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HomeMy WebLinkAboutAU-11/21/2017 Fishers Island PR m k A FISHERS ISLAND FERRY DISTRICT VENDOR ,001332 ANDREW RAMSEY AHRENS 11/21/2017 CHECK 4466 A FUND &: ACCOUNT P.O.# \ INVOICE DESCRIPTIONAMOUNT, SM .5712.4.000.000 111317 117 COMM MTG JUL-SEP M7 350.00 TOTAL 350.00 J g'go-g-vo m �N 00 04� 42 T • W 44 ' FISHERS ISLAND FERRYDISTRICT, 53095 MAIN-ROAD,PO BOX-1179 CHECK VO; 44 66' "' - SOUTHOLD,'NY 11971--0959- THE SUFF:61_K.60.'NAtIONAL BANK DATE, J ' AMOUNT -1-7 _'$350;:0'0,' 1/21/20 -54612-14 50 R HUNbRRD -FIFTY AND 0 0 I:O'Q, DO A' 'THREE LLS p Y � ANDREW �RAMSEY ^AHRENS IWE. ORDER -tkTHkOP' Di,. -FISHERS -ISLAND-NY 06390 , OF 11/004466 116 1:0 2 L 40 5 L,C3 Ltl: G 8 OOLS02 I g ,E Vendor No. Check No. Town of Southold, New York - Payment Voucher 1332 414 r o(a — Vendor Address Entered'by 386.Winthrop Drive,#718 Fishers Island, NY 06390 Audit Date Ahrens,Andrew WOV 2 12017 Vendor Telephone Number Clerk 1 �- Vendor Contact Invoice Invoice Invoice Net Purchase Order Number Date Total Discount Amount Claimed Number Description of Goods or Services General Ledger Fund and Account Number 17 I l 11/13/2017 $350.00 $350.00 Commissioner Meeting SM5712.4.000.000 . Jul-Sep 2017 7 Mt9s @$50/mt $350.001 1 $350.00 Payee Certification Department Certification The undersigned(Claimant)(Acting on behalf of the above named claimant) I hereby certify that the materials above specified have been received by me does hereby certify that the foregoing claim is true and correct,that no part has in good condition without substitution,the services properly been paid,except as therein stated,that the balance therein stated is actually performed and that the quantities thereof have been verified with the exceptions due and owing,and that taxes from which the Town is exempt are excluded or discrepancies noted,and payment is approved Signatur w -Title Signature Company Name Fishers Island Ferry District Date 11/10/2017 Title Date f BOC Meetings Rugg, Peter Ahrens,Andrew Shillo, Di Bloethe, W Burnham, H 10-Jul-17 X X X X X 5 24-Jul-17 X X X X X 5 7-Aug-17 X X X X X 5 18-Aug-17 X X X X X 5 5-Sep-17 X X X X 4 18-Sep-17 X X X X 4 29-Sep-17 X X X X 4 32 5 7 7 6 7 32 3Q17 $ 250 $ 350 $ 350 $ 300 $ 350 $ 1,600 $ - r✓�� Page 1 \\fiserv1\D$\FD Network Directory\BOC\2017 Meetings-Commissioner Stipends 10/4/2017 Minutes of the Meeting of the Board of Commissioners Fishers Island Ferry District July 10, 2017 TCommissioner _hf"en_s the Fishers Island CommunityCenter called to order a meetingof the Board of Commissioners o t e Fishers Island Ferry District("the Ferry District")on June 26, 2017 at 4:30 PM. Commissioners William Bloethe, Heater Burnham, Peter<gg and Di Shillo were present.Also in attendance were Gordon Murphy, Geb Cook and Deanna Ross. RJ Burns was present via phone. Several members of the public were present. Commissioner Ahrens established that a quorum was present. Everyone in attendance pledged allegiance to the flag. Correspondence/Public Comment—Mr. Cook received two pieces of correspondence via email regarding the hovercraft. One letter was received from Mr. Rich Bartels expressing his discontent with the hovercraft docking at Silver Eel Cove at 2:30am. Mr. Cook reached out to the captain of the Hovercraft and moving forward,they have agreed to not permit chartered trips that late.The second piece of correspondence was received from Ms. Lauren Calahan voicing,nolse complaints in Silver Eel Cove. Mr. Cook spoke with Ms. Calahan at length last Friday regarding her concerns, Mr. Peter Burr asked the BOC to reconsider resuming the half-priced fares for non residents during the peak season. Mr. Burr feels that it was a nice benefit in years past and the majority of passengers have not abused it. Discussion ensued among the BOC and members of the public.The BOC has agreed to revisit the current policy. A member of the public asked the BOC what the liability was for folks entering and exiting the hovercraft using the ladder on the dock. Mr.Cook informed everyone that both parties carry liability insurance and there will be consideration of a floating dock if the partnership with the hovercraft continues after the trial season. A question was brought to the attention of the BOC regarding the recourse for damaged freight. Mr. Burns informed all that the policy is that the FIFD will not accept damaged goods at the New London Terminal. In the event that freight is damaged, anyone receiving the freight should address that with a manager. Another question arose regarding times in which the Fishers Island freight shed is closed to process incoming freight. The BOC and management has agreed to ensure proper signage so customers' are aware of closing times. Management Reports SEC Dolphin Project-Mr. Burns updated the BOC. Mr. Burns and Mr. Cook reviewed the contract documents with Keith Neilsen of Docko,who has been in contact with Mohawk. The funding is in place and they are now waiting for a date to meet and sign the agreement to get the project underway for the Minutes of the Meeting of the Board of Commissioners Fishers Island Ferry District July 24, 2017 Commissioner r� at the Fishers Island Community Center called a meeting of the Board of ` Commissioners of the Fishers Island Ferry District("the Ferry District")to order on July 24,2017 at 4:32 PM, J Commissioners William'Bl /the, Heathe�'BL urnham, Peter Rugg and D.Shillo were present. Also in attendance were Gordon Murphy,Geb Cook, Diane Hansen and Deanna Ross. RJ Burns was present via phone. No members of the public were present. Commissioner Ahrens established that a quorum was present. Everyone in attendance pledged allegiance to the flag. Correspondence/Public Comment—No correspondence was received.There is no public comment. Minutes RESOLUTION 2017-125 RESOLVED,that the Board of Commissioners of the Fishers Island Ferry District hereby approves the minutes of the May,30,2017 meeting. Moved by:Commissioner A.Ahrens Seconded by:Commissioner W. Bloethe Ayes:A.Ahrens,W. Bloethe, H. Burnham, P. Rugg and D.Shillo Nays: None Warrants RESOLUTION 2017-126 RESOLVED,that the Board of Commissioners of the Fishers Island Ferry District hereby approves an additional Warrant(D)dated July 10th in the amount of$388.19 for the MTA payment. Moved by:Commissioner H. Burnham Seconded by:Commissioner D.Shillo Ayes:A.Ahrens,W. Bloethe, H. Burnham, P. Rugg and D.Shillo Nays: None, RESOLUTION 2017-127 RESOLVED,that the Board of Commissioners of the Fishers Island Ferry District hereby approves the Warrant dated July 24,2017 in the amount of$57,846.41. Minutes of the Meeting of the Board of Commissioners Fishers Island Ferry District August 7,2017 Commissioner A rens at the Fishers Island Community Center called a meeting of the Board of Commissioners of the Fishers Island Ferry District("the Ferry District")to order on August 7,2017 at 4:30 PM, Commissioners William Bloethe, Heather Burnham, Peter Rugg and D.Shillo were present.Also in attendance were Gordon Murphy,Geb Cook, Diane Hansen and Deanna Ross. No members of the public were present. Commissioner Ahrens established that a quorum was present. Everyone in attendance pledged allegiance to the flag. Correspondence/Public Comment— An email correspondence was received from Mr. Bob Evans stating that the airport lights are unnecessarily bright and invasive. The BOC has agreed that the lighting is in compliance with the FAA. Commissioner W. Bloethe questioned management regarding the refusal of accepting freight after 12:30pm on Saturdays at the New London Terminal. Management agrees that a mistake may have been made and will look into the matter further to avoid any future issues. Warrant RESOLUTION 2017-139 RESOLVED,that the Board of Commissioners of the Fishers Island Ferry District hereby approves the Warrant dated August 7,2017 in the amount of$58,685.99. Moved by:Commissioner P Rugg Seconded by:Commissioner A Ahrens Ayes:A.Ahrens,W. Bloethe, H. Burnham, P. Rugg and D.Shillo Nays: None Budget Modification RESOLUTION 2017—140 RESOLVED that the Board of Commissioners of the Fishers Island Ferry District hereby increases the 2017 Fishers Island Ferry District budget as follows: Revenues: SM.4960.50 FEMA AID-TRANSPORTATION 12 055.00 Total $ 12,055.00 Minutes of the Meeting of the Board of Commissioners Fishers Island Ferry District August 18,2017 Commissioner rens at the Fishers Island Community Center called a meeting of the Board of Commissioners of the Fishers Island Ferry District("the Ferry District")to order on August 18,2017 at 4:42 PM. Commissioners William Bloethe, Heather.Burnham, Peter Rugg and D.Shillo were present.Also in attendance were Gordon Murphy,Jeb Cook and Deanna Ross.Several members of the public were present. Commissioner Ahrens established that a quorum was present. Everyone in attendance pledged allegiance to the flag. Members of the public were welcomed and the BOC congratulated Commissioner D.Shillo for winning the election. Correspondence/Public Comment— Mr. Cook received one letter from the Town of Southold thanking the FIFD for use of the ferry on Town of Southold Day.There is no public comment. Minutes RESOLUTION 2017-150 RESOLVED,that the Board of Commissioners of the Fishers Island Ferry District hereby approves the minutes of the June 26, 2017 meeting. Moved by:Commissioner P Rugg Seconded by:Commissioner W Bloethe Ayes:A.Ahrens,W. Bloethe, H. Burnham, P. Rugg and D.Shillo Nays: None -RESOLUTION 2017-151 RESOLVED,that the Board of Commissioners of the Fishers Island Ferry District hereby approves the minutes of the July 10,2017 meeting. Moved by:Commissioner D Shillo Seconded by:Commissioner A Ahrens Ayes:A.Ahrens,W. Bloethe, H. Burnham, P. Rugg and D.Shillo Nays: None Budget Modification RESOLUTION 2017-152 Minutes of the Meeting of the Board of Commissioners Fishers Island Ferry District September'5,2017 -Comm! ss' ne Ahr� he Fishers Island Community Center called a meeting of the Board of -Commissioner a Fishers Island Ferry District("the Ferry District")to order on July 24,2017 at 4:30 PM. Commissioners William Bloethe, Heather Burnham and D.Shillo were present.Also in attendance were Gordon Murphy,Jeb Cook, RJ Burns, Diane Hansen and Deanna Ross. Commissioner Ahrens established that a quorum was present. Everyone in attendance pledged allegiance to the flag. Correspondence/Public Comment-Mr.Cook received one email regarding a cancelled Hovercraft run due to weather but then running it because the weather improved and not notifying the initial passengers that were cancelled. Mr.Cook spoke with that customer and acknowledged the error. A letter was received from Friends of the Fisher's Island Theatre(FFIT)expressing that they are currently in the process of obtaining 501(c)(3)status and their desire to purchase the Fishers Island Theatre. In addition a letter of intent was received from Walsh Park regarding a feasibility study to lease the second floor of the freight shed and turn into affordable housing apartments. Warrants RESOLUTION 2017-154 RESOLVED,that the Board of Commissioners of the Fishers Island Ferry District hereby approves the Warrant dated September 5th,2017 in the amount of$26,132.18. Moved by:Commissioner D Shillo Seconded by:Commissioner A Ahrens Ayes:A.Ahrens,W. Bloethe, H. Burnham and D.Shillo Nays: None Management Reports SEC Dolphin Status-Mr. Burns updated the BOC. The lack of progress is due to difficulty with the bottom. Permission was granted to allow the contractor to move some of the dolphins in order to get good penetration of 12-20 feet. Estimated time of completion is set for the end of next week. RacePoint Insulation-Mr. Burns informed the BOC that RP will be dockside the last two weeks of October for the installation of the A-60 structural fire protection. Minutes of the Meeting of the Board of Commissioners . : Fishers Island Ferry District September 18,2017 Commissioner Ahrens at the Fishers Island Community Center called a meeting of the Board of Commis- ' __ _- -------- --- - sioners of the Fishers Island Ferry District("the Ferry District")to order on September 18,2017 at 4:30 PM. Commissioners William Bloethe, Heather Burnham,and D.Shillo were present.Also in attendance were Geb Cook and Deanna Ross. Commissioner P. Rugg, RJ Burns and Diane Hansen were present via phone. Commissioner Ahrens established that a quorum was present. Everyone in attendance pledged alle- giance to the flag. Correspondence/Public Comment—Mr.Cook informed the BOC that a letter was received from Rev. Candy Whitman requesting if management and the BOC would consider changing the Sunday 7am boat departing from New London to 8am to accommodate guest speakers and musicians on Sunday morning church service at the Union Chapel which begins at 10am. Mr.Cook has agreed to evaluate over the next coming year. An email was received by Fishers Island School Principal,Christian Arsenault expressing thanks and gratitude to the ferry district and crew members for holding the annual ferry safety day. Chairman Ahrens reported to the BOC that he received a phone call from Mrs. Patty Faulkner'requesting if someone was available to go to the utility office and explain the new two-way ticketing system to her and staff members. Mr.Cook agreed to take that responsibility.There is no public comment. Impending Weather-Mr. Burns informed the BOC that he'has been in contact with Mr.Arsenault and the FI School. Mr. Burns does not foresee any upcoming cancellations with the current ferry schedule. The cargo run has been moved to Friday and will be on MV Munnatawket as it is a better sea boat and fits better in the cove.Additionally both barges will be removed from Silver Eel Cove due to impending weather. Minutes RESOLUTION 2017-166 RESOLVED,that the Board of Commissioners of the Fishers Island Ferry District hereby approves the ,,minutes of the July 24,2017 meeting. Moves(by:Commissioner W. Bloethe Seconded,by:Commissioner A.Ahrens Ayes:A.Ahrens,W. Bloethe, H. Burnham and D.Shillo Nays: None RESOLUTION 2017-'167 i I i Minutes of the Meeting of the Board of Commissioners Fishers Island Ferry District September 29,2017 Commissioner Ahrens-at the Fishers Island Community Center called to order a meeting of the Board of Commissioners of the Fishers Island Ferry District("the Ferry District")on September 29,2017 at 1:00 PM. Comm issioners'Heather Burnham, Peter Rugg and Dianna Shillo were present.Also in attendance were Geb Cook, RJ Burns, Diane Hansen and Deanna Ross. Marcia Marien of O'Connor Davies was present. Commissioner William Bloethe and Gordon Murphy were absent. Commissioner Ahrens established that a quorum was present. Everyone in attendance pledged alle- giance!to the flag. Correspondence/Public Comment—Mr.Cook reported that no correspondence was received. There was no public comment. The BOC agreed to add an executive session to the September 29,2017 agenda. Moved by:Commissioner D.Shillo Seconded by:Commissioner A.Ahrens Ayes:A.Ahrens, H. Burnham, P. Rugg and D.Shillo Nays: None Warrants RESOLUTION 2017-177 RESOLVED,that the Board of Commissioners of the Fishers Island Ferry District hereby approves the Warrant dated September 29,2017 in the amount of$66,700.36. Moved,by:Commissioner A.Ahrens Seconded by:Commissioner D.Shillo Ayes:A.Ahrens, H. Burnham, P. Rugg and D.Shillo Nays: None Audit Review-Ms. Marcia Marion,CPA for O'Connor Davies presented the Fishers Island Ferry District December 31,2016 Audit to the BOC. Audit RESOLUTION 2017-178 Whereas the 2016 financial audit was approved by the Board of Commissioners of the Fishers Island Fer- ry District. v,;a' -`a�?'F` �Rv;.i'I •Ba,cva>,��:, ;iw;:n .. >�. n 7771, Fm FISHERS ISLAND FERRY DISTRICT - VENDOR 001297 ALARM DESIGN, LLC 11/21/2017 CHECK 4467 ,. H FUND & ACCOUNT P.O.# INVOICE DESCRIPTION AMOUNT 7- SM SM .5709.2.000,.200 29331 ALARM REPORT-11/1/17 86.14 TOTAL 86.14 � I ��t {0i:•Y:^'. - „5Pe:,.."i-•-;�F,.�:ar:•'sbi:4',;r..niF,,s;•f s 'e�:•:i5i'rrW"'iy;•F.+�,'•:•"'`^:+:•o.•:.:e_?ae.•o•:oa.+..�«v.z-i:y•�«✓,u:.,;� I' - ,� a's '•i�i� °,v�.y'Q;ik<4�•i ,.;*sPii'':•,r,.ye:r.-Y.3;r;•;;�},ii-;?,lPr`_'>,:;±;:}:;.•,,.ar,,., ««..o...a ,:i34 �� <� ,•'ray ^t3 w. ,:. , h-•.r? i .. I jwF�' I arta � 14�ij .y KA 0ZEN S„ =` ' -FISHERS•ISLAAD,FERRYDIS- RIGT 53095 MAINflOAD,PO BOXc1178 AUDIT`''11/2 i'�17 r' SOUTHOLD,NY't 197,1.0959' _ 'CfiRCK NO:. 44.67- .THE SUFFOLK C0:NATIONAL'BANK DAtE AMOJUNT.' j N -CUTCHOGUE,NY 11'935 `:; .� --_ )._:'�=`= �-- - ' =-�- - ' -"- - • ` . . _`----_)_ - - -- - ;- - 1.2, '�_�"1,�'-;- — --:-_-- - -=_,$'6:14` 50-546/214' _ l i 1^/ r _ EIGHTY'-SIX';'P:ND,-=14t/160`''DOLI.iARS. "!i Ak ALARM>�DESiGN;_ LLC TQTHE 69-.-CASE=STI2ET_' ORDER NORW'ICH•_=CT,;06360 ��'004467ll' �:0 2 L4054641: 68 00 L50 2 Lii' }' Vendor No. Check No. Town of Southold, New York - Payment Voucher 1297 1467 Vendor Address $rttel'e � 69 Case Street Norwich, CT 06360 Audit Date Alarm Design LLC NOV 2 12017 Vendor Telephone Number 860-889-7576 ` Vendor Contact ' Invoice Invoice Invoice Net Purchase Order Number Date Total Discount Amount Claimed Number Description of Goods or Services General Ledger Fund and Account Number 29331 11/1/2017 $86.14 $86.14 - Alarm report 11/1/17 SM5709.2.000.200 f $86.14 $86.14 Payee Certification Department Certification The undersigned(Claimant)(Acting on behalf of the above named claimant) I hereby certify that the materials above specified have been received by me does hereby certify that the foregoing claim is true and correct,that no part has in good condition without substitution,the services properly been paid,except as therein stated,that the balance therein stated is actually performed and that the quantities thereof have been verified with the exceptions due and owing,and that taxes from which the Town is exempt are excluded or discrepancies noted,and payment is approved - - Signature - e - - - - - — - - Signature - - - Company Name Fishers Island Feny District Date 11/7/2017 Title Date l ALARM DESIGN LLC Invoice 69 CASE ST NORWICH, CT 06360 DATE INVOICE# CT LIC#105999 TEL 860 889-7576 29331 11/1/2017 BILL TO FISHER ISLAND FERRY DISTRICT PO BOX 607 FISHER ISLAND, NY 06390 TERMS DUE DATE ACCT NUMBER SERVICE DATE Due on receipt 11/1/2017 107-3177&6W 908 JUNE DESCRIPTION RATE AMOUNT Alarm Report 81.00 81.00T SALES TAX 6.35% 5.14 vn 1L REMEMBER TO TEST YOUR ALARM MONTHLY&CLEAN YOUR SMOKE DETECTORS TWICE A YEAR Tota $86.14 FISHERS ISLAND FERRY DISTRICT VENDOR 001481 ANCHOR INSULATION CO. , INC. 11/21/2017 CHECK 4468 A FUND & ACCOUNT P.O.