 ACCOUNT NAME ACCOUNT # BILLING DATE ENROLLMENT FISHERS ISLAND FERRY OISTRICT ENY4561251 INVOICE # 03/14/2013 SUBSCRIBER PERIOD 800-928-6459 5085830 04/01/2013 - 04/30/2013 FISHERS ISLANO FERRY DISTRICT ATTN: ASSISTANT MANAGER DEBBIE DOUCETTE 261 TRUNBULL DR PO BOX 607 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 AMOUN- AMOUNT ~,MOUNT BARRETT FREDERICK N/A 883Ml1083 05/01/2011 EMPLOYEE 37.58 BROWN DONALD N/A 895Ml1083 05/01/2011 EMPLOYEE+SPOUSE 76.68 BURKE STEPHEN N/A 648M11229 05/01/2012 EMPLOYEE 37.58 BURNS RONALD N/A 484Ml1357 01/01/2013 EMPLOYEE+SPOUSE 76.68 FLORA MICHAEL N/A 878Ml1083 05/01/2011 EMPLOYEE 37.58 FOLEY PAUL N/A 877Ml1083 05/01/2011 EMPLOYEE 37.58 FORD POLLY N/A 337M11227 04/01/2012 FAMILY 139.67 HILLER dONATHAN N/A 262Ml1092 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 881Ml1083 05/01/2011 EMPLOYEE 37.58 LYNCH MATTHEW N/A 880Ml1083 01/31/2013 EMPLOYEE MARKS dASON N/A 626Ml1227 04/01/2012 EMPLOYEE 37.58 MARSHALL dESSE N/A 896Ml1083 05/01/2011 EMPLOYEE+SPOUSE 76.68 MORGAN dOHN N/A 897Ml1083 05/01/2011 EMPLOYEE+SPOUSE 76.68 MURPHY GORDON N/A 095Ml1203 03/01/2012 FAMILY 139.67 SCHMIB NINA N/A 898Ml1083 05/01/2011 EMP+CHI LD(REN) 91.89 TRAUB dAMES N/A 879Ml1083 05/01/2011 EMPLOYEE 37.58 1 EMP+CHILD(REN) 91 .89 0.00 91.89 SUBSCRIBER LISTING P, cE 2 EMPIRE PO BOX 856 MINNEAPOLIS MN 55440-0856 ACCOUNT NAME ACCOUNT # BILLING DATE ENROLLMENT FISHERS ISLAND FERRY DISTRICT ENY4561251 INVOICE # 03/14/2013 SUBSCRIBER PERIOD 800-928-6459 5085830 04/01/2013 - 04/30/2013 CUSTOMER REPORTING NUMBER SUBSCRIBER EFFECTIVE COVERAGE CURRENT RETRO TOTAL LAST NAME FIRST NAME REF # ID DATE TYPE AMOUNT AMOUNT AMOUNT 9 INDIVIDUAL 338.22 75.16 263.06 5 EMPLOYEE+SPOUSE 383.40 0.00 383.40 1 EMP+CHILD(REN) 91.89 0.00 91.89 2 FAMILY 279.34 0.00 279.34 GRAND TOTAL FOR ALL TF CUSTOMER REPORTING NUMBERS 17 1,092.85 -75.1B 1,017.B9 ENROLLMENT CHANGES MUST BE RECEIVED AT LEAST 5 BUSINESS DAYS PRIOR TO YOUR SCHEDULED BILL RUN DATE. TIME IS MONEY!! ..... and here is a way to save a little of both! Using ACH (Automated Clearing House) to pay your dental premiums has clear advantages over the traditional method of writing a check each month. · Good for the environment - go green and save paper and ink · Convenient- save time, no manual check writing/signing process · Reliable - payments are made on the 1st business day of each month. Ensures timely crediting to your account. · Cost effective - no more check or postage expense Automated Clearing House Authorization Agreement for Fully Insured Groups Company Name authorizes the charge to our bank account through the Automated Clearing House (ACH) for the Total Amount Due according to our Invoice/Statement. Premium will be taken on the first business day of each month. Group Number ACH Effective Date Bank Name Bank Address Bank Account Number Type of Account Bank Account Name Bank Routing Number [] Checking [] Savings (The nine-digit routing number is found between the barcode symbols at the bottom of your check.) Note: A voided check may be included with this form, but is not required. Authorized Individual of the Account Print Signature Today's Date Title Telephone # Email Address Questions? Please call our Billing and A/R Department at: 1-877-606-3409. Please complete this form and fax to us at: 1-877-803-2433 or mail to PO Box 1171, Minneapolis, MN 55440-1171. STATEMENT ACCOUNT NA~E FISHERS ISLAND FERRY DISTRICT ACCOUNT ENY456!28I BILLING DATE 03/14/2013 BILL/PY~T INQUIRIES 877-606-3409 ENROLLMENT INQUIRIES 800-928-6459 ~MPIRE DE.'~fA-L PO BOX 202837 DEPARTMENT 83703 DALLAS TX 75320-2837 1,017.69 AMOLr~ REMI ]IRED SUBSCRIBER LISTING EMPIRE PO BOX 836 i~'VOICE 508583~ SUBSCRIBER P~RTOD 04/0Z/2013 - 04/30/2013 SUBSCRIBER LISTING Eh~. SLI/~ENT CH/I.NGES MUST BE RECEIVED AT ~EAST 5 BUSINESS DAYS Em fre INVOICE EMPIRE PO SOX 856 MINNEAPOLIS .~ 55440 0956 FISHERS ISL~ FERRY DISTRICT-BROKER ATTN: 5LRRY CENTER 261 TRUMBULL DR PO BOX 607 FISHERS ISLED NY 06390 ACCOLrN? NAbIE FISF~-RS ISLAND FERRY DISTRICT ACCOLR~T ENY4581251 INVOIC~ 5085830 BII*LING D~rE 03/14/2013 SUBSCRIBER PERIOD 04/01/2013 - 04/30/2013 BILLINO/PYMT INQUIRIES 877 606-3409 CLAIM PERIOD REMIT TO: EMPIRE DENTAL P0 BOX 202837 DEP~TMENT 83703 DALLAS TX 75320-2837 456128-0001-0001 550 17 338.22 37.58/EE/MO 76.68/EE/MO 139.67lEE~MO YOUR BALO~CE IS DUE BY THE FIRST OF THE PLEASE INCLUDE A STATEMENT COPY WITH YOUR PAYMENT. FISHERS ISLAND FERRY DISTRICT VENDOR 006155 FEDEX 04/09/2013 CHECK 1081 FUND & ACCOUNT P.O.g INVOICE DESCRIPTION A]MOLrNT SM .5710.4.000.000 2 203 00905 AIRBILLS PAYROLL,W]~RRANT 107.17 TOTAL 107.17 ONE HUNDRED SEVEN ~ t7/t00 DOL~E TOTHE IORDER PO BOX i OF PITTSBURGH PA t5250-7461 04/O 9/2013 $107.17 · Vendor N o. Town of Southoid, New York - Payment Voucher 6155 Vendor Tax [D Number or Social Securit~ Number Vendor Name Fedex Vendor Telephone Number 800-622-1147 Vendor ~'ontact Vendor Address P.O. Box 371461 Pittsburgh, PA 15250-7461 Check No. IOgl Entered by Audit Date APR 0 9 ~013 Town Clerk -- '/! Invoice lnxoice Invoice ] Purchase Order I : Number Date lotal Discount Number Description of Goods or Sen'ices General Ledger Fund and Account Number SM5710.4.000.000 2-203-00905! 3/1112013 $107.17 Net ~Amount Claimed $107.17 Airbills-PayrolI,Warrant I $i07.17 $107.17: Payee Certification The undersigned (Claimant) (Acting on behalf of the aboxe named claimant I does hemb~ ccrli[~ that the tbregoing claim is true and correct, that no pan has been paid, except as therein stated, that the balance therein stated is act uallx due and oxxing, and that taxes t¥om x~hich the [ m~m is exempt are excluded Signature ~ i die_ Department Certification I hcreb5 certi~ that the materials above specified have been received b5 me m good condition without substitution, the sen, ices properly perfbnned and that thc quantities thereof have been verified witl~ the exceptions or discrepancies noted, and payment is approx ed Signature ~ - lille /; - [)ate ~' ' ~.~3 Invoice Number 2-203-00905 Invoice Date '~ [ Account Number '~ Page Mar 11, 2013 1206-0334-5 1 of 5 FedEx Tax ID: 71-0427007 Billin§ Address: FISHERS ISLAND FERRY 01STRICT DEB E]OUCETTE PO BOX H FISHEF~S ISLAND NY 06390-0607 Invoice Summary Mar 11, 2013 Shippinq Address: FISHERS ISLAND FEF~RYTERMINAL 5 WATERFRONT PARK NEW LONDON CT 06320 Invoice Questions? Contact FedEx Revenue Services Phone: (800) 622-1147 M-Sa 7-6 (CST) Fax: (800) 548-3020 Internet: www fedex corn FedEx Express Services T;ansportation Charges 11070 Base E}iscount 1346 Special Handling Charges 993 Total Charges USD $10717 TOTAL THIS INVOICE USD $107.17 You saved $13 46 in discoul;ts this period! Oth@r discounts may apply. Detailed descriptions of surcharges can be located at fedex.corn Invoice Number Adjustment Request Fax to (800) 548-3020 2-203-00905 Invoice Date '~ [ Account Number '~ Pa§e Mar 11,2013 1206-0334-5 2of5 ' 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 www.fedex.com or calling 800.622.1147. Please use multiple forms for additional requests. ]~i ~ C Please complete all fields in black ink. o n Request°rNamel I I I I I I I I I I I I I I I I I I I I I I I [ [ [ [ oatel I Il( I Ill I I~ t a Phone I I I I-I I I /-I I I I I Fax#1 I I I-I I I IJ I I I I c t E-mail Address E~Yes, I wantto update account contact with the above inlormation R Tracking Number ellllllllllllllll PIIIIIIIIIIIIIIII IIIIIIIIIIIIIIIII Sllllllllllllllll Bill to Account I I I I I I I I I I I I I I I I I I I I I I I I I I I I ! I I I I I I I I I I I $ Amount I I I I I I-I I I I I I I I I-I I I I I I I I I.I I I I I I I I I.I I I ADR - Address Correction oc DVC- DeclaredValue d. lAN- InvalidAcct# INW -Incorrect Weight INS - Incorrect Service OCF- Grd Pick-up Fee OCS- Exp Pick-up Fee OVS - Oversize Surcharge RSU- Residential Delivery PND - Pwrshp Not Delivered SaR - Saturday Delivery For all Service failures or other surcharges please use our web site www.fedex.com or call (800)622-1147 : Rerate information only (round to nearest inch) C Tracking Number Code SAmount LBS L W H r ti I I I I I I I I I I I I I I I I I I I I I I I I I-I I I I I II I I Ixl I I Ixl I I si I I I I I I ] I I I I I I I ] I I I I I I I I I I.I I I I I II I I Ixl I I Ixl I I Invoice Number 2-203-00905 FedEx Express Shipment Summary By Payor Type "~ l Invoice Date '~ Account Number '~ Page' Mar 11,2013 1206-0334-5 3of5 FedEx Express Shipments (Original) Hated Weight Transportation Payor Typo Shipments lbs Cha~ges Shipper 1 2.0 2400 Recip~em 4 20 86,70 Total FedEx Express $ 4,0 $110i70 Special Handling Ret Ch~ax Charges Credits/Other Discounts Total Cha~ges 2.16 -240 2376 777 -11.06 8341 $9.93 -$13A6 $107,17 Total This Invoice USD $107.17 InvoiceNumberlllnvoiceDateI AccountNumber1 Page 2-203-00905 M a r 11,2013 1206-0334-5 4 of 5 FedEx Express Shipment Detail By Payor Type (Original) Picked uP Feb 2~,20i'~ C~ R~i!!NO REFERENcEiNFORMAT]ON Def.#2: PaYor:Shipper Automation NSAB Sender Recipient Tracking LO 875071430772 GS MORPS BEET BEPT TOWN OF SECTHBLD Service Type FedEx Priority Overnight FISHERS ISLAND FERRY TERMINAL 54375 MAIN RD Package Type FedEx Pak 5 WATERFRONT PARK SOUTHOLB NY 11971 US Zone 02 NEW LONDON CT 06320 US Packages Rated Weight 20 lbs, 0 9 kgs Delivered Feb 22, 2013 11:08 Transportation Charge Svc Area AM Discount Signed by O.WHITECAVAGE Fuel SurcDarge FedEx Use 005203232/0001486, Total Charge USD 24.00 2 40 216 $23,76 Shipper Subtotal USD Dropped off: Feb 13; 20~3 Payor: Recipient · FuelSL~rcharge FedExhasappliedafuelsurchargeoll000%tothissllipment · Distance Based PricingrZone 2 Automation USAB Tracking id g01403333568 Service Type FedEx Priority Overnight Package Type FedEx Envelope Zone 02 Packages I Rated Weight N/A Delivered Feb 14, 2013 09:38 Svc Area A4 Signed by M JIM FedEx Use 06¢A41939/0000186/ Dropped off: Feb 25; ~013 Payor: Recipient · RmlSurcharge FedExhasappliedafLpersurchargeolT000%[oBlissilipment · Distance Based Pricing, Zone 2 Cust Ref NO REFERENCE NFORMATION Refit; Ref.#3i Sender Recipient DIANA WHITECOVAGE DON LAMB TOWN OF SOUTHOLD FI FERRY DISTRICT 53095 ROUTE 25 5 WATERFRONT PK SOUTHOLD NY 11971 4642 US NEW LONDON CT 06320 US Transportation Charge Fuel Surcharge Discount Total Charge USD CUst, Refj ['JO REFERENCE NFORMATION Ref.#2: Ref;#3: Automatim~ USAB Sender Tracking iO 80140B323579 JANtCE L FOULIA Service Type FedEx Priority Overnight TOWN OF SOUTHOLD Package Type FedEx Pak 53095 ROUTE 25 Zone 02 SOUTHOLD NY 11971-4642 US Packages 1 Rated Weight lO lbs, 05 kgs Delivered Feb 26, 2013 0937 Transportation Charge Svc Area PM Fuet Surc0arge Signed by M RAY Biscount FedEx Use 005647672/0001486/_ Total Charge Recioient DONALD LAMB FISHER ISLAND FERRY DISTRICT FISHERS ISLAND NY 06390 US USD $23 19 80 1,66 3.17 $18.Z9 23.55 2.36 $23.31 2-203-00905 Mar 11~ 2013 1206-0334-5 Dropped off Feb 27, 20i3 cust Rofg NO REFERENCENFORMAT ON Ref.