# INVOICE\ DESCRIPTION- AMOUNT SNI .5710.21.000.200 CT1-1562 RP-A-60 INSULATION 47,561.85 TOTAL 47,561.85 0 "N' A 2*1; ISMA TR Y- --, '--:AUD2:It-1f/ 11-17" 14sim R �'DISTNC,,, 53095 MAI N,,ROAD,,I'O,PDX,1,4 79 Io -4 CHECk-140. 4 6 W01ONALZANK, 68 tti THE SUFFOLK' 6. ,PUTCHOGUE.JNY11935,' DATE% 77 -,�AMOUNT � 5b-546&14'-'.'1 - 5 -D,givp. HuNbk • 85/1:00,• DOL ' B9 THOb`8AN E y ANCHOR-"INS�UIAtION-'co INC Z 't-PARK,-DRI 35 N ",' AR RAGAISib tT -4 -- J,� PAWTUC-KET`k1-E029'61-021 0 2 0' 0'' IR i in, x:0'2 L40S L.G L.i: 68 001 SO 2 Lill `' AF. Vendor No. Check No. Town of Southold, New York - Payment Voucher 1481 141405 Vendor Tax ID Number or Social Security Number Ente"red by 05-0390251 435 Narragansett Park Drive Pawtucket, RI 02861-4321 Audit D' Anchor Insulation Company, Inc. NOV 2 12017 Vendor Telephone Number 401-438-6720 Town Clerk Vendor Contact Invoice Invoice Invoice Net Purchase Order 3 Number Date Total Discount Amount Claimed Number Description of Goods or Services General Ledger Fund and Account Number f CT1-1562 11/8/2017 $47,561.85 $47,561.85 RP A-60 Insulation SM5710.2.000.200 {i {{i 4 { t 3 j $47,561.85 $47,561.85 Payee Certification Department Certification The undersigned(Claimant)(Acting on behalf of the above named claimant) I hereby certify that the materials above specified have been received by me does hereby certify that the foregoing claim is true and correct,that no part has in good condition without substitution,the services properly been paid,except as therein stated,that the balance therein stated is actually performed and that the quantities thereof have been verified with the exceptions due and owing,and that taxes from which the Town is exempt are excluded or di cjepancies noted,and payment is approved Signature s}1 GRn Title Signature (:::;6 ci� / Company Name Fishers Island Ferry District Date: 11/9/2017 Title 6 t A/ Date_ q "JANCHOR INGULATI ® N INVOICE Industrial,Commercial and Marine Insulator-Heating and Cooling-Noise Control-Residential Insulation-Gutters-Fireplaces-Shelving 435 Narragansett Park Drive-Pawtucket,Rhode Island 02861-4321 (401)438-6720 Fax:(401)438-6480 SM63 rim 11/8/2017 CTI-1562 Bill To: Fisher Island Ferry ,Yob Location: M/V RACE POINT Box 1-1 NEW LONDON,CT Fishers Island,NY 06390 17-31217 FISH002 SEE BELOW CT industrial C'f Sales Tax Net 30 Qu.'kNT CE • For furnishing,delivering and applying insulating materials to the engine room of the M/V Race Point. PO#Resolution 2017-155/2017-787 Sep 5,2017 All as directed by: R.J. Burns Agreed Contract Price $44,722.00 C2 \Ij SUBTOTAL: $44,722.00 ADD: FREIGHT 0.00 SALES TALC $2,839.85 LESS RETAINAGE 0.00 'arrymg charge at the rate of 1-1/2%per month will be charged on invoices unpaid after 45 days from ate of invoice Deliyuent account.%wail have attorneys fees added thereto if placed for collection , 547,561.55 Southold Town Board-Letter Board Meeting of September 12,2017 RESOLUTION 2017-787 Item#5.25 * ADOPTED DOC ID: 13370 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO.2017-787 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON SEPTEMBER 12,2017: RESOLVED that the Town Board of the Town of Southold hereby ratifies and approves the resolution of the Fishers Island Ferry District Board of Commissioners dated September 5,2017 in regard to Anchor Insulation Company, Inc. Elizabeth A. Neville Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: William P. Ruland, Councilman SECONDER:Louisa P. Evans,Justice AYES: Dinizio Jr, Ruland, Doherty, Ghosio, Evans,Russell Generated September 13,2017 Page 35 FISHERS ISLAND FERRY DISTRICT September 5,2017 Race Point Insulation Award RESOLUTION 2017- 155 Whereas A-60 rated structural fire protection is required in the engine room of the M/V Race Point; and Whereas a Request For Proposals was issued and advertised in a widely circulated publication;and Whereas one proposal was received,the proposal conforms to the published specifications,the pricing is acceptable to management, and management recommends accepting the proposal from Anchor Insulation Company, Inc.;and Whereas there may be unforeseen circumstances which require change orders, now therefore it is Resolved that the Board of Commissioners of the Fishers Island Ferry District accepts the bid from Anchor Insulation Company, Inc.for$44,722 to install A-60 rated structural fire protection in the MV Race Point; and be it further Resolved to authorize management to review and authorize change orders up to$4,472;the total cost not to exceed$49,194. It is further Resolved to authorize management to execute contract and ancillary documents for this project after review by District counsel. Moved by: Commissioner H Burnham Seconded by: Commissioner D Shillo Ayes:A.Ahrens,W. Bloethe, H. Burnham and D. Shillo Nays: None ANCHOR IImSULAT1C3im Industrial,Residential,Commercial and Marine Insulators,Noise Control,Heating and Cooling,Fireplaces,Gutters,Shelving,Waterproofing April 25th,2017 RJ Burns Fishers Island Ferry District 5 Waterfront Park New London,Conn 06320 Re:MN Race Point'Structural Fire Protection Mr.Burns, -Weare pleased-to•provide our proposal to supply all necessary materials;labor and supervisioffrequifed to'"" install A-60 rated structural fire protection in the Engine Room of the MN Race Point. Scope of Work and Specifications: A-60 rated structural fire protection will be installed in the following areas: 2"thick USCG 164.007 approved mineral wool board faced with white cloth will be installed on the deck plates,over 3"mild steel l Oga CD weld pins and secured with 1 '/z"diameter white painted stainless steel washers and white painted aluminum dome caps. All seams will be covered with 2"wide fiberglass mesh tape and painted with a USCG 164.112 approved weather barrier mastic. 'I"thick USCG 164.007 approved mineral wool board faced with white cloth Vill be installed on the transverse stiffeners over 2"mild steel I Oga CD weld pins and secured with 1 '/2"round white painted stainless steel washers and white painted aluminum dome caps. All seams will be covered with 2"wide fiberglass mesh tape and painted with USCG 164.112 approved"weather barrier mastic. The longitudinal beams will be insulated with 1"thick USCG 164.007 approved mineral wool board faced with white cloth installed over 2"mild steel 10ga CD weld pins and secured with 1 %"diameter round white painted_stainless steel washers and white painted aluminum dome caps. All seams will be covered with 2"fiberglass mesh tape and painted with USCG 164.112 approved weather barrier mastic. The port,starboard,fore and aft bulkheads will be insulated to a level of 12"below the overhead insulation using 3"thick USCG 164.007 approved mineral wool board faced with white cloth over 4" l Oga mild steel CD weld pins and secured with 1 '/s"diameter white painted stainless steel washers and White painted aluminum dome caps. All seams will be covered with 2"fiberglass mesh tape and painted with USCG 164.112'approved weather barrier mastic. Price: $44,722.00 plus all applicable taxes Notes: Purchase Order is required before any work can be started Price is based,on normal work hours 7-3:30 M/F. Price is based on regular,non-prevailing wages. Waste generated will be disposed of in customer-provided receptacles. . Excludes painting after pinning.' Anchor Insulation Company, Inc. 435 Narragansett Park Drive Pawtucket,RI 02861, Ph: 401-438-6720 Fax: 401-438-6480 43 Wisconsin Ave,Norwich, CT 06360 Ph: 860-739-3111 Fax: 860-739-2090 1500 Shawsheen Street,Unit 5 Tewksbury,MA 01876 Ph: 978-658-9592 Fax: 978-658-4158 A MOMUR INSULATION Industrial,Residential,Commercial and Marine Insulators,Noise Control,Heating and Cooling,Fireplaces,Gutters,Shelving,Waterproofing Thank you for the opportunity to provide The Fishers Island Ferry District with our services,please contact me should you have any questions. Sincerely, Michael Sonn CT Industrial Sales/Estimator Anchor Insulation 43 Wisconsin Ave. Norwich, CT.06360 Cell: (860)961-2617 Michael.Sonn@anchorinsulation.com Anchor Insulation Company, Inc. 435 Narragansett Park Drive Pawtucket,RI 02861 Ph: 401-438-6720 Fax: 401-438-6480 43 Wisconsin Ave,Norwich, CT 06360 Ph: 860-739-3111 Fax: 860-739-2090 1500 Shawsheen Street,Unit 5 Tewksbury, MA 01876 Ph: 978-658-9592 Fax: 978-6584158 MV RACE POINT STRUCTURAL FIRE PROTECTION INSTALL PROJECT Scope of Work and Specifications:A-60 rated structural fire protection will be installed on the ferry Race Point, in the following areas: Overhead Plate and Stiffeners: 2"thick USCG 164.007 approved mineral wool board faced with white cloth will be installed on the deck plates over 3" mild steel 10ga CD weld pins and secured with 1%" diameter white painted stainless steel washers and white painted aluminum dome caps. All seams will be covered with,2"wide fiberglass mesh tape and painted with USCG 164.112 approved weather barrier mastic. 1"thick USCG 164.007 approved mineral wool board faced with white cloth will be installed on the Transverse Stiffeners over 2" mild steel 10ga CD'weld pins and secured with 1%" round white painted stainless steel washers and white painted aluminum dome caps. All seams will be covered with 2" wide fiberglass mesh tape and painted with USCG 164.112 approved weather barrier mastic. The longitudinal beams will be insulated with 1"thick USCG 164.007 approved mineral wool board faced with white cloth installed over 2" mild steel 10ga CD weld pins and secured with 1%" diameter round white painted stainless steel washers and white painted aluminum dome caps. All seams will be covered with 2"fiberglass mesh tape and painted with USCG 164.112 approved weather barrier mastic. It will be necessary to insulate the port, starboard,fore and aft bulkheads to a level of 12" below the overhead insulation. In this case 3"thick USCG 164.007 approved mineral wool board faced with white cloth will be installed over 4" 10ga mild steel CD weld pins and secured with 1%" diameter white painted stainless steel washers and white painted aluminum dome caps. All seams will be covered with 2"fiberglass mesh tape and painted with USCG 164.112 approved weather barrier mastic. Notes: Sight visit is mandatory Waste generated will be disposed of in customer-provided receptacles. Installation/work will be conducted dockside, at our facility in New London, CT. PUBLISHER'S CERTIFICATE State of Connecticut County of New London, ss. New London Personally appeared before the undersigned, a Notary Public within and for said County and State, Sharon Foret, Legal Advertising Clerk, of The Day Publishing Company Classifieds dept, a newspaper published at New London, County of New London, state of Connecticut who being duly sworn, states on oath, that the Order of Notice in the case of 23474 LEGAL NOTICE Request for Proposals The Fishers Isla EW:�`, 10 A true copy of which is hereunto annexed was published in said newspaper in its issue(s)of 04i24i2017 AF Cust: FISHERS ISLAND FERRY DISTRIC Ad#: d00717302 ,E mai�;sii7i�tss�ons;�nl�t'` "S;i.s�w�,s-iaiit• Subscribed and sworn to efore me This Monday, April 24, 2017 12 AAL"V, Notary Public '/j My commission expires � Arena, Laura From: Diane Hansen <dhansen@fiferry.com> Sent: Wednesday, November 15, 2017 1:53 PM To: Hansen-Hightower, Kristie;Arena, Laura;Geb Cook; Kasia Asmolov;Gordon Murphy, RJ Burns Subject: RE:Anchor Insulation The invoice is$47,561.85 and there are no additional charges anticipated, as the work is complete. So we will not meet the$100,000 CT threshold. CT prevailing wage may enter into future contracts. From: Hansen-Hightower, Kristie [mailto:kristieh@southoldtownny.gov] Sent: Wednesday, November 15, 2017 1:45 PM To: Diane Hansen; Arena, Laura; Geb Cook; Kasia Asmolov; Gordon Murphy; RJ Burns Subject: RE: Anchor Insulation Hi Diane, Thank you for sending this. Any chance they also addressed whether you have to comply with Connecticut Prevailing Wage? This project exceeds their$100k renovation threshold. Thanks, Kristie Xristie Hansen-Hightower, CPM. Comptroller Town of Southold 54375 Main Road PO Box 1179 Southold, NY 11971 631-765-4333 Phone 631-765-1366 Fax From: Diane Hansen lmailto:dhansen@fiferry.coml Sent: Wednesday, November 15, 2017 11:35 AM To: Arena, Laura; Geb Cook; Kasia Asmolov; Gordon Murphy; RJ Burns Cc: Hansen-Hightower, Kristie Subject: RE: Anchor Insulation Prior legal opinion regarding Prevailing Wage for work not performed in New York. From: Arena, Laura [mailto:lauraa@southoldtownny.gov] Sent: Wednesday, November 15, 2017 10:45 AM To: Geb Cook; Kasia Asmolov; Gordon Murphy; Diane Hansen; RJ Burns Cc: Hansen-Hightower, Kristie Subject: RE: Anchor Insulation 1 Hi Geb, Can you please provide some form of backup that explains why you are exempt? Thank You, LauaralAranal Account Clerk Typist Town of Southold PO Box 1179 Southold, NY 11971 PH: (631)765-4333 FX: (631)765-1366 From: Geb Cook [mailto:gcook@fiferry.com] Sent:Wednesday, November 15, 2017 8:55 AM To:Arena, Laura <lauraa@southoldtownny.gov>; Kasia Asmolov<kasmolo @fiferry.com>; Gordon Murphy <g_murphy@fiferry.com>; Diane Hansen<dhansen@fiferry.com>; RJ Burns<rburns@fiferry.com> Subject: RE:Anchor Insulation Hi Laura, We are exempt from prevailing wage for work that is done in Connecticut. Geb Cook District Manager Fishers Island Ferry District PO Box 607 Fishers Island,NY 06390 www.fiferry.com 203.410.8156 From:Arena, Laura [mailto:lauraa@southoldtownny.gov] Sent:Wednesday, November 15, 2017 8:36 AM To: Kasia Asmolov; Gordon Murphy; Diane Hansen; RJ Burns Cc: Geb Cook Subject:Anchor Insulation Good Morning, Can you please forward a copy of the contract and certified payroll report from Anchor Insulation for the A-60 Insulation? You did send a copy of the resolutions and proposal paperwork. Thank You, Lauwct1Av'e Aa1 Account Clerk Typist Town of Southold 2 IT,77-, 71,-� PFT-M FISHERS ISLAND FERRY DISTRICT VENDOR 0/61492 CORY ANDERSON 11/21/2017 CHECK 4469 FUND & ACCOUNT P.O.# INVOICE DESCRIPTION, AMOUNT Ott SM .5610.4.000.000 �062717A ARP-RT SVC-6HRS-6/11, 6/25 120.00 SM .5610.4.000.000 070217A AIRPORT SVC-3 HRS-1/2 60.00 `Sm .5610.4.000.000 070917A AIRPORT,SVC-3, HRS-7/9 60.-00 SM .5610.4.600.000 071617A AIRPORT SVC-3 .,HRS-7/16 60.00 00 8M .5610.4.000.000 072317 AIRPORT SVC-3 HRS-7/23 60. - SM 5-610-.-4-.000- ,000 -073017 AIRPORT SVC-3 HRS-7/30 60.60 - —- - TOTAL 420.00 fr .......... AI t"A! P- r FISH ERS,-lSLAA )`,AERRX MSTRICT. T _53095,MAIN ROAD,PO'80X,1179 SOUTHOLD, Y, N 11.971-0959 I CHECK NO`.. "--4469- AMOUNT- Tili SbFFIbLk'6.NATIONAL BANK- - !CUTCHOGUE,;qY:11935.r ,� 11/21" 2'017 82t4, FOUR kUNDfZED,TWENTY'Al4D,-20 6-/!'o 0 DOLLARS" 'I- C Id, ORY-'ANDERSON" p' � ' SHE ', klLt6P .DRIVE 6F, l4i -1415HAM', CT Q052566 i NORTH J, 'J nNODL,t.r39iim 1.0 2 140 5464 : 68 001502 1 lir Vendor No. Check No. Town of Southold, New York - Payment Voucher � 1492 . ' .. Vendor Tax ID Number or Social Security Number Vendor Address Entered by 33 Hiltop Dr Audit ate i Anderson Cory North Windham CT 06256 NOVVendor Telephone Number O 2 12017 won G"� r 0 Vendor Contact Invoice Invoice Invoice Net Purchase Order Number Date Total Discount Amount Claimed Number Description of Goods or Services General Ledger Fund and Account Number 062717A 6/27/2017 $120.00 $120.00 Airport Service 6/11 (3hr $20)6/25(3hr $20) SM5610.4.000.000 /070217 7/2/2017 $60.00 $60.00 Airport Service 7/2(3hr $20) 6/25 SM5610A000.000 ✓070917 7/10/2017 $60.00 $60.00 Airport Service 7/09 (3hr $20) SM5610.4.000.000 ✓071617 Pr 7/ W2017 $60.00 $60.00 Airport Service 7/16 (3hr $20) SM5610.4.000.000 2317 7T/24/2017 $60.00 $60.00 Airport Service 7/23 3hr $20) SM5610.4.000.000 070617 7/3772017 $60.00 $60.00 Airport Service 7/30 (3hr $20) SM5610.4.000.000 $420.00 $420.00 Payee Certification Department Certification The undersigned(Claimant)(Acting on behalf of the above named claimant) I hereby certify that the materials above specified have been received by me does hereby certify that the foregoing claim is true and correct,that no part has in good condition without substitution,the services properly been paid,except as therein stated,that the balance therein stated is actually performed and that the quantities thereof have been verified with the exceptions due and owing,and that taxes from which the Town is exempt are excluded or discrepancies noted,and payment is approved 5 Signature _ AA e Signature Company Name Fishers Island Ferry District Date 10/30/2017 Title Date It 4-11 Gordon Murphy From: cory.j.anderson@aol.com Sent: Tuesday,June 27,2017 10:59 PM To: Gordon Murphy Subject: Invoice Elizabeth Field operations Cory Anderson 33 Hilltop Road North Windham Ct 06256 Airport Sunday service at$20 per hour. June 11, 2017.3 hours $60 June 25, 2017 3 hours $60 ' Total $120.00 \ R f ' i -' Gordon Murp►h mmummFrom: cory.j.anderson@aol.com Seat: Sunday,July 02, 2017 7:49 PM To: Gordon Murphy Subject: Elizabeth Field Operations invoice 2 July 2017 Categories: Airport After hours airfield Operations 2 July 2017 1630-1930 $20.00 Hrs $60.00 Thank you Gordon Murphy From: cory.j.anderson@aol.com Sent: Monday,July 10, 2017 4:37 PM To: Gordon Murphy Subject: Invoice: Elizabeth Airfield Operations (EAO) OB8 9 July 2017 (Sunday) After hours operations at $20 9 July 2017: 3 hrs $60 10 11- Thank you VIT 1 Gordon Murphy From: toryj.anderson@aol.com Sent: Monday,July 17, 2017 4;25 FM To; Cordon Murphy Subject: Invoice EF016 July 2017 Sunday After hours operations at $20.00 1630-1930 3 hrs=$60.00 "hank you x Gordon Murphy From: cory.j.ander-son@aol.com Sent: Tuesday,July 25, 20171:54 PM To: Gordon Murphy Subject: Invoice EAO 23 July 2017 Sunday After hours operations at$20.00 1630-1930 3 hrs= $60.00 Thank you. 1 Gordon Murphy From: coryj.andersonOaol.com Sent: Monday,July 31, 2017 11:21 AM To: Gordon Murphy Subject: Invoice 30 July 2017 Elizabeth Field, After hours operations at $20.00 1630-1930 3 hrs= $60.00 Thank you. - 1 FISHERS ISLAND FERRY DISTRICT October 16, 2017 Airport RESOLUTION 2017 - 191 Whereas the Ferry District's resolution 2017-133 was incomplete and requires amending. Therefore it is RESOLVED to amend Resolution 2017-133 to specify that the agreement between Mr. Cory Anderson and the Ferry District is an independent contractor agreement with effect June 1, 2017 to monitor the after business hours airport activity, assist pilots to complete the landing fee documents, and provide the Ferry District with airport statistics. It is further RESOLVED to authorize management to execute the independent contractor agreement subject to review by counsel, Moved by: Commissioner D. Shillo Seconded by: Commissioner W. Bloethe Ayes: W. Bloethe, H. Burnham, P. Rugg and D. Shillo Nays• None Southold Town Board - Letter Board Meeting of October 24, 2017 RESOLUTION 2017-885 Itcm 115 19 ADOPTED DOC ID- 13 465 TIAs IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2017-885 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARI) ON OCTOBER 24, 2017: RESOLVED that the Towrr Board of the Town of Southold hereby ratifies and approves the resolution of the Fishers Island Ferry District Board of Commissioners dated October 16, 2017 in regard an agreement with Mr. Cory Anderson, Elizabeth A. Neville Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Jill Doherty, Councilwoman SECONDER:William P. Ruland, Councilman AYES: Dinizio Jr, Ruland, Doherty, Ghosio, Evans, Russell Generated October 27, 2017 Page 33 Southold Town Board- Letter Board Meeting of October 24, 2017 ,f ®, RESOLUTION 2017-885 Item# 5.19 ADOPTED DOC ID: 13465 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2017-885 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON OCTOBER 24,2017: RESOLVED that the Town Board of the Town of Southold hereby ratifies and approves the resolution of the Fishers Island Ferry District Board of Commissioners dated October 16, 2017 in regard an agreement with Mr. Cory Anderson. Elizabeth A.Neville Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Jill Doherty, Councilwoman SECONDER:William P. Ruland, Councilman AYES: Dinizio Jr, Ruland,Doherty, Ghosio,Evans, Russell Generated October 27, 2017 Page 33 f m FISHERS ISLAND FERRY DISTRICT VENDOR 002437 ANTHEM BLUE CROSS BLUE SHIELD 11/21/2017 CHECK 4470 A 'o� FUND & ACCOUNT P.O.