#2: Automation USAB Tracking ID 801403333580 Service Type FedEx Priority Overnight Package Type FedEx Envelope Zone 02 Packages 1 Rated Weig0t N/A Delivered Feb 28, 2013 09:34 Svc Area A4 Signed by M RAY FedFx Ose 00585137210000186/_ DIANA WHITECAVAOE TOWN OF SOUTROLD 53095 ROUTE 25 SOUTBOIB NY 11971 4642 US Recipie~ DONALD LAMB CR 5 WATERFRONT PK NEW LONDON CT 06320 US Transportatiml Charge FuefSurcharge Discount Total Charge Dropped olI:M ar 07, 2013 Cust. Re1.: NO REFERENCE INFORMATION Ref,#2: Payor: Recipient Ref,#3: · The packagewe,ght exceeds the maximm~l for the packaging type the,efOrerFedEx Envelope was rated as FedEx Pak USD Recipient DONALD LAMB FISHERS ISLAND FERRY DISTRICT FISHERS ISLAND NY 06390 US Automation USAB S_e_nd e~r Tracking ID 801403333903 JANIEL L FOGLIA Service Type FedEx Priority Overnight TOWN OF SOUTHOLD Package Type FedEx Pak 53095 ROUTE 25 Zofle 02 SOUFHOLB NY 1197] 4642 US Packages I Rated Weight ] glbs, 05 kgs DelNered Mar 08, 2013 1026 Transportation Charge Svc Area PM Discount Signed by P FORD Fuel Surcharge FedEx/Jse 006668336/0001486/ Total Charge Page 50f5 1980 166 311 $18.29 2355 2 36 2 33 USD $23.52 Recipient Subtotal USD $83.41 Total FedEx Express USD $107.17 ......... 8750 7143 0772 Express OTry FedEx' OuickShip at fedex.com Access the shipping tools you need directly from Microsoft® Office Outlook~ 0200 6 Special Handling and Deliver/Signature Options FISHERS ISLAND FERRY DISTRICT VENDOR 006339 FISHERS ISLJ~ND ELECTRIC CORP. 04/09/2013 CHECK 1082 FUND & ACCOUNT P . O · ~ INVOICE DESCRIPTION AMOUNT SM .5710.2.000.100 SM .5710.2.000.100 471 MU LIFTING LIFE RAFT 195.00 471 MU-DIGGER DERRICK TRK 85.00 TOTAL 280.00 TWO HUNDRED EIGHTY AND ~l/t00 DOLLARS [P,4Y ~TO THE ORDER OF FIS~rERS ISL4%NDEL~ICCoRP. PO D~AWER ~ FISHERS ISLAND NY 06390 Vendor No. Town of Southold, New York - Payment Voucher Vendor Tax D Number or Social Security Number Vendor Name Fishers island Electric Corp. Vendor Telephone Number 6339 631-788-7251 Vendor Contact Vendor Address I P.O. Drawer E Fishers island, NY 06390 Check No. Invoice Net ! Purchase Order $85.00 $85.00~ Entered by r~'-"~ Audit Date APR 0 9 2013 Town Clerk Invoice I Invoice Number Date Description of'Goods or Services General Ledger Fund and Account Number 47t 3/12/2013 MUNN Lifting life raft off SM6710.2.000.100 SM5710.2.000.t 00 digger derrick truck e-9 due and owing, and that taxes from which the Town is exempt are excluded Signature ~--~"'"~---~J~e ~ Department Certification l hereby certif5 that the materials above specified have been received by me m good condition without substitution, the set,rices properN performed and that the quantities thereof have been verified with thc exceptions or discrepancies noted, and payment ~s approved Fishers Island Electric Corp. Drawer E Fishers Island, NY 06390 Invoice Date Invoice # 3/12/2013 471 Bill To Fishers Island Ferry Distric~t Drawer H Fishers Islm~d, NY 06390 P.O. No. Terms Project 2244 Quantity Description Rate Amount 3 LIFTING LIFE RAFT OFF O]F M.S. MUNNATAWKET 65.00 195.00 DIGGER DERRICK TRUCK E-9 85.00 85.00 Total $280.00 FISltERS ISLAND FERRY DIS]IRICT VENDOR 006374 FISHERS ISLAND WASTE NL~NAGEMNT 04/09/2013 CHECK 1083 FUND & ACCOUNT P.O.~ INVOICE DESCRIPTION AMOUNT SM .5710.4.000~925 3430 APPLIANCE WITH FREON 25.00 TOTAL 25.00 TWENTY Ftlr~ ~3' OG/100 DO~S- P~4Y ORDER OF FIS~{~S ~i~L~ WASTE F~NAGEMNT PO BOX 22 FISH~S IS~ NY 06390 04/09/2C 15 1083 $25.00 Vendor No. Town of Southold, New York - Payment Voucher 6374 Audit Date A?R 0 0 2013 Town Clerk Vendor Tax ID Number or Social Scour ) Numbe FI Waste Management District Vendor Telephone Number 631-788-7455 Vendor Contact Beth Stem Vendor Address 2760 Whistler Avenue PO Box 22 Fishers Island, NY 06390-0022 Invoice Invoice Invoice i Net ; Purchase Order Number Date 'I otal Discount Amount Claimed Number Description of Goods or Serdces General Ledger Fund and Account Number 3430 2/22/2013 $25.00 $25.00 Appliance with Freon SM5710.4.000.925 [ $25.00 $25.00 Payee Certification The undersigned (Claimant) (Acting on behalf of the above named claimant) does hereby ceftin, that the ~b~egoing 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 rkom xqaich the Town ~s exempt are excluded Department Certification I hereby certify that the materials above specified have been received by me m good condition without substitution, thc services properly pert'ormed and that the quantities thereof have been verified with thc exceptlons or discrepancies noted, and payment is approved Signature ' .~77 Fide ~ Z Date ~ ~ , ~ ['Fl WASTE MANAGEMENT DISTRICT PO BOX 22 'FISHERS ISLAND, NY 06390-0022 Invoice Date Invoice # Bill To Il FERRY DRAWl- R 11 IIStIF:RS ISI,ANI). NY 0o~oll Item Description Qty Rate Disposal date Amount I RF( iN API'I,IANCI,: Wlll l [,'RE()N 25.00 25.(Ifl Tota I ,:~ Customer Total Balance ~2~), Fishers Island Waste Management ()ffice: 788-7455 Compost Station: 788-7227 Customer Visit Form Bill to / Date & Time Total Yard Waste Pickup truck $10.00/Per Cubic Yd. $10.00 Construction Debris Per cubic yard $40.00 Pallets each $5.00 Household Items Carpets over 5'x 8' $10.00 Stuffed chair, sofa, similar furniture $10.00 Twin mattress or box spring $30.00 Double, queen, king mattress or box spring $35.00 Appliances i.e. washer, dryer, stove $10.00 / Freezer, icemaker, A/C, dehumidifier (freon) $25.00 E-Waste Electronics (computers, printers, computer monitors, televisions, etc) $25.00 Signature NO HAZARDOUS WASTE ACCEPTED Quality Printers · 443-2800 · Form 2071 rev 8/12 FISHERS ISLAND FERRY DISTRICT VENDOR 006482 PAUL J. FOLEY 04/09/2013 CHECK 1084 FLrND & ACCOLrNT P.O.~ INVOICE DESCRIPTION AMOUNT SM .9060.8.000.000 SM .9060.8.000.000 040113 3307000851 REIMB RX-APR'13 90.63 REIM 2ND QTR STND ALONE 459.95 TOTAL 550.58 AUDIT 4/9/13 CHECK NO. 10E4 [ FIVE HUNDRED ~I~T%f?~ID 58/100 DOLLARS' %- PAY PAUL J ~O~SrH 690 WILL ORDgR OF NEW LONDON C~ 06320 ,'O0;.O~.L.," 1:O~.~.05L. r~L.': r~. 001.50;~ Town of Southold, New York - Payment Voucher Vendor Tax iD Number or Social S¢curit) Number Vendor Address i690 Williams Street Paul J. Foley Vendor Telephone Number Vendor Contact Vendor No, 6482 iNewLondon, CT 06320 Invoice Invoice Number Date 4/1/2013 Total Discount $90.63 Net [ Purchase Order Amoun C a[medi Number $90.63! Description or'Goods or Services Anthem Retiree Prescription Plan 90% Reimbursement $100.70 less 10% ($90.63) Paul Foley Ck #2260 Check No. iOt~q Audit Date APR 0 9 2013 Town Clerk General Ledger Fund and Account Number SM9060.8.000.000 Signature ~_ Title Payee Certification The undersigned (Claimant) (Acting on bebalf of the above named claimant) docs hereby certi~ that the Ibregoing claim is true and correct, that no part has been paid, except as therein stated, that the balance therein stated is actually ch,e and owing, and that taxes ~?om ~hich thc Town is exempt are excluded Department Certification I hereby certif> that the materials above specified have been received by me ~n good condition without substitution, the services properly perlbrmed and that the quantities thereof have been verified with the exceptions or discrepancies noted, and pabment m approved T $90.63 $90.63 i Customer Care: 1-888-620-1747 AT 01 038463 28133B123 A**31)GT PAUL J FOLEY 690 WILLIAMS ST NEW LONDON CT 06320-4132 Anthem . . I Blue MedicareRx'(PDP) $100.70 04/01/2013 G0230330801-- Pa~yment Options · For check payment or automatic withdrawal from your bank account (ACH), use the form below. · For cre&t card payment or withholding from your SSA/RRB check, call 1-888-620-1747. · For one time credit card~ayment throughh our automated system, call 1-877-358-6792. Previous Balance $100.70 Payment Activity Since Last Invoice -$100.70 Payment Type Amount Check Payment 00002252 -$100.70 Activity Detail $100.70 Date Received 02/19/2013 Transaction Type Premium Amount Due Premium Month APRIL 2013 Amount $100.70 $100.70 PAUL J. FOLEY 690 WILLIAMS ST. 2260 I',IEW LONDON, CT 06320 Order °f~~~ ~td'~ Town of Southold, New York - Payment Voucher Vendor Tax ID Number or Social S¢cufib Number Vendor Address 690 Williams Street Paul J. Foley Vendor Telephone Number Vendor Contact New London, CT 06320 Vendor No. 6482 Check No. Entered by Audit Date APR 0 9 2013 Town Clerk Invoice Invoice Number D~t¢ 3307000851 ~ Invoice Net Purchase Order Iotal Discount Amount Claimed Number Description of Goods or Services General Ledger Fund and Account Number $459.95 $459.95 Anthem BC/BS 8M9060.8.000.000 Ret ree Stand A one 90% Reimbursement 511.05 Less $51.10 Paul Foley Ck # 2259 i Quarterly 4/1/13-6/30/13 $459.95 Payee Certification $459.95 Department Certification Iht undersigned (Claimant) (Acting on behalf of thc above named claimant) does hereby certi$, that the foregoing claim is true and correct, that no pall has been paid, except as therein stated, that the balance therein stated is actually due and owing, and that taxes thom x~hich the Town ~s exempt are excluded Signature ~ Title I hereb5 cerd~ that the materials above specified have been received by me m good condition without substitution, the serx/ces properb perth*treed and that the quantities thereof have been verified with the exceptions ar discrepancies noted, and pa)ment is approved rifie . Date Anthem 37o, ,c,tRo d North Haven, CT 064734201 00090 INDIVIDUAL MARKET INVOICE h.H.Imm,.Ih.lqmdhh,. .. illllq..rl".llql.,d,.H #CTBSAOO~RCT:L# 000090 05121~ 0S1~1~ PAUL J FOLEY 690 WILLIAHS ST NE~ LCi~N CT 06S20-~132 Si nece$ita ayuda en espafiol para entender este documento, puede solicitarla sin costo adicional, Ilamando al n0mero de servicio al cliente que aparece al dorso de su tarjeta de identificaciOn o en el folleto de inscripci6n. MEMBER NO: MEMBER: INVOICE NO: BILLING ACCT NO; 0864N20101 PAUL J FOLEY 3307000851 7010864920101 PRODUCT ICLASS I PERIOD COVERED I AMOUNT MEDIGAP PLAN N,COPAY ~20. 1 04/01/2013 - 06/30/2013 + t511.05 TOTAL ANOUNT DUE BY APRIL 1, 2013 If you have any questions regarding this invoice or your coverage with Anthem Blue Cross and Blue Shield, please call our de¢!icated Customer Service Unit during normal business hours Monday through Friday. The toll flee number is 1-800-633-6673 . BO1B619910830305[]B4000070108649201013003307000&51031213001095OflOff1511056 PAUL J. FOLEY 2259 690 WILLIAMS ST. 51-721B~211 NEW LONDON, CT 06320 /~/ Order of ' , ~122;[72~&hm: ;;5OqO2 [ 2a,' 225q FISHERS ISLAND FERRY DISTRICT VENDOR 009682 GOOSE ISLAND CORP 04/09/2013 CHECK 1085 FUND & ACCOUNT P.O. ~ INVOICE DESCRIPTION AMOUNT SM .5710.4.000.200 SM .5710.4.000.200 SM .5710.4.000.200 27100 99.5 GAL ~2 FUEL OIL 496.51 27367 100.1 GAL g2 FUEL OIL 499.50 27378 150.1 GAL ~2 FUEL OIL 749.00 TOTAL 1,745.01 NO. 1085 - 04/09/2013 $1, 745 ONE THOU~dk%~D S~'VEN H~D~ORTY FIVE AND?~Jt0~) DOLLARS P~4Y TOTHH ORDF~ OF CORP 'ION ,'O0~ORS,' .:O~;.L. OSh~.[.,: r~P. 00~50~ ~,' Vendor No. Town of Southold, New York - Payment Voucher 9682 Vendor Tax ID Number or Social Securi~ Number Vendor Address 1633 Central Avenue P.O. Box 49 Fishers Island, NY 06390 Vendor Name Goose Island Corporation Vendor Telephone Number 631-788-7311 Vendor Contact Invoice Invoice Number Date 27100 ~ 3/4/2013 Total Discount Net AmoLmt Claimed Purchase Order I Number [ Description of Goods or Sop, does No. 1055 Entered by Audit Date APR 0 9 2013 Town Clerk Genera} Ledger Fund and Account Number $496.51 $496.51 99.5 gals @ $4.99 :~: 1 v~ / SM5710.4.000.200 27367 3/7/201: $499.50 $499.50 100.1 gals 1~ $4.99 ~. ~ .~ ~< f SM5710.4.000.200 27378 3/13/2013 $749.00 $749.00 150.1 gals @ $4.99 ~ :.' i cfi SM5710.4.000.200 $1,745.01 , $1,745.01. Payee Certification /he undersigned (Claimant) (Acting on behalf of the above named claimant) does hereby ccrtif5 that thc lbregoing claim is true and correct, that no part has been paid, except as therein stated that the balance therein stated is actuall? due and owing, and that taxes from which thc 'town is exempt are excluded Department Certification I hereby ceftin}, that the materials above specified have been received by me in good condition ~.ithout substitution, the services properly performed and that the quantities thereof have been verified with the exceptions or discrepancies noted, and pabment ~s approved GOOSE ISLAND CORP. ?' , P.O. BOx49 (F)31) 788-7311 Dyed unmarked Heating Oil: Not for use in highway or non-highway, locomotive or marine engines. GOOSE ISLAND CORP. P.O. Box49 FISHERS ISLAND, NEW YO~K 06390 (6~1) 788-7311 [] Dyed unmarked Heating Oil: Not for use in highway or non-highway, locomotive or marine envines. METER READING START OF DEL E 27:)67 4MENT RECEIVED G CASH F~ 0HECK TAX TOTAL DELIVERY RECEIVED PER ABOVE METER READING 27100 $ Lq c^~. Cq ¢.EC,< TAX / X TOTAL r/~)., ~'/ -- -- DELIVERY RECEfVED PER ABOVE METER READING GOOSE ISLAND CORP. P.O. Bex49 FISHERS ISLAND, ~ YORK 06390 (631) 788-731~ [] Dyed unmarked Heating Oil: Not for use in highway or non-highway, locomotive or marine engines. ~©~ 27378 G'oose Island Corporation 1633 Central Ave #49 Fishers Island, NY 06390-0049 Statement Date 3/] 1/2013 To: FI Feny District P.O. Box H Fishers Island, NY 06390 Amount Due Amount Enc. $1,985.47 Date Transaction Amount Balance 02/10/2013 Balance forward 839.71 02/I 1/2013 1NV #27009. Due 02/11/2013. 607.78 1.447,49 Office --- Fuel Oil, 121.8 (Q) $4.99 = 607.78 .... Tax: Exempt ~ 0.0% 0.00 02/20/2013 PMT #979. 2/12/13 -839.71 607.78 02/25/2013 [INV #1355018662. Due 02/25/2013. 131.68 739.46 --- Auto Pans. I ~ $68.18 = 68.18 .... Motor Vehicle lnspectiom I St) $21 21.00 --- Labor, I ,~z~ $42.5 = 42.50 --- Tax: Exempt ~ 0.0% = 0.00 (t2/26/2013 1NV #27077. Due 02/26/2013. 250.00 989.46 --- Fucl Oil, 50.1 5i! $4.99 - 250.00 --- Annex .... Tax: Exempt ~ 0.0% = 0.00 03/04/2013 !INV/427100. Due 03/04/2013. 496.51 1.485.97 --- Fuel Oil, 99.5 ~! $4.99 496.51 --- Tax: Exempt fa) 0.0% = 0.00 03/(17/2013 INV #27367. Due 03/07/2013. 499.50 1,985.47 --- Fucl Oil I O0. I f,,.~ $~ .09 --: 409.5,0 --- Annex-Nat Malinowski --- Fax: Exempt ¢~ 0.0% = 0.00 CURRENT 1-30 DAYS PAST 31-60 DAYS PaST 61-90 DAYS PAST OVER 90 DAYS Amount Due DUE DUE DUE PAST DUE 0,00 1,985.47 0,00 0.00 0.00 $1.985.47 G-oose Island Corporation 1633 Central Ave #49 Fishers Island, NY 06390-0049 Statement Date 3/13/2013 To: ]:1 Ferry District P.O. Box H Fishers Island, NY 06390 Amount Due Amount Eric. $2,734.47 Date Transaction Amount Balance 02/10/2013 Balance forward 839.71 02/I 1/2013 INV #27009, Due 02/I 1/2013. 607.78 1,447.49 ()ti~cc --- Fuel Oil. 121.8 ca) $4.99 - 607.78 --- Tax: Exempt (~'~ 0.0% 0.00 I)2/20/2013 PMF #979. 2/12/13 -839.71 607.78 I)2/25/2013 INV #1355018662. Duc 02/25/2013. 131.68 739,46 --- Auto Parts. I ~ $68.18 68.18 ---MotorVehiclclnspection, I (~$21 21.00 --- Labor, I ¢~ $42.5 = 42.50 --- Tax: Exe~npt (a! 0.0% 0.00 (12/26/2013 INV #27077. Due 02/26/2013. 250,00 989.46 ---FuelOil. 50.14)$4,99 250.00 --- Tax: Exempt r~ 0.0% 0.00 03/04/2013 INV #27100, Duc 03/04/2013. 496.51 1,485.97 --- Fuel ()il. 99.5 ~tz) $4.99 - 496.5 I --- Tax: Exempt (8~ 0.0% = 0.00 03/07/2013 INV #27367. Due 03/07/2013. 499.50 1,985.47 --- Annex-Nat Malinowski --* 'Fax: Exempt ~t} 0.0% = 0.00 I)3/13/2(}13 INV #27378. Duc 03/13/2013. 749.00 2,734.47 --- Fuel Oil. 150.1 fa) $4.99 - 749.00 --- Annex --- Fax: Exempt r(( 0.0% - 0.00 CURRENT 1-30 DAYS PAST 31-60 DAYS PAST 61-90 DAYS PAST OVER 90 DAYS Amount Due DUE DUE DUE PAST DUE 749.00 1.985.47 0.00 0,00 0.00 $2,734.47 FISHERS ISLAND FERRY DISTRICT VENDOR 011557 ANN KOWALCZYK-BAMKS 04/09/2013 CHECK 1086 FUND & ACCOUNT P.O.~ INVOICE DESCRIPTION AMOUNT SM .5710.4.000.600 033113 JANITORIAL-3/13 250.00 TOTAL 250.00 Vendor No. Town of Southold, New York - Payment Voucher Vendor Tax ID Number or Social Security Number Vendor Address P.O. Box 384 Vendor Name Fishers Island, NY 06390 Ann Kowalczyk Banks Vendor Telephone Number Vendor Contact Number Purchase Order Number Check No. Entered by Audit Date Invoice Invoice Date Total 3/31/2013 $250.00 $260.00 Payee Certification Net Discount ~,mount Claimed $260.00 APR 0 9 2013 Town Clerk Description of Goods or Services General Ledger Fund and Account Number Janitorial/March SM5710,4.000.600 I $250.00 The undersigned (Claimant) (Acting on behalf of the above named claimant) does hereby certify that the foregoing claim is tree and correct, that no part has been paid, except as therein stated, that the balance therein stated is actually due and owing, and that taxes tbom which the Town is exempt are excluded Department Certification I hereby ceftin,, tbat the materials above specified have been received by me in good condition without substitution, the services properly performed and that the quantities thereof have been verified with the exceptions or discrepancies noted, and payment }s approved Oate ZT,SL~,~ /.3 FISHERS ISLAND FERRY DISTRICT VENDOR 011564 THOMAS KRAFT 04/09/2013 CHECK 1087 FUND & ACCOUNT P.O.~ INVOICE DESCRIPTION AMOUNT SM .5710.4.000.300 7921 SM .5710.4.000.300 7921 SM .5710.4.000.300 7921 SM .5710.4.000.300 7921 MU-5224.9 GAL@S3.165300 16,538.38 CT EXCISE TAX-$.5120/GAL 2,675.15 S-F COST RECOVERY.0019 9.93 LUST TAX-$.0010/GAL 5.22 TOTAL 19,228.68 OF ,l'OOi, O87,T" I:OS~,hO5hf=[,,: &8 00~50~ ~l,, Town of Southold, New York - Payment Voucher Vendor Fax ID Number or Social Security Number 45-4111778 Thomas Kraft dba Dime Oil Company Vendor Telephone Number 203-754-5334 Vendor Contact Invoice I Invoice Number Date 7921 3/1512013 Invoice Total $16,538.38! $2,675.15 $9.93: ~.O. Box 11125 Waterbury, CT 06703 Net i Purchase Order Discount Amount Claimed Number Vendor No. 11564 $16,538.38 Description of Goods or Services MUNN 5224 9 Gas I~ $3.165300 I CT Excise Tax - $.5120/gal $2,675.15! $5.22! I-F Cost Recovery .00t9 $5.22 LUST Tax - $.00101gal i Check No. 10%"1 Entered by Audit Date APR 0 9 2013 Town Clerk General Ledger Fund and Account Number SM5710.4.000.300 $19,228.681 Payee Certification (~ The undersigned (Clatmant) (Ac mg on behalf of he abo~e nam~m ctmmant) does hereby cerfi~ 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 I oum is exempt are excluded Signature ~ Title Department Certification I bereb~, certi[v 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 Oiine Oil LLC Box 11125 Watel bury,CT 06703 Phone: 203-75~-533a Date: 03/15/2013 Fishers Island Ferry D~str'ict PO Box H Attn Accounts Payable Fishers Is]and~ NY 06S90- - ACCOUNT NUMBER: Fishers Island Ferry Dist 5 Water'front Park-Race Point~ New London AMOUNT ENCLOSED: b,~.20165 Ter'ms: NET 30 Days Fr'om Invoice Date Invoice Charges and Ct'eclats Amount 63 i!5"13 7921 Fuel Invoice Total 16/13 7921 ~2OR Off Road Diesel 522~.9 GALS @ 3.165300 16538.38 Dyed Diesel Fuel for Off Road Use ONLY, S~F Cost Recovery @ 0.0019 9.93 State Excise Tax DS[. @ 0,5120 2675,15 LUST TAX 8 0,0010 5,22 19228.68 19228.68 Amount Due **Please include account number with payment*** Fed ID~ ~5~111778 Oil LLC 203~756-5336 A<;<ouht: aa2o165 -- ,o.oo,, ,o.oo, o DIME OIL COMPANY, LLC P.O. BOX 11125 WATERBURY, CT06703 TMS~ ,I T~O~E~1 (203) 754-5334 TM ~rCAS~ CHECK RGE NEGOT-11/12 585.00 83298 CSEA GENERAL-ii/12 455.00 83298 GILBERTiCRAIG-11/12 735.00 TOTAL 2,662.50 TWO TH0~S2%~k~]3 ~IX HL~DRED ~t~TY TWO A/qD 50/1'(}O ~(~LLARS ORDER OF I2 3 lo8~ ~ OA~ CJ. ~MOUN~ , . Ii Payment Due Upon Receipt Interest at the rate of 1% per month will be charged on any statement 30days past due. bTSHERS ISLAND FERRY DISTRICT VENDOR 013054 MAPLE PRINT SERVICES, INC. 04/09/2013 CHECK 1089 FUND & ACCOUNT P.O.~ INVOICE DESCRIPTION AMOUNT SM .5711.4.000.000 1915 INSPECTION LABELS 332.00 TOTAL 332.00 BOX 1179 THE StJFFO LK CO. NATIONAL BANK THREE HUNDRED TIIIRTY TWO AND 00/~0 DOLLARS 04/09/2013 $332.00 pay MAPLE PRINT g~RVICES, INC, 1Q~ 255 ROUTE 12,~ITI~ 699 ORDER OF GROTON CT 06340 Vendor No. Town of Southold, New York - Payment Voucher 13054 Vendor Tax ID Number or Social Securiiy Number 255 Rt. 12, Suite 699 Groton, CT 06340 Maple Print Services, Inc. Vendor Telephone Number 860-381-5470 Vendor Contact Invoice Invoice Invoice Net Purchase Order Number Date Total Discount Amount Claimec Number 19t5 3/7/2013 $332.00 $332.00 Check No. $332.00 $332.00 Payee Certification The undersigaed (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 ~ ~j~ Title Signature Company Name / ~r./' Date Entered by Audit Date APR 0 9 2013 Town Clerk Description of Goods or Services General Ledger Fund and Account Number Inspection Labels SM5711.4.000.000 Department Certification Signature Title ~"-~"~ Date I hereby cerdfy that the materials above sp~citied 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. Maple Print Services Inc. ~,~55 Rt. 12 uite 699 Groton, CT 06340 Invoice Invoice No. 1915 Bill To: Fishers Island Ferry Fishers Island, N.Y. 06390 Date 03/07/13 lP;O. Number Terms Due Date 03/07/13 Item Descr!pti~n Quantity Amount Printing Inspection Labels 2,500 332.00 We now accept Visa, MasterCard and Discover. Total $332.00 FISHERS ISLAND FERRY DISTRICT VENDOR 013006 JESSE A. M3XRSHALL 04/09/2013 CHECK 1090 FUND & ACCOUNT P.O.g INVOICE DESCRIPTION AMOUNT SM .5710.4.000.950 032613 REIMB TWIC APP FEE 60.00 TOTAJ~ 60.00 slXTW Jn~D 00/100 O0hnA~g TOTH£ 575 'MONTkUR ~lr~N~ ~FRDER NEW LONDON CT 06320-~'~43 J~60, o o ."O0],OqO,' ':O~t, OSL, r~hl: gl% 00;,50~ ~"" Town of Southold, New York - Payment Voucher Vendor Tax ID Number or Social Security Number Vendor Address 112 Rlvervlew Ave., 04 Vendor Same New London, CT 06320 Jesse A. Marshall Vendor Telephone Number Vendor Contact Invoice Number Date Invoice Total Vendor No. 13006 Check No. Entered by ~ Audit Date APR 0 9 2013 Net Purchase Order Amount Claimed Number $60.00 Town Clerk Discount Description of Goods or Services General Ledger Fund and Account Number ~)~,~ 19 3/26/2013 $60.00 TWIC Application Fee SM5710.4.000,950 $60.00 $60.00 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 dtm and owing, and that taxes from which the Town is exempt are excluded~ Signat.re ~'~__~ Title Company Name~'~ fP Date Department Certification I hereby certi~ that the materials above specified have been received by me in good condition without substitution, the services properly performed and that the quantities thereof have been verified with the exceptions or discrepancies noted, and payment is approved Signature Title Date Page 1 of 1 Date: To: Subject: <noreply~payconnexion.com> Tuesday, March 26, 2013 8:48 AM <jmarshal175~holmail.com> Payment Conf'nnnation for TWIC Application Fee *** PLEASE DONOT RESPOND TO THIS EMAIL *** Thank you for submitting your payment for TWIC Application Fee. This email is to confirm that on Mas-26-2013, you authorized Lockheed Martin to charge the credit card Listed below on the scheduled payment date. Confirmation Number: LMCTSA001139852 Confirmation Date (ET): Mar-26-2013 08:47:53 AM Payer Name: Jesse Marshall Payment Amount: $60.00 Scheduled Payment Date: Mar-26-2013 Cardholder Name: Card Number: Card Type: Jesse Marshall XXXXXXXXXXXXX9078 Visa Credit If you have questions about this payment or need assistance please view thc payment online at hnps://v, wv..pa',connexion.com/pconWeb/custom/callCustomerScrvice, html, or call Customer Service at (866) 347-8942. Thank you for using the Lockheed Martin electronic payment system. 3/26/2013 tqSHERS ISLAND FERRY DISTIR1CT VENDOR 013682 PETER MROWKA 04/09/2013 CHECK 1091 FUND & ACCOUNT P.O.