# INVOICE DESCRIPTION AMOUNT SM .9060.8.000.000 444M81629-1217 N SCHMID 12/17 MEDICAL -1,270.48 1,270.48 TOTAL 'o Fte J - ------ ---- W, FISHERS lSLAAV,FEWR, ---------- 717- DlS7WIC­T,­ -AUDIT 2 `i-1; IAl � 53095 MAIN ROAD,PO.BOX,1179 'SOUTHOLD,INY 3 197 1:QS59" Nd 4470 �Fi SIJFPO,K'CO.NATIONAL,.AN' DAT ­ :AMOUNT CUTcHOGUI �q -546�214 /'2 17 Eli DOLLARS", ONE, THOUSAND NO HUNDRED 'SEVENTY._ANb' 48/160 ;galSHIELD,`pA ANTHEM' CROSS,BLUE" to,fy BOX,11-7 92: ORDER NEWARK­NJ ,on'bi- 'OF, 1100004 0-2 L4054641: P313 00LS02 111' Vendor No. Check No. Town of Southold, New York- Payment Voucher 2437 LAM70 Vendor Tax ID Number or Social Security Number Vendor Address Entered Sy 77 P.O. Box 11792 Vendor Name Newark, NJ 07101 Audit Date Anthem NOV 2 12017 Vendor Telephone Number er Vendor Contact Invoice Invoice Invoice Net Purchase Order Number Date Total Discount Amount Claimed Number Description of Goods or Services General Ledger Fund and Account Number 1QN 444M81 29 12/1/2017 1,270.48 1,270.48 Medical Insurance Premium SM9060.8.000.000 Nina J Schmid 12/1-1/1/18 1,270.48 1,270.48 Payee Certification Department Certification The undersigned(Claimant)(Acting on behalf of the above named claimant) I hereby certify that the materials above specified have been received by me does hereby certify that the foregoing claim is true and correct,that no part has in good condition without substitution,the services properly been pard,except as therein stated,that the balance therein stated is actually performed and that the quantities thereof have been verified with the exceptions due and owing,and that taxes from which the Town is exempt are excluded- or discrepancies noted,and payment is approved Signature ^ avv_ Signature Company Name Fishers Island Feny Date 11/3/20171 Title Date l Page 1 of 2 12/1/17 Member Anthem. Nina J Schmid B1ueCross BlueShield e ID 444M81629 Plan Medical Please pay 1 12 7 0 . 4 8 by due date December 1, 2017 Bill Summary Coverage from 12/01/2017 to 01/01/2018 Previous balance $1,27048 Payments received $1,270.481 Amount due from previous bill $0.00 �""Current,premium charges $1,270.481 �Otql amountyou pay $1,270.48, More ways to pay: Online at anthem.com or by phone. �tl TRAt-D-005855/055281 ACUAA8 S1-ET-M1.000002 4 t Please detach and return the bottom portion with your payment t 37M FISHERS ISLAND FERRY DISTRICT VENDOR 002439 ANTHEM BLUE CROSS BLUE SHIELD 11/21/2017 CHECK 4471 Al FUND & ACCOUNT P.O.# INVOICE DESCRIPTION AMOUNT SM .9060.8.000.000 ) 020-11711404435 VISION-GRP#A75986-12/17 172.15 SM .9060.8.000.000 0201,711404435 CREDIT-DOUCETTE-11/17 5.85- TOTAL . 166, 90 & gfoc r A Z3 Jam_l s D 8 'AUDIT, lil2l, /-17",�'-- R kl��I SLAADTER 7 44" -53095 MAIN ROAD�,-PO,BOXI 179 SOUTHOLD;NYJ1 1971-0959 -`rCHECK -N SQFFbLK,CO.NAT ONAL BANK -TH DATE--,� AMOUNT,UNT CUTCjOGpE,M 11935:x', sl 21- 2_` •2017 R Al AN -`ONE,-HbNDRED- D-9'01,100, 71 I I A 2'- bl;tJE CROSS BLUE",,SHIELD,- -,l NTH .M Po'�,BOX: I," �11E, to 6R -NEWARK-NJ`-O'7101`;=4792 6PI , J, J- 6a 001502 1118 u900 L.L, 7 1111, 1:0 21 140 S L,1�`L,1: Vendor No. � 1..E 39 Check No. Town of Southold, New York - Payment Voucher -2A37— 41471 Vendor Tax ID Number or Social Security Number Vendor Address Entered by P.O. Box 11792 Vendor Name Newark, NJ 07101 Audit Date Anthem NOV 2 12017 Vendor Telephone Number o �C Vendor Contact Invoice Invoice Invoice Net Purchase Order Number Date Total Discount Amount Claimed Number Description of Goods or Services General Ledger Fund and Account Number 0201711404435 11/1/2017 $166.90 $172.75 Vision Plan#A75986 Dec 2017 SM9060.8.000.000 (5.85) Deb Doucette ad' 11/1/17 SM9060.8.000.000 166.90 166.90 Payee Certification Department Certification The undersigned(Claimant)(Acting on behalf of the above named claimant) I hereby certify that the materials above specified have been received by me does hereby certify that the foregoing claim is true and correct,that no part has in good condition without substitution,the services properly been paid,except as therein stated,that the balance therein stated is actually performed and that the quantities thereof have been verified with the exceptions due and owing,and that taxes from which the Town is exempt are excluded or discrepancies noted,and payment is approved Signaturee Signature Company Name Fishers Island Ferry Date 11/8/20171 Title Date r ` I OF 4 ANTHEM BLUE CROSS AND BLUE SHIELD PO BOX 1049Anthem® NORTH HAVEN,CT 06473 B1ueCross B1ueShield m I��II"11�1���11'1.��'IIIII�I'I..'I111'�II�IIII�IIIIII���I�III��I 030370 1 AB 0.400 002964/030370/006476 158 02 AGV4BB WPT132 SMGRP 11/01/2017 11/02/2017 FISHERS ISLAND FERRY DIST PO BOX 607 FISHERS ISLAND,NY 06390-0607 --- Your Premium Statement Is-Enclosed - Beginning May 1, 2017, we are going PAPERLESS, Anthem's standard will be to issue bills (invoices) and accept premium payment online via EmployerAccess. Register or sign up now on EmployerAccess by logging onto https://employer1.anthem.com/wps/portal/eeaM1py All it takes is a few clicks. It's free, secure and accessible 24/7! All you need is your group number, Tax ID number, and recent Invoice number. Just select the Billing Tab on the EmployerAccess overview screen to get started today! You will receive a monthly email notification when your group invoice is available to view, download or print. If you need to opt-out of online statements or payments, send an email with Opt-Out in the subject line to: CT.ogb(aanthem.com. Provide your group number, contact name, email address,phone number and reason for opting out of the electronic billing and payment process Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans,Inc.Independent licensee of the Blue Cross and Blue Shield Association.®ANTHEM is a registered trademark of Anthem Insurance Companies,Inc.The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. 030370/006476 AGV4BB S1-ET-MI-COOOOB 4 3 OF 4 Anthem.lp 'V! B1ueCross B1ueShield Billing Summary Invoice No.: 0201711404435 Group Name: FISHERS ISLAND FERRY DIST Group Number: A75986 Billing Period: 12/01/2017 to 01/01/2018 Date Billed: 11/01/2017 Due Date: 12/01/2017 Billing Summary Prior Billing Net Amount Due Amount Paid Balance / ANTHEM $357.20 $178.60 $178.60 SubTotal $178.60 U C/ Current Billing ANTHEM $166.90 $0.00 $166.90* SubTotal $166.90 Total Amount Due $345.50 *Applicable fees are included in the premium amounts. FEES-ACA Insurer Fee,$4.40 Membership Detail Contract No Rate* Subscriber Dep Premium ID# Subscriber Product Volume Type Cov Chg Amount Amount Amount 410M90476BURNS,RONALD BWA5 EE/SP 02 $10.24 $0.00 $10.24 557M90436 COOK,GEORGE B BW A5 EE/CH/ 03 $16.12 $0.00 $16.12 223M90439 ESPINOSA,NICHOLAS BWA5 EE 01 $5.85 $0.00 $5.85 558M90436 FORA,MICHAEL Ar BWA5 EE O1 $5.85 $0.00 $5.85 763M90436 FORD,POLLY C tBWA5 EE/CH/ 03 $16 12 $0.00 $16.12 115M90476 FRANCO,MICHAEL BWA5 EE O1 $5.85 $0.00 $5.85 046M90439 HANEY,JONATHAN K BWA5 EE/SP 02 $10.24 $0.00 $1024 358M90438 HANSEN,DIANE Kc- BWA5 EE O1 $5.85 $000 $5.85 359M90438 HILLER,JONATHAN P- BWA5 EE/SP 02 $10.24 $0.00 $10.24 047M90439 LAVIN,ROBERT F-- BWA5 EE/SP 02 $1024 $000 $10.24 50SM90439 MARHSALL,JESSE A/ BVV A5 EE/SP 02 $10.24 $000 $10.24 413M90476 MASON,RHAMIR r BWA5 EE 01 $5.85 $0.00 $585 224M90439 MORGAN,JOHN E BW A5 EE/CH/ 05 $16.12 $0.00 $16.12 980M90473 NORTON,KEVIN e , BW A5 EE O1 $5.85 $0.00 $5.85 509M90439 PARADIS,JOHN L/ BWA5 EE/CH/ 03 $1612 $0.00 $16.12 360M90438 SCROXTON,DEREK E(- BVV A5 EE/CH/ 04 $16.12 $0.00 $16.12 854M90475 WILCOX,CARLTOY BWA5 EE 01 $585 $0.00 $585 Membership Detail Subtotal $172.75 $0.00 $172.75 *Rate Change Legend: B=New Age Rate C=New Area Category D=New Age Rate&Area Category E=Next Bill Reflects New Age Rate F=New Area Category&Next Bill Reflects New Age Rate T=Tobacco Use Premium Adjustment Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans,Inc.Independent licensee of the Blue Cross and Blue Shield Association.®ANTHEM is a registered trademark of Anthem Insurance Companies,Inc.The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. 4OF4 .Anthem® B1ueCross B1ueShield 4.1 9J. Invoice No. 0201711404435 Group Name: FISHERS ISLAND FERRY DIST Group Number: A75986 Billing Period: 12/01/2017 to 01/01/2018 Date Billed: 11/01/2017 Due Date: 12/01/2017 Eligibility Change(s) Eligibility charge received atter the 1 st of the month may be reflected on your next bill. Effective Change Subscriber Dep Premium ID# Subscriber Product Date Code Amount Amount Amount 045M90439 DOUCETTE,DEBORAH BVV A5 11/01/17 DELSUB -$5.85 $0.00 -$5.85 Eligibility Change Subtotal -$5.85 $0.00 -$5.85 PAYMENTPOLICY *Remember to PAY AS BILLED-pay the total amount shown as due on the bill. *Do not add or delete members by writing on your bill-your payment goes to an automatic deposit box that cannot read your changes. * Submit membership changes to Anthem as they occur. We will adjust your premiums,when applicable, on a future bill. This invoice reflects all membership information processed to date. If additional payments or member changes have been ),nailed,they will be reflected in a fixture invoice. According to Anthem eligibility guidelines, all membership changes must be received by Anthem within 31 days of the qualifying event. IMPORTANT NOTICE: If this bill reflects an outstanding premium balance for the prior month's bill,Anthem's issuance of this invoice does not extend any premium grace period applicable to the outstanding balance and does not waive Anthem's contractual right to automatically terminate your group's coverage for failure to timely pay premium. Any premiums received by Anthem or its designee are received conditionally subject to actual acceptance of the premiums by Anthem. For billing questions,please call(855) 886-6154 it FISHERS ISLAND FERRYDISTNCT VENDOR 002438 WILLIAM R. BLOETHE 11/21/2017 CHECK 4472 Yd FUND & ACCOUNT P.O.# INVOICE DESCRIPTION AMOUNT SM .5712.4.000-.,000 111317 117 -COMM MTG JUL-SEP(6) 30'0.00 Q TOTAL 300.00 N ml Q_ `51 Mivl "KS4, Z3 fl, ,71, J, --lSL-NP FERRY-DIS-MCT 7" --;FISHERS- A JDIT' ', X/21' 53095 MAKROAD,IP0 BOX-1,1 79'' i0L0F,.NYI-1-197l-'0959l '44`7 SQUT THE,SUFFOLK'Co'.NATIONAL BANK /2 0 1T 300' :11/21 j 50-6462ih 1 , I C4 'AN S ,T, b ,001-- ''WILLIAM,R- BWETHE, 2532 CRESCENT= NT=,AEV hDER Po aox,-46 4 Viz. ISLAND, NY, O 6 00, A usoo ? 20 1:02-14054641: T-8 OOLS02 LV all, Vendor No. Check No. Town of Southold, New York - Payment Voucher 2438 Vendor Address Entered by �& P.O. Box 446 Fishers Island, NY 06390 Audit Da e William R Bloethe NOV- c� Vendor Telephone Number N 2 12017 Vendor Contact e Invoice Invoice Invoice Net Purchase Order Number Date Total Discount Amount Claimed Number Description of Goods or Services General Ledger Fund and Account Number 11/13/2017 $300.00 $300.00 Commissioner Meeting SM5712.4.000.000 Jul-Sep 2017 6 Mt s @$50/mt $300.00 1 $300.00 Payee Certification Department Certification The undersigned(Claimant)(Acting on behalf of the above named claimant) I hereby certify that the materials above specified have been received by me does hereby certify that the foregoing claim is true and correct,that no part has in good condition without substitution,the services properly been paid,except as therein stated,that the balance therein stated is actually performed and that the quantities thereof have been verified with the exceptions due and owing,and that taxes from which the Town is exempt are excluded or discrepancies noted,and payment is approved Signature` Title Signature Company Name Fishers Island Ferry District Date 11/10/2017 Title Date / BOC Meetings Rugg, Peter Ahrens, Andrew Shillo, Di Bloethe,W Burnham, H 10-Jul-17 X X X X X 5 24-Jul-17 X X X X X 5 7-Aug-17 X X X X X 5 18-Aug-17 X X X X X 5 5-Sep-17 X X X X 4 18-Sep-17 X X X X 4 29-Sep-17 X X X X 4 32 5 7 7 6 7 32 3Q17 $ 250 $ 350 $ 350 $ 300 $ 350 $ 1,600 $ - Page 1 \\fiservl\D$\FD Network Directory\BOC\2017 Meetings-Commissioner Stipends 10/4/2017 Minutes of the Meeting of the Board of Commissioners Fishers Island Ferry District July 10, 2017 Commissioner Ahfens at the Fishers Island CommunityCenter called to order a meeting of the Board of g Commissioners of the Fishers Island Ferry District("the Ferry District") on June 26, 2017 at 4:30 PM. Commissionersiam Bloet , Heater Burnham, Peter lrgg and Di Shillo were present.Also in attendance we Gordon M phy, Geb Cook and Deanna Ross. RJ Burns'was present via phone. Several members of the public were present. Commissioner Ahrens established that a quorum was present. Everyone in attendance pledged allegiance to the flag. Correspondence/Public Comment—Mr. Cook received two pieces of correspondence via email regarding the hovercraft. One letter was received from Mr. Rich Bartels expressing his discontent with the hovercraft docking at Silver Eel Cove at 2:30am. Mr. Cook reached out to the captain of the Hovercraft and moving forward,they have agreed to not permit chartered trips that late.The second piece of correspondence was received from Ms. Lauren Calahan voicing noise complaints in Silver Eel Cove. Mr. Cook spoke with Ms. Calahan at length last Friday regarding her.concerns. Mr. Peter Burr asked the BOC to reconsider resuming the half-priced fares for non residents during the peak season. Mr. Burr feels that it was a nice benefit in years past and the majority of passengers have not abused it. Discussion ensued among the BOC and members of the public.The BOC has agreed to revisit the current policy. A member of the public asked the BOC what the liability was for folks entering and exiting the hovercraft using the ladder on the dock. Mr. Cook informed everyone that both parties carry liability insurance and there will be consideration of a floating dock if the partnership with the hovercraft continues after the trial season. A question was brought to the attention of the BOC regarding the recourse for damaged freight. Mr. Burns informed all that the policy is that the FIFD will not accept damaged goods at the New London Terminal. In the event that freight is damaged, anyone receiving the freight should address that with a manager. Another question arose regarding times in which the Fishers Island freight shed is closed to process incoming freight. The BOC and management has agreed to ensure proper signage so customers are aware of closing times. ' Management Reports SEC Dolphin Project- Mr. Burns updated the BOC. Mr. Burns and Mr. Cook reviewed the contract documents with Keith Neilsen of Docko,who has been in contact with Mohawk. The funding is in place and they are now waiting for a date to meet and sign the agreement to get the project underway for the Minutes of the Meeting of the Board of Commissioners Fishers Island Ferry District July 24, 2017 Commissioner Ahrens at the Fishers Island Community Center called a meeting of the Board of CommissionersOnurphy, Ferry District("the Ferry District")to order on July 24, 2017 at 4:32 PM. � Commissionersther4urnham, Peter Rugg and D.Shillo were present. Also in attendance weeb Cook, Diane Hansen and Deanna Ross. RJ Burns was present via phone. No members of the public were present. Commissioner Ahrens established that a quorum was present. Everyone in attendance pledged allegiance to the flag. Correspondence/Public Comment—No correspondence was received.There is no public comment. Minutes RESOLUTION 2017-125 RESOLVED,that the Board of Commissioners of the Fishers Island Ferry District hereby approves the minutes of the May 30,2017 meeting. Moved by:Commissioner A.Ahrens Seconded by:Commissioner W. Bloethe Ayes:A.Ahrens,W. Bloethe, H. Burnham, P. Rugg and D.Shillo Nays: None Warrants RESOLUTION 2017-126 RESOLVED,that the Board of Commissioners of the Fishers Island Ferry District hereby approves an additional Warrant(D)dated July 10th in the amount of$388.19 for the MTA payment. Moved by:Commissioner H. Burnham Seconded by:Commissioner D.Shillo Ayes:A.Ahrens,W. Bloethe, H. Burnham, P. Rugg and D.Shillo Nays: None RESOLUTION 2017-127 RESOLVED,that the Board of Commissioners of the Fishers Island Ferry District hereby approves the Warrant dated July 24,2017 in the amount of$57,846.41. Minutes of the Meeting of the Board of Commissioners Fishers Island Ferry District August 7, 2017 Commissioner ens at the Fishers Island Community Center called a meeting of the Board of Commissioners of the Fishers Island Ferry District("the Ferry District")to order on August 7,2017 at 4:30 PM. -Commissioners William Bloethe, Heather Burnham, Peter Rugg and D.Shillo were present.Also in attendance were Gordon Murphy,Geb Cook, Diane Hansen and Deanna Ross. No members of the public were present. Commissioner Ahrens established that a quorum was present. Everyone in attendance pledged allegiance to the flag. Correspondence/Public Comment— An email correspondence was received from Mr. Bob Evans stating that the airport lights are unnecessarily bright and invasive. The BOC has agreed that the lighting is in compliance with the FAA. Commissioner W. Bloethe questioned management regarding the refusal of accepting freight after 12:30pm on Saturdays at the New London Terminal. Management agrees that a mistake may have been made and will look into the matter further to avoid any future issues. Warrant RESOLUTION 2017-139 RESOLVED,that the Board of Commissioners of the Fishers Island Ferry District hereby approves the Warrant dated August 7, 2017 in the amount of$58,685.99. Moved by:Commissioner P Rugg Seconded by:Commissioner A Ahrens Ayes:A.Ahrens,W. Bloethe, H. Burnham, P. Rugg and D.Shillo Nays: None Budget Modification RESOLUTION 2017—140 RESOLVED that the Board of Commissioners of the Fishers Island Ferry District hereby increases the 2017 Fishers Island Ferry District budget as follows: Revenues: SM.4960.50 FEMA AID-TRANSPORTATION 12 055.00 Total $ 12,055.00 Minutes of the Meeting of the Board of Commissioners Fishers Island Ferry District August 18,2017 Commissioner Ahrens at the Fishers Island Community Center called a meeting of the Board of Commissioners of the Fishers Island Ferry District("the Ferry District")to order on August 18,2017 at 4:42 PM. Commissioners William Bloethe, Heather Burnham, Peter Rugg and D.Shillo were present.Also in attendance were Gordon Murphy,Jeb Cook and Deanna Ross.Several members of the public were present. Commissioner Ahrens established that a quorum was present. Everyone in attendance pledged allegiance to the flag. Members of the public were welcomed and the BOC congratulated Commissioner D.Shillo for winning the election. Correspondence/Public Comment— Mr. Cook received one letter from the Town of Southold thanking the FIFD for use of the ferry on Town of Southold Day.There is no public comment. Minutes RESOLUTION,2017-150 RESOLVED,that the Board of Commissioners of the Fishers Island Ferry District hereby approves the minutes of the June 26, 2017 meeting. Moved by:Commissioner P Rugg Seconded by:Commissioner W Bloethe Ayes:A.Ahrens,W. Bloethe, H. Burnham, P. Rugg and D.Shillo Nays: None RESOLUTION 2017-151 RESOLVED,that the Board of Commissioners of the Fishers Island Ferry District hereby approves the minutes of the July 10,2017 meeting. Moved by:Commissioner D Shillo Seconded by:Commissioner A Ahrens Ayes:A.Ahrens,W. Bloethe, H. Burnham, P. Rugg and D.Shillo Nays: None Budget Modification RESOLUTION 2017-152 Minutes of the Meeting of the Board of Commissioners Fishers Island Ferry District September 5,2017 Commissioner Ahr�at the Fishers Island Community Center called a meeting of the Board of Commissioners of the Fishers Island Ferry District("the Ferry District")to order on July 24,2017 at 4:30 PM. ✓ c� Commissioners Willia Bloe _ , Heather Burnham and D.Shillo were present.Also in attendance were Gordon Murphy,Jeb Cook, RJ Burns, Diane Hansen and Deanna Ross. Commissioner Ahrens established'that a quorum was present. Everyone in attendance pledged allegiance to the flag. Correspondence/Public Comment—Mr.Cook received one email regarding a cancelled Hovercraft run due to weather but then running it because the weather improved and not notifying the initial passengers that were cancelled. Mr.Cook spoke with that customer and acknowledged the error. A letter was received from Friends of the Fisher's Island Theatre(FFIT)expressing that they are currently in the process of obtaining 501(c)(3)status and their desire to purchase the Fishers Island Theatre. In addition a letter of intent was received from Walsh Park regarding a feasibility study to lease the second floor of the freight shed and turn into affordable housing apartments. Warrants RESOLUTION 2017-154 RESOLVED,that the Board of Commissioners of the Fishers Island Ferry District hereby approves the Warrant dated September 5th,2017 in the amount of$26,132.18. Moved by:Commissioner D Shillo Seconded by:Commissioner A Ahrens Ayes:A.Ahrens,W. Bloethe, H. Burnham and D.Shillo Nays: None Management Reports SEC Dolphin Status-Mr. Burns updated the BOC. The lack of progress is due to difficulty with the bottom. Permission was granted to allow the contractor to move some of the dolphins in order to get good penetration of 12-20 feet. Estimated time of completion is set for the end of next week. RacePoint Insulation-Mr. Burns informed the BOC that RP will be dockside the last two weeks of October for the installation of the A-60 structural fire protection. Minutes of the Meeting of the Board of Commissioners Fishers Island Ferry District September 18,2017 Commissioner Ahrens at the Fishers Island Community Center called a meeting of the Board of Commis- sioners of the Fishers Islan Ferry District("the Ferry District")to order on September 18,2017 at 4:30 PM. --Commissioners William Bloethe, Heather Burnham,and D.Shillo were present.Also in attendance were Geb Cook and Deanna Ross. Commissioner P. Rugg, RJ Burns and Diane Hansen were present via phone. Commissioner Ahrens established that a quorum was present. Everyone in attendance pledged alle- giance to the flag. Correspondence/Public Comment—Mr.Cook informed the BOC that a letter was received from Rev. Candy Whitman requesting if management and the BOC would consider changing the Sunday lam boat departing from New London to 8am to accommodate guest speakers and musicians on Sunday morning church service at the Union Chapel which begins at 10am. Mr. Cook has agreed to evaluate over the next coming year. An email was received by Fishers Island School Principal,Christian Arsenault expressing thanks and gratitude to the ferry district and crew members for holding the annual ferry safety day. Chairman Ahrens reported to the BOC that he received a phone call from Mrs. Patty Faulkner requesting if someone was available to go to the utility office and explain the new two-way ticketing system to her and staff members. Mr.Cook agreed to take that responsibility.There is no public comment. Impending Weather-Mr. Burns informed the BOC that he has been in contact with Mr.Arsenault and the FI School. Mr. Burns does not foresee any upcoming cancellations with the current ferry schedule. The cargo run has been moved to Friday and will be on MV Munnatawket as it is a better sea boat and fits better in the cove.Additionally both barges will be removed from Silver`Eel Cove due to impending weather. Minutes RESOLUTION 2017-166 RESOLVED,that the Board of Commissioners of the Fishers Island Ferry District hereby approves the minutes of the July 24,2017 meeting. Moved,by:Commissioner W. Bloethe Secondeld,by:Commissioner A.Ahrens Ayes:A.Ahrens,W. Bloethe, H. Burnham and D.Shillo Nays: None RESOLUTION 2017-167 PW 7 To" IJ FISHERS ISLAND FERRY DISTRICT VENDOR 002487 BOCA SYSTEMS, INC. 11/21/2017 CHECK 4473 A FUND & ACCOUNT P.O.# INVOICE DESCRIPTION AMOUNT SM .5710.4.000.400 1084517 TICKTS 100K @$11.51 EACH 1,268.08 TOTAL 1,268.08 ,qj A ol co n4 3A Yiy P" of _-..'AUDIT`x1' 21 -17 AA -FlSHERSJSL FERRYDISTRIC 44 -pLo,eox.117,9-­ ..... . Y-M095-MAIN,R6Ao, 'Tk&SIJOiFOI_k-CO.NATI0NAL,.I3ANK-.' [­ _,CUTCHOGUE"NY 11935 ;DATE, AMOUNT,',_ f,_`. I J- _11/2-i--/2 0 11 '56_546/214'i"_ -0 "'DOLLAR -08'/l D Sl. TY' EIGHT, ;w s x- A ON R PAY,- -BOCA SYST21\4&', .' INC. ij TO 10'6_5 Sbtl',TH',`,kOGERS';- CIP CLE 6, DER _ ., ,4 - - 4,vpq A,.'RAtON OF Wo 110 -bo L.L. ? 31, 1:0 2 140 5464 . 8 00150 1 Vendor No. Check No. Town of Southold, New York - Payment Voucher 2487 -41473 Vendor Tax ID Number or Social Security Number Vendor Address Entered by- 1065 S. Rogers Circle Vendor Name Boca Raton, Fl-33487 Audit Date .. Boca Systems, Inc. _ Vendor Telephone Number N V 12017 561-998-9600 Clerk Vendor Contact Invoice Invoice Invoice Net Purchase Order Number Date Total Discount Amount Claimed Number Description of Goods or Services General Ledger Fund and Account Number 1084517 - 11/8/2017 $1,268.08 $1,268.08 Tickets-100 Q$11.51 SM5710.4.000.400 F C t d $1,268.08 $1,268.08 Payee Certification Department Certification The undersigned(Claimant)(Acting on behalf of the above named claimant) I hereby certify that the materials above specified have been received by me does hereby certify that the foregoing claim is true and correct,that no part has in good condition without substitution,the services properly been paid,except as therein stated,that the balance therein stated is actually performed and that the quantities thereof have been verified with the exceptions due and owing,and that taxes from which the Town is exempt are excluded or discrepancies noted,and payment is approved Signature tGy I---- Title Signature ��// Company Name Date Title Date /J Invoice Boca Systems Inc. 1065 S. Rogers Circle INVOICE NUMBER : 1084517 Boca Raton, FL 33487 INVOICE DATE : 11/8/17 (561) 998-9600 cathy@bocasystems.com The paper used to produce these tickets is certified to meet the standards set forth in the Sustainable Forest Initiative(SFI)Program for Fiber Sourcing and Chain of Custody(15%certified forest content and 85%fiber sourcing) Certificate#BV-SFICOC-US003863-1 BILL TO : SHIP TO : Fishers Island Ferry District Fishers Island Ferry District 261 Trumbull Drive 261 Trumbull Drive Attn:Accounts Payable Attn: Receiving Fishers Island, NY 06390-0607 Fishers Island, NY 06390-0607 Boca Systems will close for our winter vacation on Dec 21. We will re-open on Jan 2. PO Number : email-10.18.17 Customer Name : fishers island ferry Release: 0 Order Date : Phone : 631 788 7463 Quote Num : DB239509 Ship Via : ground Terms : Net 30 Contact : Gordon Murphy Email : gmurphy@fiferry.com Quantity Description Unit Price Net Price 100 K Ticket(HS7, 2.x3.50, 4 colors) $ 11.510 $ 1, 151 . 00 Special Instructions std blackmark at 1 188 Ref JK192939 except add perforation at 1 75"from leading edge. SUB TOTAL $ 1, 151 .00 4 tickets per fold SHIPPING Ref pert tool#WHQ05-09-77409 Attn Gordon Murphy $ 117 .08 SALES TAX TOTAL $ 1,268. 08 PREPAID Order Complete BALANCE $ 1,268 .08 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 IT FISHERS ISLAND FERRY DISTRICT DE-U"R'S OIL SERVICE, INC. VENDOR 002644 BRO 11/21/2017 CHECK 4474 & ACCOUNT P.O. AMOUNT,, FUND INVOICE DESCRIPTION SM .5-710.4.000.100 69797 160.6GL #2 OIL-NLT-10/24 366.02 TOTAL 366.02 4:.4ez, WRYDISTRICIT" 11", S,lS ,' NO,'FE tt{; stir tFISHER 1-53095 MAIN FIOAD,, SOUTHOLD'NY 11971:0959L'-': PO' BOX.l 179 7 0-. ,' ,44 v-1 -THE.SUFFOLK CO.NATIONAL BAN DATE CUTCHOGUE:,'NY'11935", f'1 3 6 6 0,2r ''-546/2i4',. 11 21, CFf7 6b 2' A 0 0' DOLLARb" -19REE,,RWDRPDl''81,=YS'! 7 CHECK P AY— AD ICE, INC Tar -.STERLING RO 2 OF MOOSbP--CT, 063, 0 0 Lit, 7 L,on 1:0121' 21 L,0 S L, r.Li": 68 00L502 Vendor No. Check No. Town of Southold, New York - Payment Voucher 2644 --17 Lf Enteredby P.O. Box 602 Audit Date Brodeur's Fuel Moosup, CT 06354 17 Vendor Telephone Number Nov �� 860-564-2789 Vendor Contact ` Invoice Invoice Invoice Net Purchase Order Number Date Total Discount Amount Claimed Number Description of Goods or Services General Ledger Fund and Account Number —160 if 69797 10/24/2017 $366.02 $366.02 160.6 gal $2.143 KILT heating oil SM6710.4.000.100 $366.021 1 $366.02 Payee Certification Department Certification The undersigned(Claimant)(Acting on behalf of the above named claimant) I hereby certify that the materials above specified have been received by me does hereby certify that the foregoing claim is true and correct,that no part has in good condition without substitution,the services properly been paid,except as therein stated,that the balance therein stated is actually performed and that the quantities thereof have been verified with the exceptions due and owing,and that taxes from which the Town is exempt are excluded or discrepancies noted,and payment is approved Signature `, � Tstle Signature Company Name Fishers Island Ferry District Date 11/3/2017 Title - Date 17 v Ij BHODE�gS BRODEUR S OIL SERVICE, INC. ,. i FUEL OIL - KEROSENE - DIESEL 28 Sterling Rd. - P.O. BOX 602 - Moosup, CT 06354 Heating&Cooling } Emergency service Contractor 4 for Our Customers CT LIC#303396 564-2789 • 859-5840 923-9528 CT HOD#46 TELEPHONE NO. CHARGES AND PAYMENTS AFTER ACCOUNT NO. THIS DATE WILL APPEAR ON YOUR NEXT STATEMENT r 4R2--0 .65 530615 10/31/17 BUDGET ACCOUNTS ONLY I FISHER ' S ISLAND FERRY DIS PAYMENT DUE I PO BOX 607 1 FISHERS ISLAND , NY 06390 PAST DUE NON-BUDGET AMOUNT TOTAL DUE 5 WATERFRONT PARK Amount r Paid $ - - - PLEASE ENCLOSE THIS PORTION OF STATEMENT WffH REMPTTANCE. ACCOUNT NUMBER DATE OF THIS STATEMENT LAST STATEMENT DATE PREVIO 530615 10/31/17 10/31/17 ; BALANCEDESCRIPTION GALLONS i ® DELIVERED . 00 10/24 FUEL OIL 160 . 6 344 .17 10/24 CT SALESTX—HEAT 21 . 851 r 1 I i I 366 . 0 2 0P� ' ,AYS OVER,,,DAYS . PAY THIS AMOUNT 00 - 00 366 . 02 366, 02 11L�1 i LATE PAYMENT CHARGE SCHEDULE REMITTANCE REQUIRED UPON • RECEIPT OF STATEMENT BRODEUR'S OIL SERVICE, INC. 7o7l 1 . 50' 18 . 00 THANK—YOU FOR YOUR PROMPT PAYMENTS 1 . 50 ; 18 . 00 OFFICE HOURS MON—FRI �" 8 : 00-4 : 00 �.r LAST THREE DELIVERIES DATE /0 FACTOR T co =ROUTE FUEL- DEUR W. DM.NEXT- DATE; D.D., GALLONS K )> (1"4 1, 262 . 1 1 - 8 1 c 72 03201 4 A 4 3 248 E 1 . 73 4 OFFICE USE bDRO'- JULIAN- 03 0 A 1 4 0 0 4 287 fi 1, . 8 1 GALLONS RICE U) 5 f5 0 A A A A A ?!_3 0 - FUEL DR- R 2 JULIAN- p Z 30 DAY DAY,'�- po, W DAY BALANCE FWD., DELIVERY TOTAL CURRENT < " 21 cn F71 m FXSHER 8 ISLAND F E S'R Y DIS ACCOUNTNO. STATE 71 m T �i WATERFRONT PAkKNEW LONDON , CT i 7,, TAX 1-le-1 , ,k -:D " 442 0 165 FED" ml Vii• 4 TAX- M mj _ T 1,�ava 6.97 97 CD CT.LIC.303396 misc FILL ON HILL BY GRN EILDG s­A3 E Wf.N 0 TR A..1c. T,N-, S A Ir 1Q14 PAID CD R .p_­�-�, SALES TAX,,,'35�' CT HO #46 1 . �,.'-'_-`BRODEUR`S OIL SERVICE, INC. > 28 STERLING ROAD, P.O. BOX 602, MOOSUP, CT 06354 ffi�-2 9 859-98f 923-9528 If PayrrigntPeqpived B PAY t,T 1. dril a ,t ,n -I,, -c- t ,0 c o A r-.i.n c n q t n o 5n hi.n.hoa- --- ------------------ ----------- g; FISHERS ISLAND FERRY DISTRICT J5 VENDOR 002791 HEATHER FERGUSON BURNHAM 11/21/2017 CHECK 4475 A FUND & ACCOUNT P.O.# INVOICE DESCRIPTION AMOUNT SM .5712.4.000.000 111317 117 COMM MTG JUL-SEP(7) 350.00 m TOTAL 350.00 t ?2w It N gp%. x O'l IRICT', .AUDIT FISHERSISL 4 W,FERR YDIS MAIN RoAD,lP0,B0X-.1179 T" ^i o _SdUTH0Lq,!,NY l,,j?71-qP59 ---,THE ISU F6CK'tb.