~ INVOICE DESCRIPTION ~24OUNT SM .5709.2.000.100 893 RELOCATE WARM AIR RETURN 130.39 TOTAL 130.39 AUDIT 4J9/13 CHECK NO. 1091 $130.39 p~y PEteR MROWKA lO'ITtE DBA PET~'S~ PLUMBING ORDER OF 95 M~ETINGHOUSE LANE LEDYARD CT 06339 Town of Southold, New York - Payment Voucher Vendor Tax ID Number or Social Security Number Vendor Address Pete's Plumbing and Heating Vendor Telephone Number 860-287-3782 Vendor Contact Invoice Invoice Number Date 893 3113120t3 $t30.39 96 Meetinghouse Lane Ledyerd, CT 06339 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 $t30.39 Vendor No. 13682 Description of Goods or Services Labor relocated return for warm air system Check No. /0ql Entered by ~k~ Audit Date APR 0 9 2013 Town Clerk $t 30.39 $130.39 Department Certification Signature ~ Title Company Name~'~ f/ Date General Ledger Fund and Account Number SM5709.2.000.t00 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 95 Meetinghouse Lane Ledyard, CT 06339 860.287.3782 Date 3/13/2013 Invoice Invoice # 893 Bill To Fishers Island Ferry District annex building Description Labor-relocated return for the warm air system, bled the furnace after running out oil (2x) Tax Amount 120.00 10.39 Total $130.39 P~e's Heating & Plumbing LLC 40126-MP FISHERS ISLAND FERRY DISTRICT VENDOR 015887 OXFORD HEALTH pLJ~NS 04/09/2013 CHECK 1092 FUND & ACCOLrNT P.O.~ INVOICE DESCRIPTION AMOUNT SM .9060.8.000.000 43412076 MEDICAL PREM LOW-4/13 2,370.78 SM .9060.8.000.000 43412078 MEDICAL PREM-HIGH-4/13 6,266.72 TOTAL 8,637.50 AUDIT A19/13 CHECK NO. 1092 [ jDAT~ I 'ArMOUNT , 0~/~9/2o13 $8,637.so EIGHT THOUSAND S~X~LTNDRED T~RT~U~2~D 50/100 ~L~S ~Y~7/H OXFORD H~q ~I~A~S PO B~X 1~95 ORDF~ N~RK NJ U210T-1697 OF Town of Southold, New York - Payment Voucher Vendor Tax 1D Number or Social Security Number Oxford Health Plans Vendor Telephone Number 888-201-4216 Vendor Contact Invoice Number Invoice Date Invoice Total Discount 43412076 4/1/2013 $2,370.78 Vendor Address PO Box 1697 Newark, NJ 07101-t697 Net Purchase Order Amount Claime~ Number $2,370.78 $6,266.72 Vendor No~ 5887' I che~k No. Entered by Audit Date APR 0 9 2013 Description of Goods or Services bledi¢al Premium for 4/13 Medical Premium for 4/t5 General Ledger Fund and Account Number 8M9060.8.000.000 43412078 4/112013 $6,266.72 8M9060.8.000.000 $8,637.50 $8,637.60 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 co~rect, 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 ~ Title ~ Company Name ~'- f~ 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 Unitedltealthcare' Oxford INVOICE SUMMARY Fishers Island Ferry District We encourage you to contact your Dedicated Client Service Manager (DCSM) at 558-2014215 with any questions regarding this invoice. Group Number Billing Group Coverage Period Invoice Number Due Date of Payment FI9458 BG02 04/01/2013 - 0413012013 43412076 April01,2013 Previous Balance Payments Received Debit Memos (See Memo Details on last page of this ~nvolce.) Credit Memos ..... (See Memo Details on last page of th~s ¢nvoice.) Total Balance Fo~,'ard ............. $ 5,04768 5,047 68 0 00 0 00 $ 0.00 Adjustments to Prior Bills .......... Totals by Contract Type - Current Premium 4 Single 1 Couple 1 Family 6 Total Healthcare Contracts Current Premium ............... $ -1,784.60 1.78460 981 53 1,389 25 4,155 38 $ 4,155.38 Total Balance Forward ......... Adjustments to Prior Bills ....... + Current Premium ............ Total Amount Due ......... $ 0.00 $ -1,784.60 $ 4,155.38 $ 2,370.78 070GBILLL21672101 JOBINA MILLER FISHERS ISLAND FERRY DISTRICT P O BOX 607 FISHERS ISLAND, NY 06390 tTHIS STATEMENT REFLECTS PAYMENTS RECEIVED BY OXFORD ON OR BEFORE 03/06/2013. Please write your account number on your check when submitting payment. MS-t2.39 Thank you for choosing Oxford. the total due. Any linancaal adjustment tbr Membership activity not displayed in this invoice summary will be reflected in a future invoice, ff 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 thc 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 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 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, end 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 tmderwritten 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-bout health care guidance with Oxford On-Call®, a wealth ofweliness resources, and online access at oxfordhealth.com, are just a few examples of our ongoing efforts to help our members live healthier lives. ~ Ilni~a,a~h~' O~o~ 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: 04/01/2013 to 04/30/2013 CURRENT PERIOD Social Subscriber Contract #of Coverage Current Subscriber Security# Name Type Membem Type Benefit Premium 1121103501 Brown, Donald C 2 CS02F HEALTHCR 98153 1121083801 Burke, Stephen S 1 CSP62 HEALTHCR 446 15 1121090301 Flora, Michael S 1 CSP62 HEALTHCR 446.15 1125766701 Glidewell, Logan S 1 CSP02 HEALTHCR 446.15 1121734601 Hoch, Richard 1121093501 Lynch, Mat~ew 1121094501 Marks, Jason S 1 CSP02 HEALTHCR 44615 1121096001 Murphy, Gordon F 3 CSO2F HEALTHCR 138925 Total .................................... $ 4,155.38 ADJUSTMENTS TO PR~OR BILLS TOTALS P®dod Code Premium TOTAL 991.53 44615 446 15 446 15 o?J01rz013-02/28/2013 SUBT -446 15 93/01/2013-03/31/2013 SUBT -44615 -89239 D?J01/2013 - 02~28/2013 SUBT ~615 O3/01/2013 - 03~31/2013 SUBT J,46 15 -892 30 446 15 1389.25 ........... $ -1,784.60 $ 2,370.78 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. 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 Coverage Period Invoice Number Due Date of Payment FI9458 BG01 0410112013 - 0413012013 43412078 April 01,2013 Previous Balance $ 6,266 72 $ 0.00 Payments Received . . 8,888.04 Debit Memos 000 (See Memo Ceta/Is on last page of this invoice, Credit Memos (See Memo Details on last page of this invoice Total Balance Forward ............. $ -2,62t.32 000 Adjustments to Prior Bills .......... Totals by Contract Type - Current Premium 7 Single 1 Couple 2 Family 10 Total Healthcare Contracts Current Premium ............... 4,034 38 1,267.96 3,585 70 8,888 04 S 6,688.04 Total Balance Forward ......... Adjustments to Prior Bills ....... + Current Premium ............ Total Amount Due ......... $ -2,621.32 $ o.oo $ 8,888.04 $ 6,266.72 JOBINA MILLER FISHERS ISLAND FERRY DISTRICT P O BOX 607 FISHERS ISLAND, NY 06390 THIS STATEMENT REFLECTS PAYMENTS RECEIVED BY OXFORD ON OR BEFORE 03/06/2013, Please wdte your account number on your check when submitting payment. MS- 2- 89 Thank you for choosing Oxford. the total due. Any tinancial 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 first of the ' month. The pu~ose 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 dependants 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 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 convert to an individual policy with Oxford. More information about this conversion option can be obtained by conlacting 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 ff 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 [~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 be continued on the other side. OUR GOAL IS HELPING PEOPLE LIVE HEALTHIER LIVES How do we do this? Better infotmatian. 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 gnidance 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.Iii Unitedltealthcare' 0~o~ Thank you for choosing Oxford. INVOICE DETAILS Fishers Island Ferry District HIGH PLAN Coverage Period: 04/01/2013 to 04/30/2013 Page 1 of 1 CURRENT PERIOD ADJUSTMENTS TO PRIOR BILLS TOTALS Social Subscriber Contract # of Coverage Currant Subscriber Security# Name Type Members Type Benefit Premium Period Code Premium TOTAL 1121732001 Barrett, Fredei~ck S 1 CSP01S HEALTHCR 57634 1121732601 Easter, Mark S 1 CSP01S HEALIHCR 576 34 1121007601 Ford, Polly F 3 CSPO1 HEALTHCR 179285 1121010001 Hiller, Jonathan S 1 CSP01 HEALTHCR 57634 1121013701 Le Fevre, Raymond $ 1 CSPO1 HEALTHCR 57634 1121011301 Marshall, Jesse C 2 CSP01 HEALTHCR 1267 9~ 1121078601 Morgan, John F 3 C$P01 HEALTHCR 1792.85 1123283101 Rickel Kenneth S 1 CSP01S HEALTHCR 57634 1121733601 Schmid, Nina S 1 CSP01S HEALTHCR 57634 1121075501 Traub, James S 1 CSP01 HEALTHCR 57634 57634 57634 179285 57634 57634 126796 179285 576 34 57634 57634 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 nyc ce Deta s on the back of the Invoice Summary for an explanation of Contract Type, Benefit, and Code abbreviations Invoice Details n~ly be continued on the other side, FISHERS ISLAbD FERRY DISTRICT VENDOR 016659 PRINCIPAL LIFE GROUP 04/09/2013 CHECK 1093 FU/qD & ACCOUNT P.O.~ INVOICE DESCRIPTION AMOUNT SM .9060.8.000.000 H19730-1-4/13 LIFE PREM 4/1/13-4/30/13 164.52 TOTAL 164.52 ONE IiUIgORED SIXTY FOUR ;%ND ~2/I00 DO~tL~RS - AUDIT 4/9/13 CHECK NO. 1093 A~ou~rr S164 .52 F~Y PR~CIPAL LIFE GRO~ ORDER OES MOINES IA 503U6~3513 Vendor No. Town of Southold, New York- Payment Voucher 16659 Vendor Tax ID Number or Social Security Number Vendor Address P.O. Box 14513 Des Molnes, IA 50306-3513 Principal Life Group Vendor Telephone Number 800-843-1371 Vendor Contact Check No. Entered by Audit Date APR 0 9 2013 Town Clerk Invoice Invoice Invoice Net Purchase Order Number Date Total Discount Amount Claime¢ Number Description of Goods or Services General Ledger Fund and Account Number H19730-1 3117/2013 $164.52 $164.52 Life Prem $M9030.8.000.000 l~}~ 4/1/13-4/30113 $164.52 $164.52 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 taxes from which the Town is exempt are excluded Signaiure ~ Title ~ CompanyName~f/) Date 2(/ ~ /9 Department Certification I hereby certi~ that the materials above specified have been received by me in good condition without substitution, the services properly performed and that the quantities thereof have been verified with the exceptions or discrepancies noted, and payment is approved. Signature ~ Title Date Group Principal Financial Group Des Moines, IA 50392-0001 IPrincipal Life Insurance Company IPREMIUM STATEMENT This statement in no way changes the contract or waives any overdue payment Account Number H 19730- I Lb. No. 0819730 00001 93 DueDate 04/01/13 StmtDate 03/17/13 Billing Period 04/01/18 - 04/30/13 001350 FISHERS ISLAND FERRY ATTN J MILLER 261 TRUMBULL DR BOX 602 FISHERS ISLAND NY 06390 Please Pay Balance Due $ 164.52 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 800-621-6280. REPORTING CHANGES PROMPTLY WILL RESULT IN A MORE ACCURATE PREMIUM STATEMENT. CHANGES SHOULD NOT BE SENT WITH YOUR PAYMENT. FOR ASSISTANCE, PLEASE CALL TOLL FREE: 1-800-843-1371 NOTICE--TO AVOID DISCONTINUANCE OF YOUR PLAN, PLEASE BE SURE YOUR $73.66 BALANCE IS PAID AND RECEIVED IN THIS OFFICE BEFORE THE GRACE PERIOD ENDS ON 03/31/13. 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. Group TNZS TS YOUR COPY. Principal Financial Group Principal Life Des Moines, IA 50392-0002 Insurance Company PLEASE KEEP FOR YOUR RECORDS. PREMTUM STATEMENT This statement in no way changes the centract or waives any overdue payment ACCOUNT NO. H19730-1 FISHERS ZSLAND FERRY L[FE/AO&D BNFT PREM LB. NO. 0819730 00001 93 DUE DATE: 04/01/13 STMT DATE: 03/17/13 CHARGE/ CREDIT FOR ASSISTANCE, PLEASE CALL TOLL FREE: 1-800-843-1371 F396GP-4 ACCOUNT NO. H19730-1 04/01/2013 000 000000 000000 CGs§31830761178509001002 0003425 002 OF 003 THZS IS YOUR COPY. Principal Financial Group Principal Life Des Moines, IA 50392-0002 Insurance Company PLEASE KEEP FOR YOUR RECORDS. PREMTUM STATEMENT ACCOUNT NO, H19730-1 FISHERS ISLAND FERRY LB. NO. 0819730 00001 93 DUE DATE: 04/01/13 STMT DATE: 03/17/13 ID NAME ~UMBER LIFE/AD&D BNFT PREM CHARGE/ CREDIT PMT SINCE LAST 121.04 NET CREDITS 25.g6- SAL FORWARD 73,66 CHARGES THIS STMT 90.86 TOTAL AMT DUE 164.52 FOR ASSISTANCE. PLEASE CALL TOLL FREE: 1-800-843-1371 F396GP-4 ACCOUNT NO. H19730-1 04/01/2013 000 O0000O 000000 CGS63183076117850900qO02 0003426 003 CF 003 1,7SHERS ISLAND FERRY DISTRICT VENDOR 018011 CHRISTOPHER L. P~AFFERTY 04/09/2013 CHECK 1094 FUND & ACCOUNT P.O.~ INVOICE DESCRIPTION AMOUNT SM ,5712.4.000,000 123112 '12 COMM MTG OCT-DEC{9) 450.00 TOTAL 450.00 FoUR HUNDRED F~FT¥ AND 00/10~ ~OL~RS 04 1094 $450 TOTH~ PO ~BOX 393 ORDER ~ISTd~RS ISLAND NY 06%9~;~393 OF Town of Southold, New York Vendor Tax ID Number or Social Security Number - Payment Voucher P.O. Box 393 Christopher L. Raffsrty Fishers Island, NY 06390 Vendor Telephone Number Vendor Contact InvoiceDa~ Invoice $460.00 Total 12131/2012 $450.00 Net Amount Claimed [nvoice Number Discount $460.00 $450.00 Payee Certification lhe undersigned (Claimant) (Acting on behalf of the above named claimant) does hereby cerdfy 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 fi.om which the Town is exempt are excluded. Vendor No. 18011 Check No. Entered by Audit Date APR 0 9 2013 Description of Goods or Services Commissioner Meetings October - December 12 9 Mtgs ~ $ $0.00 General Ledger Fund and Account Number SM6712.4.000.000 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 eeting Date 04/03/12 04/09/12 04/17/12 05/01/12 05/15/12 06/05/12 06/19/12 07/03/12 07/11/12 07/17/12 07/18/12 07/19/12 07/21/12 07/24/12 07/30/12 08/07/12 08/11/12 08/17/12 08/28/12 09/06/12 09/17/12 Brooks, Robert 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Burnham, David 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Edwards, Christopher Herrick, Lucinda 1 1V 1 1V 1V 1 1 lV 1 1 1 1 1 1 1V 1 Rafferty, Christopher 1 1 1 1 Rugg, Peter Wall, J~obert. 1 1 1 1 1 1 1 1 1 3~1 18 15 19 16 20 2 3 10/2/2012 10/2/2012 0/15/2012 0/24/2012 11/6/2012 1/20/2012 12/4/2012 2/18/2026 2/26/2012 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 4Q 12 8 0 9 0 9 6 9 $400 $- ~ $450 $- $450 $300 $450 FISHERS ISIMND FERRY DISTRICT VENDOR 014022 RING'S END, INC 04/09/2013 CHECK 1095 FUND & ACCOI~T P.O.~ INVOICE DESCRIPTION AMOUNT SM 5710.2.000.000 518841 PAINT TOTAL 137.80 137.80 OI~E HUI~DRED T}IIRTY SEVEN AND 8(Y/t¢~ oOLLARS 1095 Town of Southold, New York - Payment Voucher Vendor Tax ID Number or Social Security Number Vendor Address PO BOX 714 Nlantic, CT 06357 RING'S END Vendor Telephone Number 860-739-5441 Vendor Contact Vendor No. 14022 Check No. Entered by I~,~ Audit Date APR 0 9 2013 Town Clerk Invoice Invoice Invoice Net Purchase Order Number Date Total Discount Amount Claimec Number Description of Goods or Services General Ledger Fund and Account Number 518841 3/19/2013 $t37.80 $t3'/.80 Paint 8M5710.2.000.000 $t 37.80 $137.80 Payee Certification The undersigned (Claimant) (Acting on behalf of the above named claimant) does hereby ceni~ that the foregoing claim is true and correct, that no part has been paid, except as therein stated, that the balance therein stated is actually due and owing, and that taxes from which the Town is exempt are excluded. Company Name 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 bTSHERS ISIMND FERRY DISTRICT VENDOR 018752 PETER RUGG 04/09/2013 CHECK 1096 FUND & ACCOUNT P.O.# INVOICE DESCRIPTION AMOUNT SM .5712.4.000.000 123112 '12 COMM MTG OCT-DEC(6) 300.00 TOTAL 300.00 ;13 1096 $300. O0 ~TO THE ORDER OF PF~A~R RUG~ 136 E-7~H ST. A~T 5A NEW YORK NY 10021 Town of $outhold, New York Vendor Tax ID Number or Social Security Number - Payment Voucher Vendor No. 18752 130 E. 70TH STREET, APT SA NEW YORK, NY 10021 Vendor Telephone Number PETER RUGG Vendor Contact Date Number Total Net Amount Clalme¢ Discount t2/31/2012 $300.00 $300.00 $300.00 $300.00 Payee Certification The undersigned (Claimant) (Acting on behalf of the above named claimant) does hereby certify that the foregoing claim is true and correct, that no part has been paid, except as therein stated, that the balance therein stated is actually due and owing, and that taxes from which the Town is exempt are excluded Signature ~ Title ~ Company Name~ Date Purchase Order Number Check No. 10% Entered by ~k~ Audit Date APR 0 9 2013 Town Clerk Description of Goods or Services General Ledge~ Fund and Account Number Commission Meeting 8M$712.4.000.000 October - December 12 $ Mtgs ~ S80/mtg 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 w?th the exceptions or discrepancies noted, and payment is approved Signature Title Page # 1 ~t 860-439-Z369 ~)4~155 (~ ~6 ~) ~528 ~2-~ P.O. ~x H X , 137.9,~ , 0.0~ 00G , ' ~137:.80 CUSTO~R ~Y . ;' / eeting Date Brooks, Robert Burnham, David Edwards, Christopher 04/03/12 1 1 04/09/12 1 1 04/17/12 1 1 1 05/01/12 1 1 1 05/15/12 1 1 06/05/12 1 1 06/19/12 1 1 1 07/03/12 1 1 1 07/11/12 1 1 1 07/17/12 1 1 07/18/12 1 1 1 07/19/12 1 1 1 07/21/12 1 1 1 07/24/12 1 1 1 07/30/12 1 1 1 08/07/12 1 1 1 08/11/12 1 1 08/17/12 1 08/28/12 1 1 09/06/12 1 1 09/17/12 1 1 Herrick, Lucinda 1 Rafferty, Christopher 1 1 1V 1 1 1 1V 1 1V 1 1 1 1 1 1V 1 1 1 I 1 I 1 I 1 1 1 1 1 1V 1 1 Rugg, Peter Wall, Robert 10/2/2012 1 10/2/2012 1 0/15/2012 1 0/24/2012 1 11/6/2012 1 1/20/2012 1 12/4~2012 1 2/18~2026 1 2/26/2012 4Qt 2 8 $400 0 0 $- ~ 1 1 1 1 1 1 1 1 1 9 $450 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 9 6 9 $450 $300 $450 3~1 18 15 19 16 20 2 3 1 1 1 1 1 1 1 1 1 FISHERS 1SIMND FERRY DISTRICT VENDOR 019794 JOHN STANFORD 04/09/2013 CHECK 1097 FUND & ACCOUNT P.O.~ INVOICE DESCRIPTION AMOUNT SM .5710.4.000.000 30 PLOWING/CLEAN UP NL-3/8 600.00 TOTAL 600.00 SIX HUNDRED ~t~D D0/t00 DOLLAR~ - p~ y JOHN ~ ~7~NF~D ORDER PRESTON CT 06365 OF AUDII t3 )~ 1097 DATE ;{ AMOUNT o /o /2o s * oo.oo Town of Southold, New York - Payment Voucher Vendor Tax ID Number or Social Security Number Vendor Address Vendor Name John S. Stanford Vendor Telephone Number 860-908-2194 Vendor Contact Invoice Invoice Number Date 30 3/1112013 Total $600.00 Discount $600.00 $600.00 Payee Certification The undersigned (Claimant) (Acting on behalf of tbe above named claimant) d~es hereby certify that the foregoing claim is true and correct, that no par~ has been paid, except as therein stated, that the balance therein stated is actually due and owing, and that taxes from which the Town is exempt are excluded Signature ~~ Title Company Name fP Date 8 Burdlck Road Preston, CT 06365 Net Purchase Order ~mount Claimed Number $600.00 Vendor No. 19794 Check No. I oq'l Entered by ~ Audit'Date APR 0 9 2013 Town Clerk Description of Goods or Services Plowing/Clean up NL 3/8/2013 General Ledger Fund and Account Number Department Certification 1 hereby certify that the materials above specified have bc~n received by me in g~od 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 ~ Tit,. ata 08/22/13 7:28 AM JOHN / DAWN 6TANFORD ~ ~ ,, , John S Stanford 6608591777 Page 1 8 Bun:lick Phone: 860 908 2194 ;ax: 860 859 1777 Billing Address Iqshers Island Ferry District 5 Waterfront Park Ct 06365 Due Det~: Shipping Hethod: Shipping Address 5 Waterfront Park New London, Ct 06320 3/11/2013 30 4/10/2013 ~ Plowlflg of the lot:on 3/08/13 2 3OO Customer Not~: SubTotal: Tax: T(XaI: FISHERS ISLAND FERRY DISTRICT VENDOR 019719 STAPLES CREDIT PLAN 04/09/2013 CHECK 1098 FUND & ACCOUNT P . 0 . ~ INVOICE DESCRIPTION AMOUNT SM .5711.4.000.000 SM .5711.4.000.000 SM .5711.4.000.000 3004748002 FI OFFICE SUPPLIES 57.99 3363101001 FI OFFICE SUPPLIES 44.97 3902988001 FI OFFICE SUPPLIES 132.31 TOTAL 235.27 ."OO~.OqP,." ~:D8I, L, OSL.~,h': hB 00~,508 Town of Southold, New York - Payment Voucher Vendor Tax ID Number or Social Sec ~r y Number I Vendor Address PO Box 414524 Vendor Name ~.~ ..~l' ~ ~ ~ r. -- Boston, MA 02241-4524 Staples Cc ...... t = .............. , ..... Vendor Telephone Number 866-996-8103 Vendor Contact Invoice Number Invoice Date Invoice l Fotal Discount Net Purchase Order Amounti~ Claimed Number $132.31 Vendor No. 19719 Check No. Entered by Audit Date APR 0 9 201] Town Clerk f Description of Goods or Services 3004748002 2161201 $57.99 FI Office Supplies SM5711.4.000.000 3363101001 2/15/2013 $44.97 $44.97 FI Office Supplies SM5711.4.000.000 3902988001 3/1/20t3 $132.31 FI Office Supplies SM5711.4.050.000 $235.27i $235.27 Payee Certification The undersigned (Claimant) (Acting on behalf of the above named claimant) does hereb5 certi[x 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 o~ing, and thal taxes t¥om x~hich the fo,an ~s exempt are excluded Signature __~--~...~/) Fdic Department Certification hereby certit\ 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 pasmcnt is approved that was easy: O Customer Service: steples.accountonline.com []Account Inquiries: 1-~0~-767-1291 Fax 1~8~1-779-7425 Account Statement Commercial Account: FISHER ISLAND FERRY DIST Account Number: 6035 5178 2~=5 7673 Previous Balance $413,75 Payments -$0.00 Credits -$000 Purchases +$235,27 Debits +$0.00 FINANCE CHARGES +$0,00 Late Fees +$0.00 New Balance $649.02 Current Due Minimum Payment Due Payment Due Dele $28.00 + $25.00 $53.00 04/02~3 Credit Line Credit Available I Closing Date SeodNetiseof B~gErrors andGu~omerSer~,celnqalriesto: I Next Closing Date STAPLES CREDIF PLAN PO Box 790449, St Louis, MO 63179-0449 I Days in Billing Period Did you overlook your payment to us? If so, please send the amount due today. If payment is in the mail thank you] 03/01 ~923790298~0~(~001 PUTNAM CT $ 132 31 ~ ~ , i ,,~, , ~,/~v?~4~ ¥ YourAnnualPercentageRate(APR)isthean~ualblerestrateonyouraccount Type of Balance Annual Percentage Daily Periodic Balance Subject to Rate (APR) Rate Finance Charge Rnance Charge PURCHASES REGULAR REVOLVING CREDIT PLAN 000% 000000% $0 00 $0.00 $10,500 $9,850 03/08/13 04/08/13 30 NOTICE: SEE REVERSE SIDE FOR IMPORTANT INFORMATION Page 1 of 4 This Accourit is Issued by Citibank, N.A. that was easy: Remit payment and make checks payable to STAPLES CREDIT PLAN DEPT 51 7820657673 INVOICE DETAIL BILL TO: Acct: 6035 5178 2065 7673 SHIP PO: DEB DOUCETTE FISHERS ISLAND FERRY 261 TRUMBULL DR FISHERS ISLAND. NY 00000 0oo0 PRODUCT SKU# Amount Due: PO: $5799 Trans Date: 02/06/13 Store: 100088887, PUTNAM QUANTITY UNIT PRICE TOTAL PRICE MAT,GLDN WLKOFF 3XS,OCBK 000276188 Purchased by: GORDON MURPHY I 0000 EA $57.99 $57 99 SUBTOTAL $57.S9 TAX $5.0O SHIPPING $500 TOTAL $57 99 SILL TO: Acct: 6035 5178 2065 7673 SHIP TO: DEB DOUCEYI E FISHERS ISLAND FERRY 261 TRUMBULL DR FISHERS ISLAND, NY 00000-~000 PRODUCT SKU# Amount Due: PO: $44.97 Trans Date: 02/15/13 3363101001 Store: 100088887, PUTNAM QUANTITY UNIT PRICE TOTAL PRICE SUGAR PACKS 000699751 SYMPHONY PAPER HOT CUP 10 000901661 BROTHER TZE~2312PK 12MM B 000917881 Purchased by: GORDON MURPHY I 0000 BX $1 49 $1 49 1.0000 PK ,$499 $499 1 0000 PK $38.49 $38.49 SUBTOTAL $4497 TAX $0 00 SHIPPING $0 O0 TOTAL $4497 BILL TO: 6035 5178 2065 7673 SHIP TO: DEB DOUCETTE FISHERS ISLAND FERRY 261 TRUMBULL DR FISHERS ISLAND, NY 00000 0000 PRODUCT SKU # Amount Due: Trans Date: 03/01/13 I Store: 100088887, PUTNAM invoice # 3902988001 QUANTITY UNIT PRICE TOTAL PRICE 3-TAB FLDR LTR MANILA 100 000116657 SPLS 8.5Xl I COPY CS 000135848 BROTHER TN-550 BLACK TONE 000612783 Purchased by: GORDON MURPHY 2 0000 BX $6.99 $1398 1 0O0O CT $37.79 $37 79 1 0000 EA $80.54 $80 54 SUBTOTAL $132 31 TAX $000 SHIPPING $0.00 TOTAL $132.31 Page 3 of 4 1-800-767d 291 staples accountonline com Slaples.com(R) [ Printable Order Summar3 Page 1 of 2 Printable Order Summary Thank You for Your Order For complete order details like sales tax, shipping info and Software Download instructions, keep an eye out for an email from Staples at the address below. Order confirmation will be sent to: ddoucette@fiferry.com Order number1:9237004748 Order date: February 6, 2013 You'll also find complete details of this order in the Order Status section of My Account on Staples.com®. Shipping Address Deb Doucette Fishers Island Ferry District 26L Trumbull Dr Box 607 Fishers Island, NY, 06390 (631) 788-7463 Not going to be around to receive or sign for yOUF order? Please fill out a Driver Release Agreement: http://www.staples.com/sbd/content/help/shipping/nothome popup.html Gordon Murphy Fishers Island ferry District 261 Trumbull Dr Fishers Island, NY, 06390-0607 (631) 78S-7463 Your order may be sent in different shipments. :If it is, no additional charges will apply. For Software Download, an email containing download instructions, software link(s) and activation code(s) will be sent following the email confirmation of your order. Order number: 9237004748 Item MLL64030530 Guardian Golden Polypropylene Dual Expected business- Qty: i Price: Rib Indoor Wiper Plat, 60"Lx36"W, day delivery: Fri at $57.99 Each $57.99 Charcoal 02/08 Subtotal: S57.99 Couoons: $0.00 Estimated Tax: Tax Exempt Dehvery $0.00 Tota $57.99 Remaining Balance $57.99 https //w~stap~es~c~m/~f~ce/stp~ies/~rderc~nfprnt?cata~g~d=~5~&~rder~d=~6827~9.