-N'A'Ti'O'N'A"L'B'A'Ni ','CUTCHOGUE,NYli1935-a— DATE AMOUNT, C 50-546/ 11%21,/2'017: 214 Ty 2, Yi ;kTHREFI'HUNDRED' P AY' 4lEAkH2R"jFERG HAM y. PC T1O THE,"i-_ I bkDEj? LAND NY_:aG 01, OF' S- 0 0 LL ? S no 1:02lL,0SL3L : C3 001502 L N_ Vendor No. Check No. Town of Southold, New York - Payment Voucher 2791 y '175 Vendor Address Entered by P.O. Box 335 fl Fishers Island, NY 06390 Audit Date Heather Ferguson Burnham NOV 2 12017 Vendor Telephone Number Glc Vendor Contact Invoice Invoice Invoice Net Purchase Order Number Date Total Discount Amount Claimed Number Description of Goods or Services General Ledger Fund and Account Number it 131"7 11/13/2017 $350.00 $350.00 Commissioner Meeting SM5712.4.000.000 Jul-Sep 2017 7 Mt s $50/mt $350.00 1 $350.00 Payee Certification Department Certification The undersigned(Claimant)(Acting on behalf of the above named claimant) I hereby certify that the materials above specified have been received by me does hereby certify that the foregoing claim is true and correct,that no part has in good condition without substitution,the services properly been paid,except as therein stated,that the balance therein stated is actually performed and that the quantities thereof have been verified with the exceptions due and owing,and that taxes from which the Town is exempt are excluded or discrepancies noted,and payment is approved Signature hC@/1.i- Title Signature Company Name Fishers Island Ferry District Date 11/10/2017 Title Date 7 Z /�- BOC Meetings Rugg, Peter Ahrens, Andrew Shillo, Di Bloethe,W Burnham, H 10-Jul-17 X X X X X 5 24-Jul-17 X X X X X 5 7-Aug-17 X X X X X 5 18-Aug-17 X X X X X 5 5-Sep-17 X X X X 4 18-Sep-17 X X X X 4 29-Sep-17 X X X X 4 32 5 7 7 6 7 32 3Q17 $ 250 $ 350 $ 350 $ 300 $ 350 $ 1,600 $ - Page 1 \\fiserv1\D$\FD Network Directory\BOC\2017 Meetings-Commissioner Stipends 10/4/2017 Minutes of the Meeting of the Board of Commissioners Fishers Island Ferry District July 10, 2017 Commissioner Ahf"ens at the Fishers Island Community Center called to order a meeting of the Board of Commissioners of the Fishers Island Ferry District("the Ferry District")on June 26, 2017 at 4:30 PM, Commissioners William Bloethe, Het urnham, Peter R6'gg and Di Shilio were present.Also in attendance were Gordon Murphy, Ge Cook and Deanna Ross. RJ Burns was present via phone. Several members of the public were present. Commissioner Ahrens established that a quorum was present. Everyone in attendance pledged allegiance to the flag. Correspondence/Public Comment—Mr. Cook received two pieces of correspondence via email regarding the hovercraft. One letter was received from Mr. Rich Bartels expressing his discontent with the hovercraft docking at Silver Eel Cove at 2:30am. Mr. Cook reached out to the captain of the Hovercraft and moving forward,they have agreed to not permit chartered trips that late.The second piece of correspondence was received from Ms. Lauren Calahan voicing noise complaints in Silver Eel Cove. Mr. Cook spoke with Ms. Calahan at length last Friday regarding her concerns. Mr. Peter Burr asked the BOC to reconsider resuming the half-priced fares for non residents during the peak season. Mr. Burr feels that it was a nice benefit in years past and the majority of passengers have not abused it. Discussion ensued among the BOC and members of the public.The BOC has agreed to revisit the current policy. A member of the public asked the BOC what the liability was for folks entering and exiting the hovercraft using the ladder on the dock. Mr. Cook informed everyone that both parties carry liability insurance and there will be consideration of a floating dock if the partnership with the hovercraft continues after the trial season. A question was brought to the attention of the BOC regarding the recourse for damaged freight. Mr. Burns informed all that the policy is that the FIFD will not accept damaged goods at the New London Terminal. In the event that freight is damaged, anyone receiving the freight should address that with a manager. Another question arose regarding times in which the Fishers Island freight shed is closed to process incoming freight. The BOC and management has agreed to ensure proper signage so customers are aware of closing times. Management Reports SEC Dolphin Project- Mr. Burns updated the BOC. Mr. Burns and Mr. Cook reviewed the contract documents with Keith Neilsen of Docko,who has been in contact with Mohawk. The funding is in place and they are now waiting for a date to meet and sign the agreement to get the project underway for the Minutes of the Meeting of the Board of Commissioners Fishers Island Ferry District July 24, 2017 Commissioner Ahrens at the Fishers Island Community Center called a meeting of the Board of Commissioners of the Fishers Island Ferry District("the Ferry District")to order on July 24, 2017 at 4:32 PM. Commissioners William 1314the, Heath rnham, Peter Rugg and D.Shillo were present. Also in attendance were Gordon Murphy,Geb Cook, Diane Hansen and Deanna Ross. RJ Burns was present via phone. No members of the public were present. Commissioner Ahrens established that a quorum was present. Everyone in attendance pledged allegiance to the flag. Correspondence/Public Comment—No correspondence was received.There is no public comment. Minutes RESOLUTION 2017-125 RESOLVED,that the Board of Commissioners of the Fishers Island Ferry District hereby approves the minutes of the May 30,2017 meeting. Moved by:Commissioner A.Ahrens Seconded by:Commissioner W. Bloethe Ayes:A.Ahrens,W. Bloethe, H. Burnham, P. Rugg and D.Shillo Nays: None Warrants RESOLUTION 2017-126 RESOLVED,that the Board of Commissioners of the Fishers Island Ferry District hereby approves an additional Warrant(D)dated July 10th in the amount of$388.19 for the MTA payment. Moved by:Commissioner H. Burnham Seconded by:Commissioner D.Shillo Ayes:A.Ahrens,W. Bloethe, H. Burnham, P. Rugg and D.Shillo Nays: None RESOLUTION 2017-127 RESOLVED,that the Board of Commissioners of the Fishers Island Ferry District hereby approves the Warrant dated July 24,2017 in the amount of$57,846.41. Minutes of the Meeting of the Board of Commissioners Fishers Island Ferry District August 7,2017 Commissioner A ks at the Fishers Island Community Center called a meeting of the Board of Commissioners of the Fishers Island Ferry District("the Ferry District")to order on August 7,2017 at 4:30 PM. Commissioners William Bloethe,_Heather urn ham, Peter Rugg and D.Shillo were present.Also in attendance were Gordon Murphy,Geb Cook, Diane Hansen and Deanna Ross. No members of the public were present. Commissioner Ahrens established that a quorum was present. Everyone in attendance pledged allegiance to the flag. Correspondence/Public Comment— An email correspondence was received from Mr. Bob Evans stating that the airport lights are unnecessarily bright and invasive. The BOC has agreed that the lighting is in compliance with the FAA.Commissioner W. Bloethe questioned management regarding the refusal of accepting freight after 12:30pm on Saturdays at the New London Terminal. Management agrees that a mistake may have been made and will look into the matter further to avoid any future issues. Warrant RESOLUTION 2017-139 RESOLVED,that the Board of Commissioners of the Fishers Island Ferry District hereby approves the Warrant dated August 7, 2017 in the amount of$58,685.99. Moved by:Commissioner P Rugg Seconded by:Commissioner A Ahrens Ayes:A.Ahrens,W. Bloethe, H. Burnham, P. Rugg and D. Shillo Nays: None Budget Modification RESOLUTION 2017—140 RESOLVED that the Board of Commissioners of the Fishers Island Ferry District hereby increases the 2017 Fishers Island Ferry District budget as follows: Revenues: SM.4960.50 FEMA AID-TRANSPORTATION S 12 055.00 Total $ 12,055.00 Minutes of the Meeting of the Board of Commissioners Fishers Island Fery District August 18,2017 Commissioner Ahrens at the Fishers Island Community Center called a meeting of the Board of Commissioners of the Fishers Island Ferry District("the Ferry District")to order on August 18,2017 at 4:42 PM. % Commissioners William Bloethe, Heather Burnham, Peter Rugg and D.Shillo were present.Also in attendance were Gordon Murphy,Jeb Cook and Deanna Ross.Several members of the public were present. Commissioner Ahrens established that a quorum was present. Everyone in attendance pledged allegiance to the flag. Members of the public were welcomed and the BOC congratulated Commissioner D.Shillo for winning the election. Correspondence/Public Comment— Mr. Cook received one letter from the Town of Southold thanking the FIFD for use of the ferry on Town of Southold Day.There is no public comment. Minutes RESOLUTION 2017-150 RESOLVED,that the Board of Commissioners of the Fishers Island Ferry District hereby approves the minutes of the June 26, 2017 meeting. Moved by:Commissioner P Rugg Seconded by:Commissioner W Bloethe Ayes:A.Ahrens,W. Bloethe, H. Burnham, P. Rugg and D.Shillo Nays: None RESOLUTION 2017-151 RESOLVED,that the Board of Commissioners of the Fishers Island Ferry District hereby approves the minutes of the July 10,2017 meeting. Moved by:Commissioner D Shillo Seconded by:Commissioner A Ahrens Ayes:A.Ahrens,W. Bloethe, H. Burnham, P. Rugg and D.Shillo Nays: None Budget Modification RESOLUTION 2017-152 Minutes of the Meeting of the Board of Commissioners Fishers Island Ferry District September 5,2017 Commissioner Ahr�at the Fishers Island Community Center called a meeting of the Board of Commissioners of the Fishers Island Ferry District("the Ferry District")to order on July 24,2017 at 4:30 PM. Commissioners William Bloethe, Heath am and D.Shillo were present.Also in attendance were Gordon Murphy,Jeb Cook, RJ Burns, Diane Hansen and Deanna Ross. Commissioner Ahrens established that a quorum was present. Everyone in attendance pledged allegiance to the flag. Correspondence/Public Comment—Mr.Cook received one email regarding a cancelled Hovercraft run due to weather but then running it because the weather improved and not notifying the initial passengers that were cancelled. Mr.Cook spoke with that customer and acknowledged the error. A letter was received from Friends of the Fisher's Island Theatre(FFIT)expressing that they are currently in the process of obtaining 501(c)(3)status and their desire to purchase the Fishers Island Theatre. In addition a letter of intent was received from Walsh Park regarding a feasibility study to lease the second floor of the freight shed and turn into affordable housing apartments. Warrants RESOLUTION 2017-154 RESOLVED,that the Board of Commissioners of the Fishers Island Ferry District hereby approves the Warrant dated September 5th,2017 in the amount of$26,132.18. Moved by:Commissioner D Shillo Seconded by:Commissioner A Ahrens Ayes:A.Ahrens,W. Bloethe, H. Burnham and D.Shillo Nays: None Management Reports SEC Dolphin Status-Mr. Burns updated the BOC. The lack of progress is due to difficulty with the bottom. Permission was granted to allow the contractor to move some of the dolphins in order to get good penetration of 12-20 feet. Estimated time of completion is set for the end of next week. RacePoint Insulation-Mr. Burns informed the BOC that RP will be dockside the last two weeks of October for the installation of the A-60 structural fire protection. Minutes of the Meeting of the Board of Commissioners Fishers Island Ferry District September 18,2017 Commissioner Ahrens at the Fishers Island Community Center called a meeting of the Board of Commis- sioners of the Fishers Island Ferry District("the F rry District")to order on September 18,2017 at 4:30 PM. Commissioners William Bloethe, Heather Burnham,and D.Shillo were present.Also in attendance were Geb Cook and Deanna Ross. Commissioner P. Rugg, RJ Burns and Diane Hansen were present via phone. Commissioner Ahrens established that a quorum was present. Everyone in attendance pledged alle- giance to the flag. Correspondence/Public Comment—Mr.Cook informed the BOC that a letter was received from Rev. Candy Whitman requesting if management and the BOC would consider changing the Sunday 7am boat departing from New London to 8am to accommodate guest speakers and musicians on Sunday morning church service at the Union Chapel which begins at 10am. Mr.Cook has agreed to evaluate over the next coming year. An email was received by Fishers Island School Principal,Christian Arsenault expressing thanks and gratitude to the ferry district and crew members for holding the annual ferry safety day. Chairman Ahrens reported to the BOC that he received a phone call from Mrs. Patty Faulkner requesting if someone was available to go to the utility office and explain the new two-way ticketing system to her and staff members. Mr. Cook agreed to take that responsibility.There is no public comment. Impending Weather-Mr. Burns informed the BOC that he has been in contact with Mr.Arsenault and the FI School. Mr. Burns does not foresee any upcoming cancellations with the current ferry schedule. The cargo run has been moved to Friday and will be on MV Munnatawket as it is a better sea boat and fits better in the cove.Additionally both barges will be removed from Silver Eel Cove due to impending weather. Minutes RESOLUTION 2017-166 RESOLVED,that the Board of Commissioners of the Fishers Island Ferry District hereby approves the ,minutes of the July 24,2017 meeting. Moved by:Commissioner W. Bloethe Seconded,by:Commissioner A.Ahrens Ayes:A.Ahrens,W. Bloethe, H. Burnham and D.Shillo Nays: None RESOLUTION 2017-167 Minutes of the Meeting of the Board of Commissioners Fishers Island Ferry District September 29,2017 Commissioner Ahrens at the Fishers Island Community Center called to order a meeting of the Board of Commissioners of the Fishers Island Ferry District("the Ferry District")on September 29,2017 at 1:00 PM. Commissioners Heather Burnham, Peter Rugg and Dianna Shillo were present.Also in attendance were Geb Cook, R1 Burns,Diane Hansen and Deanna Ross. Marcia Marien of O'Connor Davies was present. Commissioner William Bloethe and Gordon Murphy were absent. Commissioner Ahrens established that a quorum was present. Everyone in attendance pledged alle- giance t6 the flag. Correspondence/Public Comment—Mr.Cook reported that no correspondence was received. There was no public comment. The BOC agreed to add an executive session to the September 29,2017 agenda. Moved by:Commissioner D.Shillo Seconded by:Commissioner A.Ahrens Ayes:A.Ahrens, H. Burnham, P. Rugg and D.Shillo Nays: None Warrants RESOLUTION 2017-177 RESOLVED,that the Board of Commissioners of the Fishers Island Ferry District hereby approves the Warrant dated September 29,2017 in the amount of$66,700.36. Moved by:Commissioner A.Ahrens Seconded by:Commissioner D.Shillo Ayes:A.Ahrens, H. Burnham, P. Rugg and D.Shillo Nays: None Audit Review-Ms. Marcia Marion,CPA for O'Connor Davies presented the Fishers Island Ferry District December 31,2016 Audit to the BOC. Audit RESOLUTION 2017-178 Whereas the 2016 financial audit was approved by the Board of Commissioners of the Fishers island Fer- ry District. Vendor No. Check No. Town of Southold, New York- Payment Voucher 2791 LA4 75 Vendor Address Entered by - P.O.Box 335 Fishers Island, NY 06390 Audit Heather Ferguson Burnham _ C_ _9 _2_011 Vendor Telephone Number Vendor Contact Invoice Invoice Invoice Net Purchase Order Number Date Total Discount Amo t Claimed Number Description of Goods or Services General Ledger Fund and Account Number 1�131� 11/13/2017 $350.0 $350.0 Commissioner Meeting SM5712.4.000.000 Jul-Sep 2017 7 Mt s $50/mt $350.00 $350.00 Payee Certification Department Certification The undersigned(Claimant)(Acting on behalf of the above named claimant) I hereby certify that the materials above specified have been received by me does hereby certify that the foregoing claim is true and correct,that no part has in good condition without substitution,the services properly been paid,except as therein stated,that the balance therein stated is actually performed and that the quantities thereof have been verified with the exceptions due and owing,and that taxes from which the Town is exempt are excluded or discrepancies noted,and payment is approved Signature ^ .a. Title Signature Company Name Fishers Island Ferry Distract Date 11110/2017 Title Date ? /� ' •1•r• 'r k r a r ,N;�,,, t� sn•�',-:�, _ P�`ES:1',`j .�j �! `4� FISHERS ISLAND FARYDISTRICT VENDOR 002791 HEATHER FERGUSON BURNHAM 11/21/2017 CHCK 4475 I c� A , ! FUND & ACCOUNT P.O.# INVOICE DESCRIPTION AMOUNT j SM .5712.4.000.000 111317 117 COMM MTG JUL-SEP(7) 350.00 TOTAL 350.00y� l 1 1 \ gj1 10 C:'4�p�� ri l `rj T r' +` i• '''7 ,t!_ .'y'C,.. ••i4-'... ..« ..• .. .,e..c.,,vnv::'�.:c,�.. .3a'�'sw`�r:�•�'Y•� ^h-t .. .a t- � v%c:".�.•�.-;c:,g; cn+,'kSS'r•. �•c ti,x^ / .•.t'S;1; ogJ c�^•n.a+•>^:s.••�a:,rq���•a�K!.b,Y;;;tx•,i�•r,•'3 1:�-y •,�...c;,;?• „? G,t�'',Y.S.'•,..,';•'"•y,r"",••`--.:'.�f`Y:'L''n<•r•,•• •sS,?`♦wr.`94c'�rr".`. G`tkc `�: �."w.�^•^r' J��a l ,nom•:.: •:••`4�'s+.,•+3Fi+=S: ,`•:4•vr:-K':'a`k' ..•'e4'?y�3±'j.,.;.5. c`�-s k r.:-xi„t ,xg<ja:. ,e;,<,^ b...x •+t_ciA?'�,-',�: ` J r: '6a n;.•�t zcs....":__: `ki .+vrs,•¢C7- .,`+.t•+,«;,. '" 3 '4 . _C �4-.r;-•�-yJ r r'`i.:Kv *" ;'•°1is°,�rv,k'a'° � +�'�"t�.•^^`h:-•,•!.�: '"•�= .'`°3'� 1 i y• Nil 4"e r:8 4R I ? F7SFIBRSISI,A'1-V Mi RRYDISTRICT' eB3095MAIN AOAD,tPO.90X:1'179 -SOUTHOLD;;NY,:1;1971-0959 J;,. '+'• r. CHEZ:&`•NO. '4475:f' ';`• k +' fiHESUFFOIX"CU:NAT10NAL`'6ANIC'' d j ti `:t'<•, ;CU1 CHOGUE,NY,°1.1935 r• DATE" :'.e-: AMOUNT, -. '•_ ;; :t r: �" `;i ;Ilv, - , =71"/2]�2'017 �..'- :j., $-a'5o 010':;.�i,•- 50-546/214 °,'THREE, HU kI D`"F•IF`TY:"TND!._00;'/10&IDOL i - - ,y 1 A,� t.. -:N,' 1 r' - :1 y,,, ;, ,•-�_-•,a. ,'!it .' •J:'''-4i,.,"y+, , • ";•,:e" .,I,'' 'I. `'l,i..1 '. ,•S 11 i,T, �} ,it ••"1' ,•, •It��• •� t, ° °�•c, - �, ••}I '' '{'�n�' J ,•1' 1 ,1 1,5111 t.i°' y''' _.r' .G., ! 3 1�L: r.'4, y..1� 15p. - l•r- _J_ --1, __J_.'_ - _ _ - ' -t. • ' 1 - ''t•J' 1141 = 1E&HER 'FERGTJSON 'BL]RNHAM '- � , ,' ` A% To T�IEF. '35:_ i'r. s:, 6!' i, 'i'i',• •{j,� 1 k•l`• i ,_3`t,. jk :�6 n 1 O] 38IHF]RS',ISLAND''NY,=063;9,0 3 �', ' _ _ .', - ,y - - '_ - „'1,_ _ '-i; _ -_' _ "'� _ �r'•'r,,r' •- •'i�._ is -� I'" i�,'i?`(( I u'00447Slim 1:0 2 14054o: M 001502 L110 I IV 1, � t Stop Payment Confirmation Page 1 of 1 Stop Payment Confirmation Submitted: 12/15/2017 Account *5021 -FI Ferry Accounts Payable Check number: 4475 Date on check: 11/21/2017 Payee: Amount $350.00 Reason. lost check https://peoplesunited.ebanking-services.com/nubi/Services 2_0/Stop_Payment/StopPaym... 12/15/2017 FISHERS ISLAND FERRY DISTRICT rs VENDOR 003891 CWPM, LLC 11/21/2017 CHECK 4477 A FUND & ACCOUNT P.O.# INVOICE DESCRIPTION AMOUNT SM .5709.2.000.200 1210327 REFUSE RMVL/l,NL-11/17 448.29 -A TOTAL 448.29 i l L ->M 7 I N` o o 50, -------------- - ------ y,a I' j r c'r mom "-. , FISHERSISLAAD,,FERRY-DISTA[Cr, A' 53095MAINRC )AD,TPO BOXI 179,- 4 59 CHEEK NO SOUTHOLP';NY 1_1 9:71-09 CBANk- r4 FF&W'60'. 'NATIONA su CUTCH0GUE;-,Nr,l 35, --,=AMOUNT-_ 9 'HUNDRED f FOP -V,EIGHT'-AND-' 9'1 2 -110 Oa`DOLLARS 1%' _J PAY,, RDE t T 0 Ida O 1 T-,,0 A 10,0 o 4 4 ? 711' 1:'0 2 14 0 S L,F31-1: G 13 001502 I LJ �. Vendor No. Check No. - Town of Southold, New York - Payment Voucher 3891 ?7 Vendor Address Entered by PO Box 416 Vendor Name Plainville, CT 06062 Audit Date - CWPM, LLCc� i, Vendor Telephone Number - 86 1473 'Clerk Vendordor Contact Invoice Invoice Invoice Net Purchase Order ; NumberDate Total Discount Amount Claimed Number General Ledger Fund and Account Number 1210327 11/1/2017 $448.29 $448.29 Nov 2017 Refuse and Recycling SM6709.2.000.200 F F 4 ' ' 3 $448,29 1 $448.29 Payee Certification Department Certification The undersigned(Claimant)(Acting on behalf of the above named claimant) I hereby certify that the materials above specified have been received by me does hereby certify that the foregoing claim is true and correct,that no part has in good condition without substitution,the services properly been paid,except as therein stated,that the balance therein stated is actually performed and that the quantities thereof have been verified with the exceptions due and owing,and that taxes from which the Town is exempt are excluded or discrepancies noted,and payment is approved Signature c. Tule Signature Company Name Fishers Island Ferry District Date 11/3/2017 Title Date I CWPM,LLC INVOICE Page 1 of 1 PO Box 415 Plainville,CT 06062 2�"'A•,,,, ;�{��,, „N '•, �� , Phone'1-888-966-CWPM Fax:860-793-2624 Account Number 12761300 www cwpm net Invoice Date 11/1/17 Invoice Number 1210327 P O Number Date Due 12/1/17 Previous Balance $000 Current Charges $44829 FISHERS ISLAND FERRY DIST Please Pay: $448.29 P O BOX 607 FISHERS ISLAND,NY 06390 RTMENNN , ---------PLEASE DETACH HERE AND RETURN ABOVE PORTION WITH YOUR PAYMENT USE REVERSE SIDE WITH ENVELOPE------ COMMERCIAL&INVOICES �>im , ActNbr 12761300 StteName FISHERS ISLAND FERRY DIST STATE ST NEW LONDON,CT 06320 11/1/2017 MONTHLY SERVICES 100 $22156 $22156 11/1/2017 RCY MONTHLY SERVICES 100 $8522 1 $8522 11/1/2017 MONTHLY SERVICES 200 $4545 I $9090 I ! I L I I i I ' i � I f ' i i i CWPM,LLC u PO Box 415 ani @ .