~ 2/6/2013 Staples.com® ] Printable Order Summary Page 2 of 2 Remaining Balance will be applied to following: Staples Credit Card ending in 7673 Hold on to your Staples Rebate Visa Cards and Prepaid Gift Cards until your order has been received If you have any questions or concerns about your order, please call 1-800-STAPLES (1-800-782-7537) or email support@orders.staples.com Important information concerning coupons and sales tax can be found at: coupons and sales tax The tax shown is estimated, Your 13~rder Confirmation Email will include shipment details, product availability and estimated tax. Important information concerning return policy can be found at: return policy, For complete order details like sales tax, shipping info and Software Download instructions, keep an eye out for an email from Staples at the address above,You'll also find complete details of this order in the Order Status section of Ny Account on Staples,corn®. Sign up to receive Staples emails with great online and in~store offers and exclusive money-saving discounts. This Web site is intended for LlSe by US residents only. See International Sites. See our delivery policy for full details. Copyright 2012, Staples, Inc., All Rights Reserved. Questions? Call 1-800-333-3330 or email us. Site Nap I RSS Feed I AdChoices https://www.staples.com/office/supplies/orderconfprnt?catalogld: 10051 &orderId=1682709... 2/6/2013 STAPLES COM STAPLES. CON 415 WILDWOOD AVE /o COWHUNlI¥ AV~. WOBURN MA 01801 FISHERS ISLAND FERRY DISTRICT 261 TRUMBULL DR BOX 607 FISHERS ISLAND NY 06390 3ADDH1 OS6ZJZN UPS UPSUP SHIP VIA: UPS ~REF#:923700~7qS-O00-O02 Price UTD Drop Ship Order CONTACT CUSTOMER SERVZCE AT 800-333-3330 Item Number Ordered As Description MLL 64030530 MAT,GLDN WLKOFF 3XS,CCBK 001000 Quantity Unit UM Ord Ship Price EA I THANKYOU FOR YOUR ORDER SEE' REVERSE SIDE FOR RETURNS INFORMATION 12 LBS SHIP FISHERS ISLAND FERRY DISTRICT 1 OF 1 TO: 261 TRUMBULL DR BOX 607 FISHERS ISLAND NY 06390 CT O63 $-71 UPS GROUND TF~AC~I~ 1Z 030 810 03 1176 2418 BILLING: 3RD PARTY FSUS2012 KEWILL COM 36 5V 102012 PO#:3ADDH1 UTD Drop Ship Order CONTACT CUSTOMER SERVICE AT 800-333-3330 9237004748-000-002 UP UPS ATTN: DEB DOUCETTE (631)7887463 4265-4503 MLL 64030530 QTY: 1 FA 056ZJZN MAT,GLDN WLKOFF 3X5,CCBK 1 OF 1 2000 PL INSIDE 0-S NED/UPS/LOOK UP U667 o5o37o3oo9~8S31 CTN 1 OF TIME: 15:25 SEQ# 003~ DP Items should be returned after obtaining a Return Authorization. · With this Packing List · To the Return Address noted on the front of the form · Free from markings · In the original carton and packaging REFER TO THIS ORDER NO. FOR ALL INOUIRIES that was easy: For Customer Service, call 1 800-333 3330, or emaii an support@orders.staples.com. Order online, by phone or by fax 24 hours a day, 7 days a week. STAPLES that was easy FISHERS ISLJ~ND FERRY DISTRICT DEB DOUCETTE Floor: 1 261 TRUMBULL DR BOX 607 FISHERS ISLJ~ND, NY 063908021 Contact: (631) 788 7463 - DEB DOUCETTE SHIPPING LOCATION:Putnam, CT FC CARRIER ROUTE:UPS/UPS /U2 TOTAL PACKAGES: PAGE: 1 Order Date: 02/15/2013 Coupons and other adjustments are deducted after the Merchandise Total. On large orders some be×es may be arriving in separate shipments. 1 699751 SUGAR PACKS /23310 BX 1 1 1.49 1.49 2 901661 SYMPHONY PAPER HOT CUP 10 OZ /370SM-J8000 PK 1 1 4. 99 4. 99 3 917881 BROTHER TZE-2312PK 12MM BKWHT /TZe-2312PK PK 1 I 38.49 38.49 Material Safety Data S~eets (MSDS) may be found by visiting http://msds ce} ~.com/meds/91788[ .pdf M~rc landise Total ........ 44.97 Check your order statu~ online by going to www. Staples.com and clicking on "My Ord(rs". ]~ Need to resurn something? Please ~Ne~r~thatwaseaSYeviews call Customer Service to process TOTAL VALUE a return. OF ORDER: 44 . 97 Thank You For Your Order! Staples, Inc. THIS IS NOT AN LYVOICE OC1 Staples.com~p I Printable Order Summary Page 1 of 2 that was easy:, Printable Order Summary Thank You for Your Order For complete order details like sales tax, shipping info and Software Download instructions, keep an eye out for an email from Staples at the address below. Order confirmation will be sent to: ddoucette@fiferry.com Order number1:9237363101 Order date: February 15, 20]_3 You'll also find complete details of this order in the Order Status section of My Account on Staples.corn®. Shipping Address Deb Doucette Fishers Island Ferry District 261 Trumbull Dr Box 607 Fishers Island, NY, 06390-802]_ (631) 788-7463 Not going to be around to receive or sign for your order? Please fill out a Driver Release Agreement: http://www.staples.com/sbd/content/help/shipping/nothome popup.html Billing Address Gordon Murphy Fishers Island ferry District 261 Trumbull Dr Fishers Island, NY, 06390-0607 (631) 788-7463 Your order may be sent in different shipments. If it is, no additional charges will apply. For Software Download, an email containing download instructions, software link(s) and activation code(s) will be sent following the email confirmation of your order. Order number: 9237363]_01 Item917881 Brother®TZe-2312PKP-Touch® Label Tape, 1/2" Black on White, 2/Pack Item 699751 Dixie Crystais Pure Sugar Packets, 100/Box Item 901661 SOLO® Symphony® Paper Hot Cups, 10 oz., 50/Pack Expected business-day Qty: ]_ Price: delivery: Wed 02/20 at $38.49 2/Pack $38,49 Expected business-day Qty: i Price: delivery: Wed 02/20 at $1.49 100/Box$1.49 Expected business-day Qty: I Price: delivery: Wed 02/20 at $4.99 50/Pack $4.99 Subtotal: $44.97 Coupons: $0.00 https://www.staples.com/office/supplies/ordcrconfprnt?catalogld=10051 &orderld= 168810... 2/15/2013 Staples.corn® [ Printable Order Summary Page 2 of 2 Estimated Tax: Tax Exempt Delivery: $O.O0 Total: $44.97 Remaining Balance: $44.97 Remaining Balance will be applied to following: Staples Credit Card ending in 7673 Hold on to your Staples Rebate Visa Cards and Prepaid Gift Cards until your order has been received If you have any questions or concerns about your order, please call 1-800-STAPLES (1-800-782-7537) or email su pport@orders.staples.com Important information concerning coupons and sales tax can be found at: coupons and sales tax The tax shown is estimated. Your ~3~rder Confirmation Email will include shipment details, product availability and estimated tax. Important information concerning return policy can be found at: return policy. For complete order details like sales tax, shipping info and Software Download instructions, keep an eye out for an email from Staples at the address above.You'll also find complete details of this order in the Order Status section of My Account on Staples.com®. Sign up to receive Staples emails with great online and in-store offers and exclusive money-saving discounts. This Web site is intended for use by US residents only. See International Sites. See our delivery policy for full details. Copyright 20:[2, Staples, Inc., All Rights Reserved. Questions? Call :[-800-333-3330 or email us. Site rvlap J RSS Feed J AdChoices https://www.staples.col~ffoffice/supplies/orderconfprnt?catalogld= 10051 &orderld= 168810... 2/15/2013 that was easy: For Customer Service, call support@orders.staples.com. Order online, by phone er by fax 24 hours a day, 7 days a week. REFER TO THIS ORDER NO. FOR ALL INOUIRIES STAPLES that was easy FISHERS ISI~ND FERRY DISTRICT DEB DOUCETTE Floor: 1 261 TRUMBULL DR BOX 607 FISHERS ISLAND, NY 063908021 Contact: (631) 788 7463 DEB DOUCETTE SHIPPING LOCATION:Putnam, CT FC CARRIER ROUTE:UPS/UPS /U2 TOTAL PACKAGES: 2 PAGE: 1 Order Date: 03/01/2013 Coupons and other adju!tments are deducted after the Merchandise Total. On large orders some b/ may be arriving in separate shipments. 116657 3-TAB FLDR LTR MA2qILA 100 /116657 135848 SPLS 8.5Xll COPY CS /135848 WH 612783 BROTHER TN 550 BI=~CK TONER /TN-550 Check your order statu~ online by going to www. Staples.com and clickin "My 6.99 13.98 37.79 37.79 80.54 80.54 .00 ,00 Need to return something? Please call CusEomer Service to process a return. TOTAL VALUE OF ORDER: 132 ,3 ! Thank You For Your Order! Staples, Inc. THIS IS NOT AN INVOICE Staples.com~~ Printable Order Summary Page 1 of 2 Printable Order Summary Thank You for Your Order For complete order details like sales tax, shipping info and Software Download instructions, keep an eye out for an email from Staples at the address below. Order confirmation will be sent to: ddoucette@fiferry.com Order number1:9237902988 Order date: Hatch 1, 2013 You'll also find complete details of this order in the Order Status section of My Account on Staples.corn®. Shipping Address Deb Doucette Fishers Island Ferry District 261 Trumbull Dr Box 607 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 (631) 788-7463 Your order may be sent in different shipments. Tf it is, no additional charges will apply. For Software Download, an email containing download instructions, software link(s) and activation code(s) will be sent following the email confirmation of your order. Order number: 9237902988 Item 116657 Staples® Hanila File Folders, Expected business-day Qty: 2 Price: Letter, 3 Tab, Assorted Position, delivery: Tue 03/05 at $6.99 100/Box $13,98 100/Box Item 135848 Staples® Copy Paper, 8 1/2" x Expected business-day Qty: i Pr ce 11", Case delivery: Tue 03/05 ~at $37.79 5,000~CaseS37.79 Item 612783 BrotherTN-550 Black Toner Expected business~day Qty: 1 Price: Cartridge delivery: Tue 03/05 :at $80.54 Each $80,54 Subtotal: $132.31 Coupons: $O.OO https://www.staples.com/o ffice/supplics/ordercon fprnt?catalogld= 10051 &orderId: 1693724... 3/1/2013 Staples.com® ] Printable Order Summary Page 2 of 2 Estimated Tax: Tax Exempt Delivery: $O.OO Total: $132.31 Remaining Balance: $132.31 Remaining Balance will be applied to following: Staples Credit Card ending in 7673 Hold on to your Staples Rebate Visa Cards and Prepaid Gift Cards until your order has been received If you have any questions or concerns about your order, please call 1-800-STAPLES (1-800-782-7537) or email support@orders.staples.com Important information concerning coupons and sales tax can be found at: coupons and sales tax 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: return policy. For complete order details like sales tax, shipping info and Software Download instructions, keep an eye out for an email from Staples at the address above.You'll also find complete details of this order in the Order Status section of My Account on Staples.com®. Sign up to receive Staples emails with great online and in-store offers and exclusive money-saving discounts. This Web site is intended for use by US residents only. See International Sites. See our delivery policy for full details. Copyright 2012, Staples, ][nc., All Rights Reserved. Questions? Call 1-800-333-3330 or email us. Site Map I RSS Feed I AdChoices https://www.staples.com/office/supplies/orderconfprnt?catalogId= 10051 &orderld: 1693724... 3/1/2013 FISItERS ISLAND FERRY DISTRICT VENDOR 019768 SUFFOLK COUNTY NATIONAL BANK 04/09/2013 CHECK 1099 FUND & ACCOUNT P.O.~ INVOICE DESCRIPTION AMOUNT H7 .626 SM .9730.7.000.000 041113A 041113A NL TERMINAL 2012 BAN PRN 550,000.00 NL TERMINAL 2012 BAN INT 2,193.89 TOTAL 552,193.89 PAY ORDER OF CHECK NO, 1099 04/P9/20t3 $552, 193.89 FIVE HL~N~P~D FIFTy TWO THOU~ Olde HONDRED ~y THREE AND ~9/100 CUTCtlOG~E NY 11935 Town of Southold, New York - Payment Voucher Vendor Tax ID Number or SociaI Securit3 Number Vendor Address PO Box 702 Vendor Name Suffolk County National Bank Vendor Telephone Number Vendor Contact Cutchogue, NY 11935 Vendor No. 19768 Entered b) Audit Date APR 0 9 2013 To~e.rk Invoice Number ('41113 ~41113 (' 4/11/2013 4/11/2013 Invoice Net Total Discount Amount Claimed 550,000.00 550,000.00 2,193.89 2,193.89 552,193.89 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 part [las Purchase Order Number Description of Goods or Services NL Terminal 2012 BAN Principal NL Terminal 2012 BAN Interest General l.ed~er Fund and Account Number HI ~626 SM.9730.7.000.000 Department Certification I hereby certify, that the materials above specified ha~e been recei',ed b> me in good condition ~ithout substitution the services properh been paid, except as therein stated, that the balance therein stated is actualb due and owing, and that taxes l¥om which thc Town ~s exempt are excluded Slgnatt -ff~,g~ Title ~o~n Comptroller C%r~fName Town of Somhold Date March 6~ 2013 pcrfbrmed and that the quantities thereof have been verified with the exceptions or discrepailcles noted a * payrment is approved Title ToWn Comptroller Date March 6 2013 FISHERS ISLAND FERRY DISTRICT VENDOR 014599 TOWN OF SOUTHOLD CAP PROJECTS 04/09/2013 CHECK 1100 FUND & ACCOUNT P.O.# INVOICE DESCRIPTION 32dOUNT SM .9730.6.000.000 041113 NL TERMIN3~L REDEMPTION 100,000.00 TOTAL 100,000.00 1100 04/09/Z0t3 ~100,000.00 PAY TO TH~ ~OF Town of Southold, New York - Payment Voucher Vendor Tax ID Number or Social Security Number Vendor Address Vendor Name Town of Southold -- Capital Projects Vendor Telephone Number Vendor Contact Vendor No. 14599 53095 Route 25, PO Box 1179 Southold, NY 11971-0959 Audlt Date Invoice Number Invoice Net Total Amoum Claimed Purchase Order Number Discount Description of Goods or Services 041113 4/11/2013 100,000.00 100,000.00 NL Terminal Redemption $100,000.00 Payee Certification q he undersigned (C!aiman:) (Acting on behalf of the above named claimant) does hcrcb.x ceftin' that the foregoing claim is rue a d correc that no part has been paid, except as therein stated, that thc balance therein stated is actuall) due and ox~ing, and that taxes l?om which the Tox s exemp are excluded Signature 7~'~'./t ~ e' ,~'3w:y~--Vitl¢ Toxin Comptroller COml~Name qown of Southold Date March 6. 201} Generat Ledger Pund,~nd Accqunt,~umber SM.9730.6.000.000 Department Certification performed and that the quantities thereof have been verified with the exceptions or discrepancies noted, and payment is approved Signature ~ Date March 6. 2013 I hereby certif},' that the materials above specified have been received b~, me m good condition without substitution, the services properly FISHERS ISLAND FERRY DISTRICT VENDOR 021506 [/NITED pARCEL SERVICE 04/09/2013 CHECK 1101 FUND & ACCOUNT P.O. ;~ INVOICE DESCRIPTION ~4OUNT SM .5710.4.000.700 SM .5710.4.000.700 26639103 W/E 3/9/13-(2)PKGS 94.25 26639113 W/E 3/16/13-(5)PKGS 84.08 TOTAL 178.33 ONE HL]ND,p~ED S~VE~FPy ~T AND 33/100 CHECK NO, 1101 I °~¥E AMOUNT 04/O9/2013 $178,33 Town of Southoid, New York - Payment Voucher ~endor No. Check No. I101 Vendor ~Iax ID Number or Social Security Number United Parcel Service Vendor Telephone Number 800-811-1648 Vendor Contact Vendor Address P.O. Box 7247.0244 Ph~ adelph;a, PA 19170-0001 [n¥oiee Invoice Date Total 3/9/2013 Entered b3 Audit Date lerk Net Purchase Order Amount Claimed Number $94.25 Number Discount Description of Goods or Se~ices General Ledger Pund and Account Number 26639103 W/E 3/16/13/5) J'(()- 26639113! 3/16/2013 $84.08 SM5710.4.000.700 SM5710.4.000.700 $178.33: $178.33 Payee Certification I'he undersigned (Claimant) (Acting on behalf of the above named claimant) does hereby ccrdt\ that the foregoing claim is true and correct that no par[ has been paid, except as therein stated, that thc balance therein stated is actuall5 due and owing and that taxes l¥om which the Town is exempt arc excluded Compan~ Name Department Certification ] hereby certify that the materials above specified hate been received by me In good condition without substitution, the sen tees properly performed and that thc quantdies thereot have been verified with the exccptmns or discrepancies noted, and payment ts approved [)ale 0}0 /~e..''''~ Title Shipped from: FISHERS ISLAND FERRY 1 STATE ST NEW LONDON, CT 06320 Delivery Service In voice Invoice date March 9, 2013 invoice number 00000266391 03 Shipper number 026639 Control ID 667V Page 1 of 3 m 0720A00000266392 77366200011274 FP 01 067607 251971219 A**3DGT Hv¢l~.v~l~l.vvhllq,lh,lq,lhv.~.v.,~l..~,¢¢lhh FISHER ISLAND FERRY PO BOX 607 FISHERS ISLAND, NY 06590 Account Status Summary We~kly Payment Plan Amount Due This Period $ 94.25 Amount Outstanding (prior invoices} $ 395.38 Tolal Amount Outstanding $ 489.63 P~ease include the Return Portion ol each outstanding invoice with your payment See Account Status for details. Questions about you_r cbarcjes? To get a better understanding of the cha~ges on your invoice. visit our invoice guide and glossary of billing charges at ups.com/invoiceguide. Sign up for electronic billing today! Visit ups.com/billing For questions about your invoice, call: (800) 811-1648 Monday - Friday 8:00 a.m. - 9:00 p.m.E.T. UPS P.O. Box 7247-0244 Philadelphia, PA 19170-0001 Thank you for using UPS. Summary of Charges Page Chmge Outbound 3 UPS WorldShip $ 55.76 3 Adjustments & Other Charges $14 00 3 Fees $ 2 49 Service Charges $ 22 00 Amount due this period $ 94.25 UPS payment terms require payment of this invoice by March 20, 20t3. Payments not received by April 3, 2013 are subject to a late fee of 6% of the Amount Due This Period. (Details in UPS Tariff, available at ups. corn) Note: This invoice may contain a fuel surcharge as described at ups.com. The published fuel surcharge is 7.0% for UPS Ground Services and 11.5% for UPS Air Services, UPS 3 Day Select, and International services. For moro information, visit ups. com. Delivery Service In voice Invoice date March 9, 2013 Invoice number 00000266391 03 Shipper number 026639 Page 2 of 3 Account Status Weekly Payment Plan Amount Outstanding (prior invoices): Please include the Return Portion of each outstanding invoice with your payment Balance Invoice Number Invoice Date Due 0000026639053 02/02/2013 $ 7036 0000026639063 02/09/2013 $ 41.55 0000026639073 02/16/2013 $ 26 04 0000026639083 02/23/2013 $ 59 42 0000026639093 03/02/2013 $19801 Total $ 395.38 Outstanding balances reflecl any payments received as of 03/08/2013. Please ignore this message if a recent payment has been made for any outstanding invoices. Outbound UPS WorldShip Delivery Service Invoice Invoice date March 9, 2013 Invoice number 0000026639103 Shipper number 026639 Page 3 of 3 Pickup Pickup Date Record Message Codes Numberof Packages BilJed Charge 03/05 9121174090 1392 03/08 9121t7410t 41.84 Total UPS WorldShip 2 Package(s) 55 76 Total Outbound 2 Package(s) 5576 Adjustments & Other Charges Address Corrections Tracking Number Service Number of Packages 1Z0266390341606129 Ground 1st ret: G S MURPHY 687 WHISTLER AV FINY 063 Recorded: GRACE BG MURPHY 917 MURPHY ROAD QUECHEE VT 05059 2nd ret: 631 7887335 Corrected: M U RPHY,GIGI 917 MURPHY RD Floor:APT Suite:lC QUECHEE VT 05059 Billed Charge 12 00 Total Address Corrections I Package(s) 12 00 Miscellaneous Explanation WEEKLY PRINTER SERVICE FEE FOR 1 PRINTERS AT $2 00 EACH FOR 08 MAR~2013 Billed Charge 200 Total Miscellaneous 2 O0 Total Adjustments & Other Charges Fees 1400 WeekEnding Date Unpaid Balance Rate Billed Charge 02/09 Late Payment Fee Pursuant to the UPS Tanft, a late payment fee has been assessed 41 55 600 % 249 Total Fees 2 49 Invoice Messa~lin~l Code r Dimensional weight applied D67607 2/2 Shipped from: FISHERS ISLAND FERRY 1 STATE ST NEW LONDON. CT 06320 Delivery Service Invoice Invoice date March 16, 2013 Invoice number 0000026639113 Shipper number 026639 Control ID 374V Page 1 of 3 0720A00000266392 77366300011642 FP 01 071071 28480[228 A**3DGT FISHER ISLAND FERRY PO BOX 607 FISHERS iSLAND, NY 06590 ISign up for electronic billing today! Visit ups.corn/billing For questions about your invoice, call: (800) 811-1648 Monday - Friday 8:00 a.m. - 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 This Period $ 84.08 Amounl Outstanding (prior invoices) $ 489.63 Tolal Amount Outstanding $ 573.71 Please include the Return Portion of each outstanding invoice with your payment See Account Status for details. Special offer celebrates March Madness~ The UPS Store~ has created Small Business Tool Kits, which can be a great way to promote your company. To celebrate NCAA March Madness®, choose your "Starting 5" - a mailbox, a house account, a discount card for packing services, plus your choice of brochures, flyers or business cards and you can save up to 40%. For promotion details, or to learn more about the tool kits. visit theupsstor¢..com Thank you for using UPS. Summary of Charges Page Charge Outbound 3 UPS WoddShip $ 61 52 3 Adjustmenls & Other Charges $ 1 00 3 Fees $1 56 Service Charges $ 22 00 Amount due this period $ 84.08 UPS payment terms require payment of this invoice by March 27, 2013. Payments not received by April 10, 2013 are subject to a lale fee of 6% of lhe Amount Due This Period, (Details in UPS Tariff, available at ups. corn) Note: This invoice may contain a fuel surcharge as described at ups. com. The published fuel surcharge is 7.0% for UPS Ground Services and 11.5% for UPS Air Services, UPS 3 Day Select, and International services. For more information, visit ups.com. m Delivery Service In voice Invoice date March 16, 2013 Invo~cenumber 0000026639113 Shipper number 026639 Page 2 of 3 Account Status Weekly Payment Plan Amount Outstanding (prior invoices): Please include the Return Portion of each outsta~qding invoice with your payment Invoice Number Invoice Date Due 0000026639053 02/02/2013 $ 70.36 0000026639063 02/09/2013 $ 41.55 0000026639073 02/16/2013 $ 26 04 0000026639083 02/23/2013 $ 59.42 0000026639093 03/02/2013 $ 198.0 t 0000026639103 03/09/2013 $ 