` _„ ' Charges $39768 I Plainville,CT 06062 $aas z9 $0 00 go.00 \ $o 0o Taxes: $26.76 Phone,1-888-966-CWPM Fuel Surcharges $23 85 Fax:860-793-2624 Finance charge $000 www.cwpm net Invoice Total- $44829 TOTAL DUE: $448.29 FISHERS ISLAND FERRY DISTRICT VENDO R 004277 DIME OIL COMPANY, LLC 11/21/2017 CHECK 4478 A FUND & ACCOUNT P.O.# INVOICE DESCRIPTION' AMOUNT SM .5710.4.0'00.300 69695 MU 4025 GAL@$19164/GAL 7,713.51 SM .5710":4.000.300 696.95 CT EXCISE TAX-$.-41701GAL 1,678,.43- / SM .571 . .0 ' 0 4 00.300 G9695 S-F COST RECOVERY .0021 8.45 SM .5710.4.000.300 69695 LUST TAX-$.0010/GAL 4.03 SM .5710.4.000.300 69765 I RP 5474.4GL @$1.9659/GAL 10,762.12 is SM .5710,4.000.300 i 69765 CT EXCISE TAX-$.4170/GAL 2,28\2.82 ' 7-10—.4--000,.-300 5VRRY-: . 2 SM .5710.4.000.300 69765 LUST TAX-$.0010/GAL- 5.47 TOTAL 22,466.33 "A. A-) 4.©-' x" 'y ,F ERS"ISi 6",iikRYD1S7RICT- ISH AN 53 PO B, -MAINROAD, OBR'1179 ', 095 "CHECK N iOLO'NY-11971-0959" SOUT THE SUFFOLK CO.'NATIO.NAL'BANK CUTCHOGU,E;,NY, 1,19351 '4 DATE ' 'AMOUNT:- , 50 546/2'14 '$2'2 -33' ;,,y -=TWENTY,--TWO'.-THFOUR-.- OUSjWb --' HUNDRED,;SIXTY;''SIX_ 10 0 ff/21/2017 PiLARS-',,',.:' PAY- -DIME-,OIL,JZOMPANYj, 'LtC 93 1 DUSTRY LANk-,.- ORDER:- -P0<BOX,liI2-5 9p, WATERBbii CTd6704,- llsobL.L', ?'^8 us 1:0214-054641: 68 00I502 I'll - -7 Town of Southold, New York - Payment Voucher Vendor No. 4277 Check No.' 4 4 Entered by P.O. Box 11125 Audit Date Dime Oil Company LLC Waterbury, CT 06703 Vendor Telephone Number NOV 2 12017 203-754-5334 e Vendor Contact �. Invoice Invoice Invoice Net Purchase Order Number Date Total Discount Amount Claimed Number Description of Goods or Services General Ledger Fund and Account Number 69695 10/27/2017 $9,404.42 $7,713.51 Mu 4025.00 gal a$1.9164/ al SM5710.4.000.300 $1,678.43 CT Excise Tax-$0.4170/ al $8.45 S-F Cost Recovery.0021 $4.03 LUST Tax-$.0010/ al 69765 11/6/2017 $13,061.91 $10,762.12 RP 5474.4 gal @$1.9659/ al SM5710.4.000.300 $2,282.82 CT Excise Tax-$0.4170/ al $11.50 S-F Cost Recovery.0021 $5.47 LUST Tax-$.0010/ al OPIS attached Federal S-F tax increased on 1/1/2017 $22,466.33 $22,466.33 Payee Certification Department Certification The undersigned(Claimant)(Acting on behalf of the above named claimant) I hereby certify that the materials above specified have been received by me does hereby certify that the foregoing claim is true and correct,that no part has in good condition without substitution,the services properly been paid,except as therein stated,that the balance therein stated is actually performed and that the quantities thereof have been verified with the exceptions due and owing,and that taxes from which the Town is exempt are excluded or discrepancies noted,and payment is approved l SignatTitle Signature Company Name Fishers Island Ferry District Date 11/10/2017 Title Date // �— dime Oil LLC Phone: 203-754-5334 ° PO Box 11125 Date 10/27/17 Waterbury, CT 06703 Page 1 Dime Oil LLC www.dimeoilco.com INVOICE ACCOUNT NUMBER : 4420165 Fishers Island Ferry District AMOUNT ENCLOSED: PO Box 607 (EMAIL) Attn Accounts Payable Fishers Island, NY 06390-0607 Re: Fishers Island Ferry Dist 5 Waterfront Park-Race Point, New London Terms: Net 30 Days From Invoice Date ---------------------------------------------------------------- - Date Invoice Charge and Credits Amount ----------------------------------------------------------------- 10/27/17 69695 4420165 -A Fishers Island Ferry 5 Waterfront Pk-Munn #20R Off Road Diesel 4025.0 GALS @ 1. 916400 7713.51 Dyed Diesel Fuel for Off Road Use ONLY. S-F Cost Recovery 8 .45 CT EXCISE TAX DSL 1678 .43 LUST TAX 4.03 10/27/17 69695 Fuel Invoice Total 9404.42 Amount Due 9404. 42 Effective Jan 1st the Federal Spill Recovery Fee increased to .0021 for Oil/Diesel & .0019 for Gas Dime Oil LLC 203-754-5334 Account:4420165 "'• TERMS:WE RESERVE THE RIGHT TO MAKE A FINANCE CHARGE COMPUTED BY A PERIODIC R+OF 1 5%PER MONTH WHICH IS AN ANNUAL PERCENTAGE RATE'OF 18%ON AMOUNTS PAST DUE SO DAYS OR MORE AND O ADD ALL COLLECTION FEES x „° •" ORDER DATEa C 10/26/2017 ,DELIVERY DATE 3 Fishers .Island' Perry- ' . 4420'16,5 ' ,�' 5 Waterfront Pk-Munnatawket. GALLONS �. m o 4-Mate Street FOR GPS $6�r,442-0'165 ,, u a Y ® S o0o i New London CT 06320® ! FULL PRICE PER GALLON �� — 1 -K Factor: , -,0 .000_ Last De y:0`9/,26/17\7 0.00-7:2:. o 0 1 95®exS'3mstra :t®f®110 sa �%s= Kasia Asmolov From: Accounting Department Sent: Monday, October 30, 2017 10:54 AM To: Kasia Asmolov Subject: FW: 10.27.17 delivery Inv. 69695 Attachments: fisher island inv 69695 (2).pdf From: Beth Skojec [mailto:beth@dimeoil.comj Sent: Monday, October 30,201710:15 AM To:Accounting Department Subject: 10.27.17 delivery Inv. 69695 **OPIS CLOSING BENCHMARK FILE** **OPIS GROSS ULTRA LOW SULFUR DISTILLATE PRICES** Move Terms No.2 Move No.l Move Pre Move Date Time Gulf b N-10 187.75 + 2.40 -- -- -- -- 190.25 + 2.40 10/26 18:00 GULF-GIE u Net 187.75 + 2.40 -- -- -- -- 190.25 + 2.40 10/26 18:00 Shell u N-10 189.32 + 2.47 -- -- -- -- -- -- -- -- 10/26 18:00 NWENGLPTR u N-10 189.35 + 2.40 -- -- -- -- 191.85 + 2.40 10/26 18:00 Valero u N-10 189.35 + 2.25 -- -- -- -- -- -- -- -- 10/26 18:00 Sprague u 1-10 190.36 + 2.67 -- -- -- -- 193.14 + 2.68 10/26 18:00 Irving b 1-10 190.39 + 2.07 -- -- -- -- -- -- -- -- 10/27 00:01 BP b 1-10 190.74 + 2.01 -- -- -- -- -- -- -- -- 10/26 18:00 S.R.& M. u 1-10 190.95 + 2.37 -- -- -- -- -- -- -- -- 10/26 18:00 Valero b 1-10 191.20 + 2.53 -- -- -- -- -- -- -- -- 10/26 18:00 Shell b 125-3 191.23 + 2.49 -- -- -- -- -- -- -- -- 10/26 18:00 XOM b 1-10 191.32 + 2.21 -- -- -- -- -- -- -- -- 10/26 19:00 Coastal b 125-3 191.43 + 2.52 -- -- -- -- -- -- -- -- 10/26 18:00 Sunoco b 125-3 191.43 + 2.52 -- -- -- -- -- -- -- -- 10/26 18:00 Citgo b 1-10 192.22 + 2.65 -- -- -- -- -- -- -- -- 10/26 18:00 Citgo u 1-10 192.22 + 2.65 -- -- -- -- -- -- -- -- 10/26 18:00 Irving u Net 192.22 + 2.36 -- -- -- -- -- -- -- -- 10/26 18:00 PBFEnergy u Net 197.27 + 2.80 -- -- -- -- -- -- -- -- 10/26 18:00 LOW RACK 187.75 -- -- 190.25 HIGH RACK_ 197.27 -- -- 193.14 RACK AVG 1.90.92 -- -- 191.37 Plus vendor mark-up .72 Total 191.64 Convert to dollars $1.9164 Katarzyna Asmolov Fishers Island Ferry District Dime Oil LLC Phone: 203-754-5334 PO Box 11125 Date 11/06/17 Waterbury, CT 06703 Page 1 Dime Oil LLC www.dimeoilco.com INVOICE ACCOUNT NUMBER : 4420165 Fishers Island Ferry District AMOUNT ENCLOSED: PO Box 607 (EMAIL) Attn Accounts Payable Fishers Island, NY 06390-0607 Re: Fishers Island Ferry Dist 5 Waterfront Park-Race Point, New London Terms: Net 30 Days From Invoice Date ------------------------------------------------------------------------------- Date Invoice Charge and Credits Amount ------------------------------------------------------------------------------- 11/06/17 69765 #20R Off Road Diesel 5474.4 GALS @ 1.965900 10762.12 Pickup No:. TM FULL Dyed Diesel Fuel for Off Road Use ONLY. S-F Cost Recovery 11.50 CT EXCISE TAX DSL 2282.82 LUST TAX 5.47 11/06/17 69765 Fuel Invoice Total 13061. 91 Amount Due 13061. 91 , Effective Jan lst the Federal Spill Recovery Fee increased to .0021 for Oil/Diesel & .0019 for Gas Dime Oil LLC 203-754-5334 Account:4420165 >" TERMS:WE RESERVE THE RIGHT TO MAKE A FIND"CE CHARGE COMPI-EE 3`/A PERIODIC RATE OF 1 5%PER MONTH WHICH ,(+ �r IS AN ANNUAL PERCENTAGE RATE OF 18`, ON A".'„UNTS PAST PUE 3N DArS OR MORE AND TO ADD ALL COLLECTION FEES IVB 5 ff LL_ _ ° ° C ORDER X1/03/2017 �� 2� Q 0620 foaG� c:33 I D DELIVERY DATI =� H E r� Pishers Island Ferry Dist 442x166 �, I` V 7im 7 5 t1a't;.ergront P ar]t®Race Point • • GALLONS m lO> �J 1 State Street FOR GPS 060-442-0165 ?4, oocn _° ! Nie -London CTx6320® 9�a4 FUU.PRIC PER GALL N o o u �e "c d�Gu :..?1.a x00- LaSt DeIV:0:%��2W-a-7-V,,a .0072 A 00 �sv 060 30 =� 3 x p i n-- x03®s��aa.t-f6ai- - �\ �cd. -_Ql_SCUUNT PRICti'f3 i'ER GALLON n I 0-ig -s—'-a Fatcllte St®®Vr -xA L.L-rAks L`-.0 term ,V �" ? I r DT 4300 ; \ PAY DISLbUNT AMOUNT � w �yl' s PAY THIS AMOUNT ? m Tax .7= $--0,k-170 0. 0010 d AFTER DAYS n� DIME 011— COMPANY, LAC' TRUC _ � TAX � c � P.O. BOX,11125 TMT WATERBURY, CT 06703 TINT AF! R�YMENTRECEIVED all ' c% 4t (203) 754-5334 TM OFD PM . �_ ❑CASH CHECK CUS O R I T `D I `2 4 CHA-C= N Kasia Asmolov From: Kasia Asmolov Sent: Friday, November 10,2017 9:08 AM To: Kasia Asmolov Subject: FW: FIFD invoice for 69765 Attachments: Invoice 69765.pdf From: Beth Skojec [mailto:beth@dimeoil.com] Sent:Wednesday, November 08, 20171:05 PM To: Kasia Asmolov Subject: RE: FIFD invoice for 69765 Attached please find invoice and opis for the 11.6 delivery. Please let me know you received this and can open the attachment. Beth **OPIS CLOSING BENCHMARK FILE** **OPIS GROSS ULTRA LOW SULFUR DISTILLATE PRICES** Move Terms No.2 Move No.l Move Pre Move Date Time NWENGLPTR u N-10 192.70 + 2.15 -- -- -- -- 195.20 + 2.15 11/03 18:00 Valero u N-10 193.45 + 3.00 -- -- -- -- -- -- -- -- 11/03 18:00 Shell u N-10 193.74 + 2.47 -- -- -- -- -- -- -- -- 11/03 18:00 S.R.& M. u 1-10 195.02 + 2.87 -- -- -- -- -- -- -- -- 11/03 18:00 XOM b 1-10 195.44 + 2.36 -- -- -- -- -- -- -- -- 11/03 19:00 Valero b 1-10 195.45 + 3.00 -- -- -- -- -- -- -- -- 11/03 18:00 BP b 1-10 195.57 + 2.77 -- -- -- -- -- -- -- -- 11/03 18:00 Sprague u 1-10 195.57 + 3.34 -- -- -- -- 197.43 + 3.33 11/03 18:00 Shell b 125-3 195.70 + 2.50 -- -- -- -- -- -- -- -- 11/03 18:00 GULF-GIE u Net 195.80 + 2.80 -- -- -- -- -- -- -- -- 11/03 18:00 Coastal b 125-3 195.89 + 2.68 -- -- -- -- -- -- -- -- 11/03 18:00 Sunoco b 125-3 195.89 + 2.68 -- -- -- -- -- -- -- -- 11/03 18:00 Gulf b N-10 195.90 + 2.90 -- -- -- -- -- -- -- -- 11/03 18:00 Irving u Net 196.17 + 2.76 -- -- -- -- -- -- -- -- 11/03 18:00 Irving b 1-10 196.38 + 3.92 -- -- -- -- -- -- -- -- 11/04 00:01 Citgo b 1-10 197.44 + 3.30 -- -- -- -- -- -- -- -- 11/03 18:00 Citgo u 1-10 197.44 + 3.30 -- -- -- -- -- -- -- -- 11/03 18:00 PBFEnergy u Net 202.02 + 3.61 -- -- -- -- -- -- -- -- 11/03 18:00 LOW RACK 192.70 -- -- 195.20 HIGH RACK 202.02 -- -- 197.43 hACK AVG _ 195.87 -- -- Pl196.32 us vendor mark-up .72 Total 196.59 Convert to dollars $1.9659 Katarzyna Asmolov Fishers Island Ferry District g FISHERS ISLAND,fERRY DISTRICT lei, VENDOR 005414 ELECTRICAL*OLESALERS,INC. 11/21/2017 CHECK 4479 ,"? A FUND & ACCOUNT P.O.# INVOICE DESCRIPTION, AMOUNT 0, sm .5710.2.000.200 S109138919.001 RP(3)TAP CONNECTORS 33., 18 TOTAL 33.18 c 'iloil i / I i hp --------- - rFrs _4 - r3 ISHER YISLAA0,'FERRYDISTk ICT _A 53095 MAIN-ROAD,PO'BOX 1179 NO.. 447 NO`..NYA 197,1`0959,, _CH CK' THE `cb -N016'Al""N SUFFOLK N ',CUTcHOGUE'NY1,1935'-, CATE-, AMOUNT, 2 8 131,.11 BF I v 0 _ 464214 It ,4y, -ELECTRICAL WH INC.P - - WHOLESALERS, MMg;",:z__,PO BOX-,78976Y C, 1. 0, ,ER­ - -PAZ PHILADELPHIA, "I 9117 8' 0 0 L,Lt,,?9 Ill 1:0 2 140546L,1: 68 00LS02 I'll 1 Vendor No. Check No. Town of Southold, New York - Payment Voucher 5414 4=79 Vendor Address Entered b Lockbox 9781 Vendor Name P.O. Box 8500 Audit Date Electrical Wholesalers Inc. Philadelphia, PA 19178-9761 NOV 2 12017 Vendor Telephone Number 800-522-3232 wn Clerk �' ��� Vendor Contact Invoice Invoice Invoice Net Purchase Order Number Date Total Discount Amount Claimed Number Description of Goods or Services General Ledger Fund and Account Number S109138919.001 10/23/2017 $33.18 $33.18 RP tap connector(3) SM5710.2.000.200 " $33.181 1 $33.18 Payee Certification Department Certification The undersigned(Claimant)(Acting on behalf of the above named claimant) I hereby certify that the materials above specified have been received by me does hereby certify that the foregoing claim is true and correct,that no part has in good condition without substitution,the services properly been paid,except as therein stated,that the balance therein stated is actually performed and that the quantities thereof have been verified with the exceptions due and owing,and that taxes from which the Town is exempt are excluded or discrepancies noted,and payment is approved Signature la Signature �✓ Company Name Fishers Island Ferry District Date 11/6/2017 Title Date 11 6 INVOICE Electrical Wholeswlers line. aus Elecftw9Se ,cu. CUSTOMER NUMBER SUB ACCOUNT# EW-NEW LONDON 27352 27352 163 STATE PIER ROAD NEW LONDON CT 06320-5817 INVOICE.NUMBER °INVOICE'DATE 860-443-4381 Fax 860-443-4570 S109138919.001 10/23/17 REMIT TO: ELECTRICAL WHOLESALERS,INC PO BOX 789761 PHILADELPHIA PA 19178 BILL TO: 327 1 AB 0.403 E0321X 10525 D2957274093 S2 P4757383 0001.0001 SHIP TO: FISHERS ISLAND FERRY DI FISHERS ISLAND FERRY DI PO BOX 607 PO BOX 607 FISHERS ISLAND NY 06390-0607 FISHERS ISLAND NY 06390-0607 CUSTOMER PO# JOB NAME]RELEASE# ORDERED BY SALESPERSON racepoint racepoint mike HOUSE ACCOUNT WRITER SHIP VIATERMS SHIP DATE ORDER DATE SALLY LEWIS PICK UP MFG DISC 10TH, NET 15TH 10/23/17 10/23/17 ORDER,QTY , ° .,SHIP QTY DESCRIPTION UNIT PRICE EXT PRICE 3ea 3ea BUR BI72/0 2/0-14 ONE SIDED UNI-TAP 10.400E 31.20 late r �DalILE � �e4 _ 2 SAVE TIME AND MONEY WITH OUR FREE E-BILLING SERVICE Choose from three easy ways to receive your invoices email,fax or Invoice Gateway,our secure online site.With e�/ Invoice Gateway,you are notified by email when new invoices are posted You can search,sort,view,print,download and pay your bills on this site.With email and fax delivery,your Invoices are sent once per day and you get an exact replica of your paper bill. Contact the Credit Department at 800-522-3232 and get setup today! 2017110123 09 44 00 AM S109138919 1 Subtotal 31.20 Invoice is due by 11/15117. Shipping Chgs 0.00 U Tax 1.98 For complete Terms&Conditions go to: Payments 0.00 http//tinyurl.com/EWCT-Customer-TC-pdf mike Amount"Due 33.18 1� A =Electrical Company Visit us at www.usesi.com ­_Services Inc 0001.0001 TO VIEW ONLINE GO TO: HTTP://EW.BILLTRUST.COM USE THIS ENROLLMENT TOKEN: FML HKS FSK Page 1 of 1 •i al Wholesalers inc. Ship Ticket aSES 1 l;.s.l'?m-lesl se1't'1CGK file.collifi1ill" SHIP DATE.- ORDER'NUMBER PAGE NO. EW-NEW LONDON 10/23/2017 S109138919.001 1 of 1 163 STATE PIER ROAD NEW LONDON,CT 06320-5817 OUST PO#: racepolnt 860-443-4381 Fax 860-443-4570 JOB/REL#: racepolnt SOLD TO: SHIP TO: FISHERS ISLAND FERRY DI FISHERS ISLAND FERRY DI PO BOX 607 PO BOX 607 FISHERS ISLAND, NY 06390-0607 FISHERS ISLAND, NY 06390-0607 CUSTOMER NUMBER CUSTOMER PHONE# ORDERED BY SALESPERSON 27352 860-442-0165 mike HOUSE ACCOUNT WRITER SHIP VIA WAREHOUSE ORDER DATE FREIGHT-ALLOWED SALLY LEWIS PICK UPShip: NELO Price: NELO 10/23/2017 No 860 443-4381 ORDER QTY SHIP QTY DESCRIPTION Sea 3ea BUR BIT2/0 2/0-14 ONE SIDED UNI-TAP 20171100 08 46 00 AM S100138910 1 mike Subtotal Any shortage, damaged or incorrect material must be reported within Shipping Chgs 24 hours. Tax For complete Terms &Conditions go to. http://tinyurl com/EWCT-Customer-TC-pdf Payments Amount Due Printed By LEWSAL on 10/23/2017 9 45 03 AM EST W Z_1 n,; FISHERS ISLAND FERRYDISTRICT VENDOR 005738 EVERSOURCE 11/21/2017 CHECK 4480 yT FUND & ACCOUNT P.O.# INVOICE DESCRIPTION AMOUNT iY SM .5710.4.000.100 51981034010OCT NL TERM SVC-9/29-10/30 1,940,,9'1 '181 TOTAL 1,940.97 ..a s ........... r 114 zj 11 11111311 FISHERS:ISI FERR'Y'DISMGT '1 '53095 1/21 7-- AU -MAIN43OAD,PO BOX 1179 SOUTHOLD,NY-1 1971`09W CHECK 'SUFF6LK'CO:'NAT1ONA ,BA0--' THE- g -.-DATE -,,,AMOUNT ,, ,GUE,'NY,1,1 935 940'.`97' 60-546121 Z017, THO'USA11 i dQqDRED,lFORTY`AND 1,O0DOLLARS-l-,"'. % % Y, 2VERSOORCE tT,- 121,1- , --1 TOTHE I OX 6 5'0-032 ORDER= 26 —DALLAS,:-TX -5 o 67 7' 5 032 +''4 1 ' 0 0 8 0 110 1:0 2 1 0 S 4 G 68 00L502 Ili Vendor No. Check No. Town of Southold, New York - Payment Voucher 5738 Vendor Address Entered by PO Box 650032 Dallas,TX 75265-0032 Audit e Eversource - NOV, 2 1 2011 Vendor Telephone Number 888-783-6617 Vendor Contact Invoice Invoice Invoice Net Purchase Order Number Date Total Discount Amount Claimed Number Description of Goods or Services General Ledger Fund and Account Number 51981034010 10/30/2017 $1,940.97 $1,940.97 NLT elec sery 9/29-10/30/17 SM5710.4.000.100 { F $1,940.97 $1,940.97 Payee Certification Department Certification The undersigned(Claimant)(Acting on behalf of the above named claimant) I hereby certify that the materials above specified have been received by me does hereby certify that the foregoing claim is true and correct,that no part has in good condition without substitution,the services properly been paid,except as therein stated,that the balance therein stated is actually performed and that the quantities thereof have been verified with the exceptions due and owing,and that taxes from which the Town is exempt are excluded or discrepancies noted,and payment is approved Signature2A�n_�_ Signature Company Name—Fishers Island Fern District Date 11/10/2017 Title VERS®URCE ° ®® ° Account Number: 5198 103 4010 Statement Date: 10/30/17 Amount Due On 10/27/17 $4,104.35 FISHER ISLAND FERRY DISTRICT Last Payment Received On 10/11/17 -$2,135.91 5 WATERFRONT PARK Balance Forward $1,968.44 NEW LONDON CT 06320-6310 Total Current Charges $1,940.97 V-kk mob&�°w MW'MMMOODWON MW V xBaw kWh/Day Supply Delivery 400- 19314.75 $626.21 Cost of electricity from Cost to deliver electricity 300- CONNECTICUT GAS&ELECTRIC from Eversource INC 200- 100 $0 $390 $780 $1,170 $1,560 $1,950 it 11 OL Nov Dec Jan Feb Mu Apr May Jun Jul Aug Sep Oct Nov 42* 321 32* 34* 33* 51* 551 66* 71* 69* 66* 60* 0* Your electric supplier is Average Temperature CONNECTICUT GAS&ELECTRIC INC 222 MAIN ST FARMINGTON CT 06032-3623 866-568-0289 This month your This month you used average daily 2.4%less electric use was than at the 2.4 289.0 kWh same time last year USAGE News For You With hurricane season here,it's important you prepare for storms,and report outages at Eversource.com,or 800-286-2000.Sign up to receive outage alerts through the channel of your choice.Now you can report an electric outage quickly and easily by texting OUT to 23129 Text REG to 23129 to enroll today. Remit Payment To:Eversource,PO Box 650032,Dallas,TX 75265-0032 CE_171030PROD TXT-99595-000001842 EVERS "URCE Account Number: 5199103 4010 Customer name key:FISH FISHER ISLAND FERRY DISTRICT 5 WATERFRONT PARK Electric Account Summary NEW LONDON CT 06320-6310 Amount Due On 10/27/17 $4,104.35 Last Payment Received On 10/11/17 -$2,135.91 uL Balance Forward $1,968.44 a . ftift u , - U rl a Current Charges/Credits ffWM@o•o . - B I W - - Electric Supply Services $1,314.76 Delivery Services $626.21 Meter Current Previous Current Reading Number Read Read Usage Type Total Current Charges $1,940.97 Total Amount Due $3,909.41 892582072 45805 44910 895 Actual Total Demand Use=21.70 kW x� 895 X Meter Constant of 10=8,950 Billed Usage Supplier(CONNECTICUT GAS&ELEC) Nov Dec Jan Feb Mar Apr May Generation Srvc Chrg** 8950.00kWh X$0.14690 $1,314.76 9170 10080 9280 8500 8910 11070 10390 Subtotal Supplier Services $1,314.76 Jun Jul Aug Sep Oct Nov 8370 8420 11180 9560 8890 8950 Delivery(DISTRIBUTION RATE:030) Contact Information Transmission Dmd Chrg 19.700 X$8.45000 $166.47 Emergency:800-286-2000 Distr Cust Srvc Chrg $44.25 www.eversource.com Distribution Dmd Chrg 19.700 X$12.37000 $243.69 BusinessCenterCTQeversource.com Revenue Adj Mechanism 8950.00kWh X$0.00136 $12.17 Pay by Phone:888-783-6618 CTA Demand Chrg 19.700 X$-0.02000 -$0.39 Customer Service:888-783-6617 FMCC Delivery Chrg 8950.00kWh X$0.00955 $85.47 Comb Public Benefit Chrg* 8950.00kWh X$0.00791 $70.79 Distribution Adj Chrg*** 8950.00kWh X$0.00042 $3.76 Subtotal Delivery Services $626.21 Total Cost of Electricity $1,940.97 Total Current Charges $1,940.97 CE-1 71030PROD TXT•99596-000001842 EVERS=IJRCE m . � ® � - , , Account Number: 5198 103 4010 Customer name key:FISH FISHER ISLAND FERRY DISTRICT 5 WATERFRONT PARK NEW LONDON CT 06320-6310 Continued from previous page... Supply Rate Dollars/'kWh 015 01- 005- 0-- Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Demand Profile Max.kW Demand 35- 30- 25- 20- 15- 10- 5- 0 Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Important Messages About Your Account Please remit the past due amount of$1968.44 This amount is due immediately in order to avoid a possible service disconnection.Please disregard if you have made a payment or confirmed a payment arrangement.