94 25 Total $ 489.63 Outstanding balances reflect any payments received as of 03/15/2013. Please ignore this message if a recent payment has been made for any outstanding invoices. Outbound uPs WorldShip Delivery Service Invoice invoice date March 16, 2013 Invoice number 0000026639113 Shipper number 026639 Page 3 of 3 Pickup Pickup Number of Billed Date Record Message Codes Packages Charge 03/13 9121174112 3 3466 03/15 9121174123 1 1343 9121174134 1 13 43 Total UPS WorldShip 5 Package(s) 61 52 Total Outbound 5 Package(s) 61 52 Adjustments & Other Charges Miscellaneous Billed Explanation Charge WEEKLY PRINTER SERVICE FEE 2 00 FOR t PRINTERS AT $2.00 EACH FOR 15-MAR-2013 Total Miscellaneous 2 o0 Residential/Commercial Adjustments UPS WorldShiP m Shipped Pickup Recorded Billed Adjustment Date Record Entry Tracking Number Corrected Charge Amount 0313 9121174112 3 lZ026639034012~172 Residential -794 Residential Surcharge -2 80 Commercial 7 94 Fuel Surcharge -0 20 300 lsl tel: Beach Plum FtNY 2nd ref: Phone# 631 788 7731 Total UPS WorldShip I Package(s) -3 O0 Total Residential/Commercial Adjustments 1 Package(s) 3 00 Total Adjustments & Other Charges 1 oo Fees WeekEnding Unpaid Billed Date Balance Rate Charge 0216 Late Payment Fee 26 04 6 00 % 1 56 Pursuant to the UPS TanfL a late payment fee has been assessed Total Fees 1 56 FISttERS ISLAND FERRY DISTRICT VENDOR 023295 ROBERT WALL 04/09/2013 CHECK 1102 Fl/ND & ACCOI/NT P.O,# INVOICE DESCRIPTION ~24OLrNT SM .5712.4.000,000 123112 '12 COMM MTG OCT-DEC(9) 450.00 TOTAL 450.00 PAY ORDER OF FOURHUNI~R~D~IFTY AI~D O~/tOO ~OLLARS ). ilO2 04/09/2013 Town of Southold, New York - Payment Voucher Vendor No. 23295 Vendor I ax ID Number or Social Securit5 N umber Vendor Telephone Number Robert Wall ~P: O, Box ~gS Fishers Island, NY 06390 Vendor Contact Check No. 1103 Entered by ~l~ Audit Date APR 0 9 2013 ' Invoice Invoice Invoice Number Date Total Discount Description of Goods or Services General Ledger Fund and Account Number 12/31/2012 $450.00 $450.00 I $460.00i Payee Certification I $4S0.00 I The undersigned (Claimant) (Acting on behalf oFthe above named claimant) does hereby certit\ that the foregoing claim is true and correct, that no part has been paid, except as therein stated that the balance thereto stated is actually due and owing, and that taxes from which the Town is exempt are excluded Commission Meeting ~ SM5712.4.000.000 October - December 12 Mtgs 1~ $60/mtg Department Certification I hereby cetti~ that the materials above specified have been received by me in good condition without substitutiom the services properly peHbrmed and that the quantities thereof have been verified with the cxccptmns or discrepancies noted, and payment is approved eeting Date 04/03/12 04/09/12 04/17/12 05/01/12 05/15/12 06/05/12 06/19/12 07/03/12 07/11/12 07/17/12 07/18/12 07/19/12 07/21/12 07/24/12 07/30/12 08/07/12 08/11/12 08/17/12 08/28/12 09/06/12 09/17/12 Brooks, Robed 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Burnham, David 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Edwards, Christopher Herrick, Lucinda 1 Raffedy, Christopher 1 1 1V 1 1 1 1V 1 1V 1 1 1 1 1 1V 1 1 1 1 1 1 1 I 1 1 1 1 1 1V 1 1 Rugg, Peter W'~II, RoSed 1 1 1 1 1 1 1 I I 3tal 18 15 19 16 20 2 3 10/2/2012 10~2/2012 0/15~2012 0/24~2012 111612012 1/20/2012 12/4/2012 2/18/2026 2/26/2012 1 1 1 1 1 1 I 1 I 1 1 1 1 1 1 1 1 1 1 1 1 1 1 I 4Q12 8 $400 0 9 $450 0 9 $450 6 $3OO 9 $450 FISHERS ISLAND FERRY DISTRICT VENDOR 023126 WEBB pUMP INC 04/09/2013 CHECK 1103 FUND & ACCOUNT P.O.# INA;OICE DESCRIPTION AMOUNT SM .5710.2.000.100 39034787 MU-FIRE PUMP 843.56 TOTAL 843.56 EIOHT HUNDRED_~ORTY THREE AND~ 5~/l!00 DOLLARS ORDER BEDFORD I~ 01730 OF AUDIT 4/~t~3 CHECK NO. 1103 Town of Southold, New York- Payment Voucher Vendor No. ' 23126 Vendor Fax ID Number or Social Securitp Number F.W. Webb Company Vendor Telephone Number Vendor Address 160 Middlesex Turnpike Bedford, MA 01730 Vendor Contact Check No. II0 _ . !Entered by ~ ~-~ Audit Date APR 0 9 2013 Town Clerk [n,,oice Invoice Invoice Number Date Total Discount General Ledger Fund and Account Number 39034787 3111/2013 $843.56 Net ] Purchase Order Amount Claimed Number Description of Goods or Serxices $843.56 Munn-Fire Pump $843.56i $843.56 Payee Certification The undersigned (Claimant) (Acting on behalf of the abo~e named claimant) does hereb5 certil~ that the Ibrcgoing claim is true and correct, that no part has been paid. except as therein state& that the balance therein stated is actualh due and owing and that taxes tiom which the Town is exempt are excluded SM5710.2.000.100 Deparl'ment Certification hereby certi~ that the materials above specified have been received b) me m good condition without substitution, the services properly pertbrmed and that the quantities thereof have been verified with the excepnon~ or discrepancies noted, and payment is approved QWEBB PUMP- r)lV OF FW WEBB CRANSTON, RI 02920-4458 401-463-8300 WEBB PUMP iNC tS A r.)lvlsIof4 oF F,W. WEEiB CO III,i,lll,ilil,ili,liilllillilil],lllllli,h,ii,iilii,,i,l,,,,,ili FISHERS ISLAND FEFIRY DIST PO Box H Fishers Island NY 06390-0607 10 ORIGINAL INVOICE Customer P.O, Number ~'lnvoice No. JOHN ~_0~4787 Cu~stome~No.No. ~-~-hip--Via I Date Shipped [ ,nvoice Date [137919 ' UN. PARSE j03/08/13 / 03/11/13 IS%HERS ,S,A,,,D PERR',' 5 WATERFRONT PARK ATTN JOHN NEW LONDON, CT 06320 PO#JOHN Ordered Shipped B.O.i 2 2 0 2 2 0 Description #SEAL ASS'Y 25271-192 G/R25271 192 S950598 #GORMAN RUPP SLEEVE STAINLESS G/R2146-L1706H S2352430 ~SEAL ASSY GS1000 G/RGS1000 S1677132 #SEAL LINER G/R83-17030 S1668774 Line # (1) (2) (3) (4) 47.950 225.000 67.000 165,000 Subtotal PAGE 1 OF 1 Price E~ension 95.90 450.00 67.00 165.00 777.90 843.56 Materials purchased hereon are subject to TFreighFHandling ! Tax terms and conditions on back hereof I 15.29 _[ 50.37 OP-002-1,REV.O b FISHERS ISLAND FERRY DISTRICT VENDOR 023290 WHALING CITY MOTORS, INC. 04/09/2013 CHECK 1104 FI/ND & ACCOUNT P.O.~ INVOICE DESCRIPTION AMOUNT SM .1930.4~000.000 B263338 RPR SCRAPE FI SCHOOL VAN 886.40 TOTAL 886.40 EIGHT HUNI~REtt ~t~HTY sl~ Atto 40/lO0 i'o THE 475 BRO/kI3 ~TR}~ET ORDER NEW LONDON CT 06320 OF 4/9/13 %HECK NO. gl3 O0 ~-50 ~ Town of Southold, New York - Payment Voucher Vendor Tax ID Number or Social Securit5 Number Whaling City ~t, Inc. Vendor Telephone Number 860443-8361 Vendor Contact Vendor Address 476 Broad Street New London, CT 06320 $886.40 Vendor No. i23290 Check No. Entered by Audit Date Invoice ln,,oice Invoice I Number Date Total Discount Description of Goods or Sen, ices General Ledger Fund and Account Number 1:1263338 3/16/2016 Net Purchase Order Amount Claimed Number $886.40 Repair to FI School's van was damaged on Ferry $666.401 = $886.40 Payee Certification The undersigned (Claimant) (Acting on behalf o~ the above named claimant) does hereby ceriifi,' that the foregoing clai~q is true and correct, that no part has been paid, except as lherein state& that the balance therein stated is actually due and o~ing, and that taxes tbom which the To~n is exempt are excluded Companx Name .~ ~ SM1930.4.000.000 Department Certification 1 bercby ccnil}, that the materials above specified have been received by mc m good condition without substitution, the services properly perforated and that the quantities thereof have been verified with the exceptions or discrepancies noted, and payment ~s approved l'itle [)ate ,; 4',~, ,~ _ 4 RO: B263338 Cashier: 08:46-2 Date Out: 03/15/2013 Office: Contact: Adviser: 1045 FISHERS ISLAND UFSD PO BOX A FISHERS ISLAND NY 06390 631-788-7444 Other: N/A FISHERS ISLANDSCHOOL 007631-MICHAEL CA_NOVA OPEN TAG:L98649 IN:1540OUT:084E VIN:lFDWE35P36HB12171 2006 FORD CAB & CHAS BLU Est. Mileage: 15496 Delivered: 04/10/2007 Hat: Date In: 03/08/2013 0P Acct Tech Hours Complaint/Cause/Correction [ CUSTOMER PAY ] ?OCE 002875 REPAIR THE RIGHT SIDE SCP~APE AS NEEDED. Body Shop Paint & Supplies REPAIRED ~LND REFINISHED THE RIGHT SIDE SCRAPE PER THE WHALING CITY ESTIPU%TE. Per Unit Extended Price Labor Total: 715. 80 Operation Total: 886.40 Customer Pay Labor: 715.00 Customer Pay Miscellaneous: 171.40 Customer Total Due: 886.40 to ux Iffol :my leason yon feel that you (alutot =re_ye ................ CO]MPI. 1TTE SATISFACTION THANK ',' ' U F i)R YOUR BUSlNE,g,S \YE .~PRECIATE YOU['. PATRONA(;E AND WELCQME YOUR QUESTIONS AND XIGNATTIIF FISHERS ISLAND FERRY DISTRICT DAMAGE/ACCIDENT REPORT Date of Occurance: 'L-I q- I ] Time ofOccurance: I Z qO Vessel: Trip: Cr~w Involved: ~ocC, Weather and Sea Conditions: Vehicle Description: Manufacturer: Year: Model: a-~.3~ \ Color: ~(oc Owner Identification: Name: ~%~c Address: City: Phone: FI Phone: ~ Provide detailed account of incident including accurate description of damage, how it occurred, burden of blame, witnesses, etc.. FISItERS ISLAND FERRY DISTRICT VENDOR 025038 Z & S FUEL & SERVICE, INC. 04/09/2013 CHECK 1105 FUND & ACCOUNT P. O. # INVOICE DESCRIPTION AMOUNT SM .5710.4.000.000 SM .5710.4.000.000 18052 10.002 GAL GAS REG 44.00 18087 9.557 GAL GAS REG 42.04 TOTAL 86.04 EIGHTY SIX AND 04/100~DO~LA~S Y 1~971~o9s9 CH<~K NO. 1105 CbrECHOGUE.THE SUFFOLK CO.Ny 1!935NATIONAl' BANK [ DATE, I AMOUNT " 5o~s4s~2~4 04/09/20~3 S86.04 PAY Z & S F%TEL & SERVICE, INC. 1DTHE DRAWER B ORD,ER FISI{ERS ISLAND NY06390 OF Town of Southold, New York - Payment Voucher Vendor No, 25038 Vendor ]'ax ID Number or Social Security Number I Vendor Address Vendor Name Z & S Fuel & Service. Inc. Vendor Telephone Number 631-788-7343 Vendor Contact P.O. Drawer B gish~rs J~iind, N~ 66391) lnvoice Invoice Invoice Net Purchase Order Number [)ate 'l oral Discount !Amount Claimed Number 18052 $44 00 18087 2/4/131 $44.00 2/20/13 $42.04 $86.041 Description of Goods or Services i2 Das cans of Daeolin'e $42.04 $86.04! Payee Certification The undersigned (Claimant) (Acting or~ behalf of the above named claimant} does hereby cenil? that the foregoing claim is true and correct, that no part has been paid. except as therein stated, that the balance therein stated is actuall.x due and owing and that taxes from which the lown is exempt are excluded iCheck . -~- No. V Entered by I10 Audit Date Town Clerk Signature ~ Title ~ Compan; Name ~/ f~-'~ Date . :~ ~rS? :; ,. [dc~, 2 gas cans of gasolthe General Ledger Fund and Account Number SM5710.4.000.000 SM5710.4.000.000 Department Certification I hereby certiI\ that the materials above specified have been received b3 me m good condition without substitution, the sept'ices properly perlbrmed and that thc quantities thereof have been verified wdb the ~xcept~ons or discrepancies noted, and payment is approved FUEL. & ~ERVICE, INC. DRAWER D~ F!SHE~$ iSLAND, NY 06]90 f67:[) 788-73~3 Liters/Qts. Oil '-i , Lubrication Oil Filtor X TOTAL ! 8 08 7 ~nl~-Y~u Z & S FUEL & SERVICE, iNC. DRAWER B F!SHERS ISLAND, NY 06390 (631) 788-7343 Liters/Qts. Oil ~ Lubrication Oil FiLter ~8052 ms and returned goods MUST be accompanied by this bill ~hank~ou Z & ~ I'UI3, & SERVICE. INC, lqshcrs Island, NY 06390 Statement To: IiSI II]RS ISI,ANI) FI.;RRY I)ISI RICI' I'.O. BOX II 115;III(RS ISI,ANIX NY 06390 Amount Due Amount Eno. $438.08 Date Transaction Amount Balance 01/31/2013 Balancc lbrward 4395 02/04/2013 GAS 44.00 4835 02/05/2(113 PMI #973. -87.47 3966 02/20,2013 GAS 42.04 438.(: CURRENT 1-30 DAYS PAST 31-60 DAYS PAST 61-90 DAYS PAST OVER 90 DAYS Amount Due DUE DUE DUE PAST DUE 86,04 352.04 0.00 0.00 0.00 $438(18