(e.g.,Matching Payment Program). 2 5 CE-1 71030PROD TXT-99597-000001842 '..,, ' i'•;.y ..; ^ .,-'iY.1, .;I.k i'' t.^,"h yy?r:t'. _+?. i' , -.>kx FISHERS ISLAND FERRYDISTRICT 1' VENDOR 006412 FISHERS ISLAND UTILITY CO 11/21/2017 CHECK 4481 A ,;4 FUND & ACCOUNT P.1O.# INVOICE DESCRIPTION AMOUNT az SM .5710.4.000.200 28000-1017 AT&T COMM-:CHARGE-10/17 53.12 SM .5710.4.000.200 28000-1017 TELEPHONE-10/17 392.26 SM .5710.4.000.200 28000-1017 INTERNET-10/17 212.00 /SM .5710.4.000.200 28000-1017 ELECTRIC-10/17 ' 660.40 z G4 SM .5710.4.000.200 28000'-1017 `WATER-10/17 120.44 , - --TOTALco 1 438 22 A I. 4:f 4„,:...,. sx a: ,.,. .<....,. ..-. < :sx<vx;:<<a:::::L'.>«.<: ,.xtt^•. k % ()•. <, ' v.M.ro <,•?,Y.•. :: F.<.'. ..^R. i:i<'•. ..,tv< .,••,•";:•;:;:;i :!' ;•< 1:', C v) x.} .tom• a'1 x < -'' ey'y''•' . ..' -F' 4.F_••:+` 'w''`'''';' :' v •, .x, ""'e. ''•"'i:'S':2° ' ,F.. sMN• f ; i i}•II ' 111 'S j'i I ,'N 1 ,;hl I ^ l)I•3`334 ' + I I -- ------ - — +— w ; ® . . . . . r 1 - ,' :'$"1 " ?ERS ISLAIVD`FERRYDISTRIC AUDz'T -11'21 17, _ I 53095_MA(N_#iOT D:PO^BOX-}179-` _ "i SOUTHOLD;NY; 1971-0959',, CHECK` NO: -4,4'$1` • ' n; - THE:SUFFOLK,CO,NATIONALBANK CUTCHOGUE;,NY 11935 t-•" =DATE AMOUNT'' ;3 ;I 50-546/2 4; .ONE. TH0LTSAND', FOUR; HiJND R'ED;'THI'RTY';'E'rGHT AND''22/;10'0 'DOLLARS' `FISHERS"ISLAND'UTILITY. CO z AY, - - :, TD'7NE, PO _ 6X.-BOX:,604:'. DItDER_ -`F ISHERS:'ISIAN D't`NY-"."063''90=0604 'II'. `ri'' 1, ";t ,p._ ,1' I .. -- L'"i,`° , °I ,. ,i5 0044A8 Lii' 1:`0 2 L4054641: 68 00 L50 2 Lil' 3,+i L L J I t Vendor No. Check No. Town of Southold, New York - Payment Voucher 6412 [ L4 !A 8 1 Vendor Tax ID Number or Social Security Number Vendor Address Entered by PO BOX E Vendor Name Fishers Island, NY 06390 Audit DaYe' FISHER ISLAND UTILITY COMPANY WOv 2 12017 Vendor Telephone Number �� 631-188-0023 C er � ��) - � , Vendor Contact 0 Invoice Invoice Invoice Net Purchase Order Number Date Total Discount I Amount Claimed Number Description of Goods or Services General Ledger Fund and Account Number 00028000 10/30/2017 $ 1,438.22 $ 53.12 AT&T Communications Charge Oct 2017 SM.5710.4.000.200 $7Sd0-10�7 $ 392.26 Telephone Oct 2017 SM.5710.4.000.200 $ 212.00 Internet Oct 2017 SM.5710.4.000.200 $ 660.40 Electric Oct 2017 SM.5710.4.000.200 $ 120.44 Water Oct 2017 SM.5710.4.000.200 $ 1,438.22 $ 1,438.22 3ayee Certification Department Certification The undersigned(Claimant)(Acting on behalf of the above named claimant) I hereby certify that the materials above specified have been received by me does hereby certify that the foregoing claim is true and correct,that no part has in good condition without substitution,the services properly been paid,except as therein stated,that the balance therein stated is actually performed and that the quantities thereof have been verified with the exceptions due and owing,and that taxes from which the Town is exempt are excluded or discrepancies noted,and payment is approved Signature ��Title Signature Company Name Fishers Island Ferry Date 11/3/2017 Title Date OrIA7 Page 1 of 10 Billing Telephone Number 631-788-5522 Account Number: 00028000 Billing Date: October 30, 2017 Due Upon Receipt-Past Due After. November 25, 2017 Bill must be paid by the due date to avoid a late charge. Total Amount Due $1,438.22 PO BOX 604 Summary of Charges FISHERS ISLAND,NY 06390-0604 Balance Information Important Messages Last Bill $1,317.91 Total Payments -$1,317.91 Go Paperless! Current Charges(see details on following pages) Would you'like to have your FI Utility Bill emailed? Fishers Island Telephone $392.26 It's simplet Visitwww.fiuc.riet AT&T Communications $53.12 Click on the"View my Bill"link and sign up. Fishers Island Internet $212.00 Also;to pay your bill online,go to www.fiuc.net Fishers Island Electric $660.40 0-ick on the"Pay my Bill"link and sign up. Fishers Island Water $120.44 If you have any questions please call(631)788-7251 Total Current Charges $1,438.22 _ and we will be happy to assist,you. Total Amount Due-Please Pay this Amount $1,438.22 ✓� I Read about how FI Water Works is Modernizing Our Water System hitp://f i uc.nei/wa ter/water-a I e rts/ v Questions about your bill?Contact our office by phone (631)788-7251 press 4 for Telephone; press 5 for Electric or Water; Monday- Friday, 8am-noon & 1 pm-4:30pm; or by email: Telephone-fitelephone@fishersisland.net Electric&Water-fiuc@fishersisland.net If you pay by check,this is notification that the check may be converted to an electronic deposit.Please detach and return below. How to Reach FISHERS ISLAND UTILITY CO. For Inquiries • By mail: PO BOX 604 FISHERS ISLAND NY 06390-0604 • By Phone: 631-788-7261 press 4 for Telephone, press 6 for ElectriclWater • Website:www.fiuc.net For Payments by Mail • FISHERS ISLAND UTILITY CO. PO BOX 604 FISHERS ISLAND NY 06390-0604 For Payments Online • www.fiuc.net CONSUMER COMPLAINTS In the case of a dispute between the Customer and the Fishers Island Utility Company which cannot be resolved with mutual satisfaction,the Customer may file a complaint by contacting the New York State Department of Public Service by phone or by mail. A. By Phone: Helpline(for complaints/inquiries)- 1-800-342-3377 omplaints/inquiries)1-800-342-3377 for Continental United States or, 1-800-662-1220 for Hearing/Speech Impaired: TDD or, 518-472-8502 for fax B. Online: hftp://Www.dps.ny.gov/complaint.html C. By Mail: NYS Department of Public Service Office of Consumer Services 3 Empire State Plaza Albany, NY 12223-7350 If however,you feel that your problems may be handled at the local level, please ask to speak with the President of the Utility Company, Chris Finan,who may be reached during business hours at 631-788-7251, press 5 for assistance. Page 3 of 10 Account Name Billing Date Account Number Due Date F I FERRY DISTRICT 10/30/2017 00028000 11/25/2017 Detail of Monthly Service Charges Payments and Adjustments (631)788-5673-UPS LINE Amount CHECK October 31,2017 -1,317.91 Current Charges for November 01 -November 30 Total Payments Applied -1,317.91 Basic Local Service -Business Local Service $23.00 -End User Charge-Multi Line $9.20 -Access Recovery Charge 3 $3.00 Fishers Island Telephone -E-911 Surcharge $0.35 (631)788-5522-FREIGHT DSL LINE Amount Federal Universal Service Charge $2.29 Subtotal $37.84 Current Charges for November 01 -November 30 Local Service Total $37.84 Basic Local Service Local Service can be disconnected for non-payment of Local Service Total. -Business Local Service $23.00 -End User Charge-Multi Line $9.20 Fishers Island Telephone Total $37.84 -Access Recovery Charge 3 $3.00 -E-911 Surcharge $0.35 (631)788-7031 -MOVIE THEATER Amount Federal Universal Service Charge $2.29 Current Charges for November 01 -November 30 Subtotal $37.84 Basic Local Service Local Service Total $37.84 -Business Local Service $23.00 Local Service can be disconnected for non-payment of Local Servi a Total. -Toll Restriction-Business $4.00 -End User Charge-Multi Line $9.20' Fishers Island Telephone Total $37.84 -Access Recovery Charge 3 $3.00 (631)788-5523-FAX/DSL/MAINOFFICE Amount -E-911 Surcharge $0.35 Federal Universal Service Charge $2.29 Current Charges for November 01 -November 30 Subtotal $41.84 Basic Local Service Local Service Total $41.84 -Business Local Service $23.00 Local Service can be disconnected for non-payment of Local Service Total. -End User Charge-Multi Line $9.20 -Access Recovery Charge 3 $3.00 Fishers Island Telephone.Total $41.84 I/ -E-911 Surcharge $0.35 (631)788-7345-FREIGHT OFFICE Amount Federal Universal Service Charge $2.29 Subtotal $37.84 Current Charges for November 01 -November 30 Local Service Total $37.84 Basic Local Service Local Service can be disconnected for non-payment of Local Se77, otal. -Business Local Service $23.00 -End User Charge-Multi Line $9.20 Fishers Island Telephone Total 7.84 -Access Recovery Charge 3 $3.00 (631)788-5559-PUBLIC DOCK PHONE Amount -E-911 Surcharge $0.35 Federal Universal Service Charge $2.29 Current Charges for November 01 -November 30 Subtotal $37.84 Basic Local Service Local Service Total $37.84 -Business Local Service $23.00 Local Service can be disconnected for non-payment of Local Service Total. -Toll Restriction-Business $4.00 / -End User Charge-Multi Line $9.20 Fishers Island Telephone Total $37.84 . / -Access Recovery Charge 3 $3.00 V -E-911 Surcharge - $0.35 (631)788-7463-MANAGERS OFFICE Amount Federal Universal Service Charge $2.29 Current Charges for November 01 -November 30 Subtotal $41.84 Basic Local Service Local Service Total $41.84 -Business Local Service $23.00 Local Service can be disconnected for non-payment of Local Service�fotal. -End User Charge-Multi Line $9.20 V/ -Access Recovery Charge 3 $3.00 Fishers Island Telephone Total $41.84 -E-911 Surcharge $0.35 Page 4 of 10 Account Name Billing Date Account Number Due Date F I FERRY DISTRICT 10/30/2017 00028000 11/25/2017 Federal Universal Service Charge $2.29 Subtotal $37.84 Optional Local Service AT&T Communications Basic Line Hunt-Residential $4.00 Questions about your billing?Call 800-222-0300 Alarm Service Monthly Charge $30.00 Subtotal $34.00 at&t /' Local Service Total $71.84 f. Local Service can be disconnected for non-payment of Local Service Total. Charges for(631)788-5522 Fishers Island Telephone Total $71.8 (631)788-7580-FIO ROLLOVER Amount] Calls for(631)788-5522,0288-AT&T Communications Date Time Called# Called Place *Type Min Cost Current es Char for November 01 -November 30 1 10/02 02.55p (860)583-3369 BRISTOL CT DOS 1.0 $1.39 Charges 210102 03 01 p (860)583-3369 BRISTOL CT DOS 3.0 $4.17 Basic Local Service 2 Calls for(631)788-5522 4 $5.56 -Business Local Service $23.00 -End User Charge-Multi Line $9.20 Total for(631)788-5522 $5.56 -Access Recovery Charge 3 $3.00 *Type CALL TYPE:EXPLANATION Minutes Amount -E-911 Surcharge $0.35 DOS Direct Dialed Out of State 4 $5.56 Federal Universal Service Charge $2.29 Subtotal $37.84 Charges for(631)788-5559 Optional Local Service Basic Line Hunt-Residential $4.00 Calls for(61)788-5559,028 AT&T Communications Subtotal $4.00 Date Time Cal d# Called Place *Type Min Cost 1 10/02 06 45p 60)449-3742 NEW LONDON CT DOS 1.0 $1 39 Local Service Total $41.84 210/02 b&.4< (860)772-7440 NEW LONDON CT DOS 1.0 $1 39 310/07 10.08a (860)861-2929 NORWICH CT DOS 5.0 $6.95 Local Service can be disconnected for non-payment of Local Service Total. 410107 10.17a (860)861-2929 NORWICH CT DOS 1.0 $1.39 510/07 1018a (321)537-2143 COCOA FL DOS 6.0 $8.34 Fishers Island Telephone Total $41.84 610107 11 24a (860)961-0624 NEW LONDON CT DOS 10 $1.39 (631)788-7744-FI TICKETING Amount 710/07 11 25a (860)961-0624 NEW LONDON CT DOS 10 $139 810/07 11 26a (860)961-0624 NEW LONDON CT DOS 40 $556 Current Charges for November 01 -November 30 910108 04 53p (203)501-7033 DANBURY CT DOS 1.0 $1.39 1010115 04 26p (860)610-9687 HARTFORD CT DOS 1.0 $1.39 Basic Local Service 1110/17 06:25p (203)217-1241 WATERBURY CT DOS 1.0 $1.39 -Business Local Service $23.00 1210/17 06.26p (203)560-4891 WATERBURY CT DOS 1.0 $1.39 -End User Charge-Multi Line $9.20 1310/17 06 28p (203)560-4891 WATERBURY CT DOS 10 $139 1410/17 06.29p (203)217-1241 WATERBURY CT DOS 20 $2.78 -Access Recovery Charge 3 $3.00 -E-911 Surcharge $0.35 14 Calls for(631)788-5559 27 $37.53 Federal Universal Service Charge $2.29 Total for(631)788-5559 $37.53 Subtotal $37.84 *Type CALL TYPE:EXPLANATION Minutes Amount Optional Local Service DOS Direct Dialed Out of State 27 $37.53 Off Premise Charge $0.50 Off Premise Charge 1/4 Mile-Business $5.20 Taxes and other Surcharges Subtotal $5.70 Universal Connectivity Charge-Interstate $8.11 Interstate Gross Receipts Tax 4.44% $1.92 Local Service Total $43.54 Total AT&T Communications Taxes $10.03 Local Service can be disconnected for non-payment of Local Service Total. Total AT&T Communications Charges $53.12 Fishers Island Telephone Total $43.5 Total Fishers Island Telephone ' Charges $392.26 Customer Information If your business makes outbound telephone solicitations,you must comply with federal do-not-call laws and regulations (47 C.F R.64.1200,&16 C.F.R.310)and any applicable state laws. Page 5of10 Account Name Billing Date Account Number Due Date F I FERRY DISTRICT 10/30/2017 00028000 11/25/2017 Fishers Island Internet (100)101-0113-FERRY.FREIGHT OFFICE Amount Current Charges for November 01 -November 30 Internet Service "Basic"12M Business $90.00 Subtotal $90.00 Internet Total $90.00 Fishers Island Internet Total $90.00 (100)101-011'4-FERRY MAIN OFFICE Amount Current Charges for November 01 -November 30 Internet Service 'Better",12M Business $122.00 Subtotal $122.00 Internet Total $122.00 Fishers Island Internet Total $122.00 Total Fishers Island Internet $212.00 Charges Affikk Page 6 of 10 , Account Name Billing Date Account Number Due Date F I FERRY DISTRICT 10/30/2017 00028000 11/25/2017 Fishers Island Electric - (300)101-0167 - FREIGHT SHED, BLDG 208 Electric Class-50 Current Charges Energy Charge(See Detail below) $142.09 Fuel Adjustment $1270 Total Current Charges $154.79 Meter Readings Energy Used Amount Current Previous MASTER 72247 71852 REG. 395 KWH $82.89 DEMAND 5.3 0 DMD. 5.3 KW $59.20 DATE 10/23/2017 09/21/2017 DMD.MIN. 3.38 $0.00 FUEL ADJUSTMENT FACTOR 0.03214 PER KWH NY SURCHARGE $0.00 Fishers Island Electric Charges $154.79 >/ Fishers Island Electric - (300)101-0168 -THEATRE Electric Class-50 Current Charges Energy Charge(See Detail below) $138.01 Fuel Adjustment $23.14 Total Current Charges $161.15 Meter Readings Energy Used Amount Current Previous MASTER 803 794 REG. 720 KWH $138.01 DEMAND 0 0 DMD. 0 KW $0.00 DATE 10/23/2017 09/21/2017 DMD. MIN. 0 $0.00 NY SURCHARGE $0.00 METER MULT. 80 FUEL ADJUSTMENT FACTOR 0.03214 PER KWH $161.15_ / Fishers Island Electric Charges v 9 Fishers Island Electric - (300)101-0169 -AIRPORT Electric Class-50 Current Charges Energy Charge(See Detail below) $63.73 Fuel Adjustment $9.06 Total Current Charges $72,79 Meter Readings Energy Used Amount Current Previous MASTER 12804 12522 REG. 282 KWH $63.73 DEMAND 0 0 DMD. 0 KW $0.00 DATE 10/23/2017 09/21/2017 DMD. MIN. 0 $0.00 FUEL ADJUSTMENT FACTOR 0.03214 PER KWH NY SURCHARGE $0.00 J Fishers Island Electric Charges $72.79 Fishers Island Electric - (300)101-0171 - BUSINESS OFFICE Electric Class-50 Page 7 of 10 Account Name Billing Date Account Number Due Date F I FERRY DISTRICT 10/30/2017 00028000 11/25/2017 Current Charges Energy Charge(See Detail below) $235.99 Fuel Adjustment $35.68 Total Current Charges $271.67 Meter Readings Energy Used Amount Current Previous MASTER 24549 23439 REG. 1110 KWH $204.16 DEMAND 2.85 0 DMD. 2.85. KW $31.83 DATE 10/23/2017 09/21/2017 DMD.MIN. 2.85 $0.00 NY SURCHARGE $0.00 FUEL ADJUSTMENT FACTOR 0.03214 PER KWH Fishers Island Electric Charges $271.67/ Total Fishers Island Electric Charges $660.40 Page 8 of 10 Account Name Billing Date Account Number Due Date F I FERRY DISTRICT 10/30/2017 00028000 11/25/2017 Fishers Island Water- (200)101-0140 -THEATRE Water Class -21 Current Charges Water Charge(See Detail below) $35.17 Total Current Charges $35.17 Meter Readings Amount Meter Date Current 61010 10/23/2017 Previous 60900 09/21/2017 Cubic Feet 110 (Cubic Feet x 7.5= Gallons)= 825 TOTAL WATER CHARGE $35.17 / Fishers Island Water Charges $35.17 J/ Fishers Island Water - (200)101-0142 - BUSINESS OFFICE Water Class -21 Current Charges Water-Charge(See Detail below) ,,, $85 27 Total-Current Charges $85.27 Meter Readings Amount Meter Date Current 102650 10/23/2017 Previous 101680 09/21/2017 Cubic Feet 97C7_275 (Cubic Feet x 7.5 = Gallons TOTAL WATER CHARGE $85.27 / Fishers Island Water Charges $85.27 V/ Total Fishers Island Water Charges $120.44 Page 9 of 10 Account Name Billing Date Account Number Due Date F I FERRY DISTRICT 10/30/20,17 00028000 11/25/2017 UNDERSTANDING YOUR ELECTRIC BILL Your contract is on a non-transferable annual basis. Federal and State Taxes are billed when applicable. A complete copy of our rate schedule can be obtained at the offices of the Fishers Island Utiility Company office building. BASIC MINIMUM CHARGE: Covers maintenance of electric lines, meters and other costs.This charge will be billed whether or not you use energy. KWH(KILOWATTHOUR): A KWH equals 1000 watt-hours of electricity use. One KWH equals the energy needed to run a 100 watt light bulb for 10 hours. FUEL ADJUSTMENT: A charge reflects changes in the actual cost of fuel purchased by the utility. RESIDENTIAL ELECTRIC RATES CLASS 1. CLASS 2. CLASS 7. Minimum Charge $10.60 Minimum Charge $32.37 Minimum Charge $23.12 First 1,000 KWH $0.1790 All KWH $0.3237 All KWH $0.2255 Over 1,000 KWH $0.2067 COMMERCIAL ELECTRIC RATES CLASS 5. Minimum Charge $15.90 Demand Charge $11.17 per KWH Energy Charge $0.1696 per KWH UNDERSTANDING YOUR WATER BILL Water usage is billed monthly Your contract is on a non-transferable basis. Monthly minimum charges are based on meter size and class. Federal and State taxes are billed where applicable. A complete copy of our rate schedule can be obtained at the offices of Fishers Island Utility Company office building. CLASS 1. Meter Size Minimum Charge Minimum Usage (Inch) (Gallons) 5/8 $27.38 3,000 3/4 $41.08 4,500 1 $68.46 7,500 11/4 $95.84 10,500 11/2 $136.92 15,000 2 $219.07 24,000 3 $438.14 48,000 4 $684.60 75,000 6 $1369.19 150,000 Water usage over the minimum is billed at$9.13 per thousand gallons. CLASS 2. 'Meter Size Minimum Charge Minimum Usage (Inch) (Gallons) 5/8 $35.17 3,000 314 $52.76 4,500 1 $87.93 7,500 11/4 $123.10 10,500 11/2 $175.86 15,000 2 $281.38 24,000 3 $562.76 48,000 4 $879.31 75,000 6 $1758.61 150,000 Water usage over the minimum is billed at$11.72 per thousand gallons. Page 10 of 10 Account Name Billing Date Account Number Due Date F I FERRY DISTRICT 10/30/2017 00028000 11/25/2017 Page intentionally left blank wn FISHERS ISLAND FERRY DISTRICT e"{ VENDOR 006374 FISHERS ISLAND WASTE MANAGEMNT 11/21/2017 CHECK 4482 FUND & ACCOUNT P.O.# INVOICE DESCRIPTION AMOUNT SM .5709.2.000.200 342702 STERLING CHARGE REFUND 312.23 - TOTAL 312.23 ,J T1. ......ww'. x Ft', X, 4 M-1-11"Yo"IMIte"]. 0 1 1 a 6 -':AC 17 Z, 53095 MAIWAOAD PO BOX,Il 79 -, SOUTHOLD,NY 11971-OSBP CHECK NO v THE'SUPFOLWcb.1NATIONAL BANK -,CUTCH,0GUE,:NY11935 r --AMOUNT, 50-5461214 ,TH A FISHERS ,ISLAND-,WASTE MANAdE,M.N'T r.tTO THEJ=`__.f)I 9TR A PER' OF' Fl9HERS'-_lSLhkb NY 11.00448 2 no 1:0 2 140S4P.L.1: 6B 00LS02 I Vendor No. Check No. Town of Southold, New York - Payment Voucher 6374 L4 Vendor Address Entered by 2760 Whistler Avenue PO Box 22 Fishers Island, NY 06390-0022 Audit Da e FI Waste Management District Nov 12017 Vendor Telephone Number 631-788-7455Clerk , +1� Vendor Contact (� Beth Stem Invoice Invoice Invoice Net Purchase Order Number Date Total Discount Amount Claimed Number Description of Goods or Services General Ledger Fund and Account Number 342702 11/7/2017 $312.23 $312.23 Sterling charge SM5709.2.000.200 - i { $312.23 $312.23 Payee Certification Department Certification The undersigned(Claimant)(Acting on behalf of the above named claimant) I hereby certify that the materials above specified have been received by me does hereby certify that the foregoing claim is true and correct,that no part has in good condition without substitution,the services properly been pard,except as therein stated,that the balance therein stated is actually performed and that the quantities thereof have been verified with the exceptions due and owing,and that taxes from which the Town is exempt are excluded or discrepancies noted,and payment is approved Signature�\� Title Signature:- Company ignatureCompany Name Fishers Island FerrV District Date Title Date a FI WASTE MANAGEMENT DISTRICT Invoice PO BOX 22 FISHERS ISLAND,NY 06390-0022 Date Invoice# 11/7/2017 342702 Bill To FI FERRY DRAWER H FISHERS ISLAND,NY 06360 Item Description Qty Rate Disposal date Amount MISC STERLING CHARGENERRY BUMPED 31223 31223 TRUCK 0 Total $31223 Customer Total Balance $312 23 Arena, Laura From: Geb Cook <gcook@fiferry.com> Sent: Wednesday, November 15, 2017 1:40 PM To: Arena, Laura Cc: Diane Hansen Subject: FIWM charges La u ra, Per your-question regarding the warrant charge for FI Waste Management charges—that is for a truck and driver that we had to turn away because our ferry was full and could not accommodate. We had booked them assuming the large ferry only to have it under repair requiring us to use the smaller boat. Thanks Geb Cook y District Manager Fishers Island Ferry District PO Box 607 Fishers Island,NY 06390 www.fiferry.com 203.410.8156 1 t , .i jl'". ®>- • {<r » in tpr... ':a;W. o t..v' P • :J t; -:;is^,'1-•L,i t.. .^ > `1,, }: FISHERS ISLAND FERRY DISTRICT l ( r•f VENDOR 006482 PAUL J. FOLEY 11/21/2017 CHECK 4483 FUND,'& ACCOUNT P.O.# INVOICE DESCRIPTION AMOUNT SM .9060.\8.000.000 / 110117 REIM RX-NOV'17 102.16 TOTALi+{ 102.16 '7 r`5 J .. r 's';: > >. ,>,.a ¢ ,: t ::i : r:., ' :;•,iw:z _::a ..as::::>°«k Fl;-?= I '. .. .^ ,s ..., w..^+... .»... a . wa>rv `2t„ J--ir: ..a.3e•: .'' '>3a: =:•:::<:;t,.j4•.i;>?! ; p 41;,f ^ E.v - Y"i• C t •i I.< ' rx„ .'.^w,g'>r». .:`.k .. <.e. y •. .v TT,,,t-,.i'E:;S•.y,,N'n .. .s ..... ..':f F..+ t r x"w t , , . ;I UM CT, FIShTER3='ISl;A1VD',FERRYDISTRI ,- AUDI it 53095 MAIN`ROAD,'PO'B X11_79 — / - 8=1197109HECK `44' SOUTHOLD;NY, _ -74SUFF&K'CO`NATIONAL BANK: CUTCHOGUE;NY.11935 AMOUNT:;:_ -- _ ,;5 ';t ^-„ ,', ,• - - + - 1'0''2 ; s'' ,' wR^^} 50.5461214,; _ --__ - -__ - _ - „ - _ -- - __ - __ - ,t ,_• _ ONE: IL7N10EA TWO AN 1,6/TOQ'`'DOLLARS'-` ; I iv' .si ,', .i „!, •; i r. . .r +l>” °• - >S ^. -^dyN''' -1 'h. S" •'X I ,AY ' PAUL J. 'FOLEY' ;` OTFIE: ' 69,O ,WER - .NEW'',LONDON CT 0'63;20 y+ ;y 11'00448311' 1:0 2 L4054641: 68 00 i50 2 L1!' t Vendor No. Check No. Town of Southold, New York - Payment Voucher 6482 14LA193 Vendor Address Entered by 690 Williams Street New London, CT 06320 Audit brate Foley, Paul NOV 2 12017 Vendor Telephone Number wn Clerk ' Vendor Contact "111 Invoice Invoice Invoice Net Purchase Order Number Date Total Discount Amount Claimed Number Description of Goods or Services General Ledger Fund and Account Number 'eOMSSM1 11/1/2017 $127.70 $102.16 Anthem Retiree Prescription Plan Nov 2017 SM9060.8.000.000 11611-7 ($25.54) 80% Reimbursement Paul Foley Ck#2787 $127.70 — t l-7 $102.16 $102.16 Payee Certification Department Certification The undersigned(Claimant)(Acting on behalf of the above named claimant) I hereby certify that the materials above specified have been received by me does hereby certify that the foregoing claim is true and correct,that no part has in good condition without substitution,the services properly been paid,except as therein stated,that the balance therein stated is actually performed and that the quantities thereof have been verified with the exceptions due and owing,and that taxes from which the Town is exempt are excluded or discrepancies noted,and payment is approved Signature �NU11-4 'rtle Signature Company Name Fishers Island Ferry District Date 11/6/2017 Title Date & r �. Customer Care: 1-888-620-1747 B1ueCross B1ueShield Blue MedicareRx"(PDP) - t® T251 P1 30388(260)093318632668 GOOD TNE+WS? Blue MedicareRx is tell"11�'�III�"°I�II�i"11'IIS"�II�IIIIIII'I�'ll'llll �(III�I� lowering your monthly premium for 20,18. To see how much you'll save,review the PAUL J WILLIAMSFOLEYAnnual Notice of Changes document you 690 LIAMS ST rec�1 receive g NEW LONDON,CT 06320-4132 y t® - - -_— - - f�iVS'��:< as:.er✓s'c.+"t'�-.,2 'x -11 $127.70 11/01/2017 G0230330801 _ Payment Options • For check payment or automatic withdrawal from your bank account(ACTT),use the form be_ fow. co to • For credit card payment or withholding from your SSA/RRB check, call 1-888-620-1747. C) o For one time credit card payment through our automated system, call 1-877-358-6792. Previous Balance $127.70 Payment Activity Since Last Invoice -$127.70 Payment Tyne Date Received Amount Check Payment-Lockbox 09/29/2017 -$127.70 00002778 Activity Detail $127.70 -Transaction-Tyne �� Premium Month Amount Premium NOVEMBER 2017 $127.70 Amount Due $127.70 Z PAUL J.FOLEY I 690 WILLIAMS ST. ! I NEW LONDON,CT 06320 51-7218R211 f a a 139 Pay to the Date ` ! Order of In $1A ° � a r Dollars �o °°"° 6 I. ftqjAe&-Unft6d i ! peoplescom i For�$6�3����� I ! ! jNow 2787 E i L 7— FISHERS ISLAND FERRY DISTRICT 11/21/2017 CHECK 4484 VENDOR 006803 FRONTIER FUND & ACCOUNT— P,.O.# INVOICE DESCRIPTION AMOUNT SM .5710.4.000.100 86003757641017 INTERNET-10/27-11/26 106.55 W3 TOTAL 106.55 rq% - UD 7 b3095-MAlN,FtOAD;--PO,BOkll 179 FlSBERS,lSLAND'FERRk'Dl9WQ T CK "84 SPUTHOLDW 11971-0959' -THE'SUFFON CO.NATIONAL'. - ­ -DATE , i- - 2 17, `,50.546%2'14 ED- 8` -'QRE-li=R ikR` v 21 -7 Y 7-6,THEW. PO---BOX- -740407 -7 RISER- -,52--4 `CIN0ikkATI`OH 4 04'07 , OF) 'I qty =[ 0 'n.-i- J Y z I jqi , 118004484118 1:0 2 140546441: LB 00 150 2 1118 Vendor No. Check No. Town of Southold, New York- Payment Voucher 6803 Vendor Address Entered by Frontier Vendor Name PO Box 740407 Audit Date _ Frontier Long Distance Cincinnati, OH 45274-0407 Nov a�12017 `- Vendor Telephone Number , --- own Clerk Vendor Contact s Invoice Invoice Invoice Net Purchase Order Number Date Total Discount Amount Claimed Number Description of Goods or Services General Ledger Fund and Account Number' 1Gt"l 860-037-6764-4444" 10/27/2017 $106.55 $106.55 NL Internet Service SM5710.4.000.100 10/27-11/26/17 i F $106.55 $106.55 Payee Certification Department Certification The undersigned(Claimant)(Acting on behalf of the above named claimant) I hereby certify that the materials above specified have been received by me — does hereby certify that the foregoing claim is true and correct,that no part has in good condition without substitution,the services properly been pard,except as therein stated,that the balance therein stated is actually performed and that the quantities thereof have been verified with the exceptions due and owing,and that taxes from which the Town is exempt are excluded or discrepancies noted,and payment is approved Signature ' pct,..,__ Title Signature " Company Name Fishers Island Ferry District Date 11/6/2017 Title Date l d' h N FISHERS ISLAND FERRY DISTRICT Page 1 of 3 FtonticAw, Your Monthly Invoice COMMUNICATIONS Account Summary New Charges Due Date 11/20/17 Billing Date 10/27/17 Account Number 860-037-5764-111413-5 PIN 1245 Previous Balance 96.98 Payments Received Thru 10/27/17 .00 Balance Forward 96.98 r/ /1 New Charges 106.55 K�! Total Amount Due $203.53 Protect your vital business data with ® ® m Frontier Secure. Protect Pa Your Bill Helps protect your computers and mobile devices against T® Y viruses and malware. Online:Frontier.com 1.800.801.6652 Connect Cloud-based storage to save and share data from any Internet-connected device. Pay by Mail W Support 24/7 phone support from U.S.-based experts for �l;! hardware,networking and Windows software issues. T® Contact Us 1,544.565.7079 ier Chat: Frontiencom Online: Frontier.com/helpcenter jli;! business.frontier.com/secure SECURE 1.800.921.8102 Email:ContactBusiness@ftr.com Requires Internet access Internet access service and charges not included.Frontier does not warrant that the services will be error free or uninterrupted Taxes,governmental and Frontier Imposed surcharges,minimum system requlrementsand othertermsand condAronsapply � o a • • ®• Page 2 of 3 Rontier Date of Bill 10/27/17 COMMUNICATIONS Account Number 860-037-5764.111413-5 For Billing and Service Questions,Call 1-800-921-8102,7 am-7 pm Monday-Friday,9:30 am-4 pm Saturday or visit www.Frontier.com. PAYING YOUR BILL Pay online,by phone, by mail or at any Authorized Payment Location.Paying by check authorizes Frontier to make a one-time electronic funds transfer from your account,as early as the day your check is received.Visit Frontier.com to set up recurring ;;!I electronic payments to streamline bill payment. LATE PAYMENTS,RETURNED CHECK FEES and PAST DUE BALANCES You are responsible for all legitimate, undisputed charges on your bill. If you pay your bill after the due date,you may be charged a fee(including a Treatment Charge if your account has been delinquent for 3 consecutive months and your past due balance is greater than$99),your service may be interrupted and you may have to pay a reconnection charge to restore service. A fee may be charged for a check that is returned by the bank for any reason. Continued nonpayment of undisputed charges (incl. 900 and long distance charges)may result in collection action and a referral to credit reporting agencies,which may affect your credit rating. When making an online payment, please allow time for the transfer of funds. If the funds are not received by Frontier by the due date,a fee may be assessed. IMPORTANT CONSUMER MESSAGES You must pay all basic local service charges to avoid basic local service disconnection. Failure to pay other charges will not cause disconnection of your basic service but this may cause other services to be terminated. Frontier Bundles may include { - - ®® FISHERS ISLAND FERRY DISTRICT Page 3 of 3 r, Date of Bill 10/27/17 COMMUNICATIONS Account Number 860.037.5764.111413-5 CURRENT BILL"I G SUMMARY CUSTOMER TALK Local Service from 0/27/17 to 11/26/17 Oty Description e60/037-5764.0 charge Basic Charges If your bill reflects that you owe a Balance Forward, you Other Charges-Detailed Below 9.00 must make a payment immediately In order to avoid CT State Sales Tax .57 collection activities. You must pay a minimum of$203.53 Total Basic charges 9.57 by your due date to avoid disconnection of your local Non Basic Charges service. All other charges should be paid by your due date Broadband Max Ultra Static IP 114.99 to keep your account current. Other Charges-Detailed Below 1.99 Partial Month Charges-Detailed Below -20.00 Important Late Payment Fee Information Beginning with Total Non Basic charges 96.98 your next bill, the Late Payment Fee will be$9.00 plus 1.5%of the unpaid overdue balance. Questions? Please TOTAL 106.55 contact customer service. ---------------------------------------------------------------------- Upon termination of service, you must return equipment owned by Frontier. Failure to return Frontier Equipment, or - **ACCOUNT ACTIVITY** returning Equipment in a damaged condition (subject only Qty Description Order Number Effective Dates to reasonable wear and tear)will result in the imposition of 1 Late Payment Fee 10/26 9.00 an Equipment fee that may be substantial. 1 Business High Speed Internet Fee AUTOCH 10/27 1.99 860/037-5764 Subtotal 10.99 Partial Month Charges Broadband Term Bus PROMOTION 10/27 11/26 -20.00 860/037-5764 Subtotal -20.00 Subtotal -9.01 I�� -t 'c , ;`s s : f`l w ^' s:, ,-,} .,, , .ae`,..5, '7;:5:.. " :,.'•s+r.". ; 4..^. - 't;:-"^A Dtl FISHERS ISLAND FERRY DISTRICT VENDOR 013564 MCMASTER-CARR SUPPLY CO. 11/21/2017 CHECK 4485 ; { 411 i FUND & ACCOUNT P.O.# INVOICE DESCRIPTION AMOUNT SM .57092.000.200 ; 48547840 NLT-WASHERS,PINS,SHIMS 68.43 `y TOTAL 68.43 t C ••kq i .. S t'.S <x>: xg_,. .. _ ..:. ,.,..,,,. .,,^,..vkffia R`ed " :.: y•;Y,f.-,!;• .,`w :Gra 'rh r .• .vi -. vaFTn„ x 6m .`+ate."- 'p i4• ..`i. ^ •' .... 'F . .....% `.,x`.,v ';SMw ' ..- r ••3 '".,. • y ,•`F' .,..T:'` '"_'`.•,.yr' e^Yr , ,?x "¢'•• ,.. e °.y y h .r. a•.s ''.,rw• •' I fE , I yrj k.3 I I . +r„ ,s s I fr p 0 0 B • • 0 • • f i i;,Y' 4 $.' ERD. RICTFISHERS1SNFRIIST ' AUDI ",11/',;2'1/] t; _ 7" - = _53096'MAIN ROAD:PO'BOX'1179 - i* t r souTHoto,NY 11s7a=os5s' OHECK"NO-l` -,` .4 4 85' _THE"SUFFOL'K'CO.NATIONAL BANK DATE 1, --CUTCHOGUE,'NY°11935 y+ AMOUNT;,_ i-A7< :$6$;:43,\' SIXTYEI'GHT_,'AND',43/100, _DOLLARS AY_r- MCMASTER=CARR``, SUPPLY CO. . ' - - - -i - - O'THEr_= ti,' _ -P&:_ 7690- _ O RDER 'CHICAGO IL` 6,0680 `7690' f _ i , ' r. , . .... i:r:,4•..4 t.+_,..r c 'n,.. -. ia ,ti..«.,.u...'..n,a• .v+:4.,..ua.., y._ u. .,,..,, , »..:L a.n.:xU .«+. W,.s. ,',.a..x.. ,....:W,*J' ;6.ti.,.....tL_,.u..t_, • II■004.48y5f1I■ ~1.0 2 L4054 4 6i: 68 001502 1 ' $ II. •Vi r I Vendor No. Check No. Town of Southold, New York - Payment Voucher 13564 I 44?;-1S', - Vendor Address fatered by P.O. Box 7690 Vendor Name Chicago, IL 60680-7690 Audit e Y McMaster-Carr Supply Co. NOV 2 12017 Vendor Telephone Number Cldrk 609-689-3000 Town _ Vendor Contact Invoice Invoice Invoice Net Purchase Order Number Date Total Discount Amount Claimed Number Description of Goods or Services General Ledger Fund and Account Number 48547840 10/19/2017 $ 68.43 $68.43 Maint Supplies SM5709.2.000.200 T— e 1 S f $ 68.43 $68.43 Payee Certification Department Certification The undersigned(Claimant)(Acting on behalf of the above named claimant) I hereby certify that the materials above specified have been received by me does hereby certify that the foregoing claim is true and correct,that no part has in good condition without substitution,the services properly been paid,except as therein stated,that the balance therein stated is actually performed and that the quantities thereof have been verified with the exceptions due and owing,and that taxes from which the Town is exempt are excluded. or discrepancies noted,and payment is approved Signature 1 QL,, Title Signature Company Name Fishers Island Ferry District Date 11/3/2017 Title Date �/ r �! WMASTERmCARR- Invoice 609-689-3000 609-259-3575(fax) nj.sales@mcmaster.com Purchase Order JOHN P Total $68.43 Invoice 48547840 Billed to Invoice Date 10/19117 FISHERS ISLAND FERRY DISTRICT Y P O BOX 607 Payment Terms 2% 10, Net 30 FISHERS ISLAND NY 06390-0607 Deduct$1.26 on merchandise if paid by 10/29/17. l Shipped to r �1 " ��J Mail Payment to McMaster-Carr Fishers Island Ferry District PO Box 7690 5►'rate,front Park ." : __ __ Chicago IL 60680-7690 New London CT 06320 Your Account 260910000 John Paradis placed this order. Line Product Ordered Shipped Balance Price Total 1 98023AO38 Zinc Yellow-Chromate Plated Grade 8 Steel 2 2 0 8.92 17.84 Washer for 1"Screw Size, 1.062"ID,2"OD, Packs Per Pack Packs of 10 2 98355A270 316 Stainless Steel Cotter Pin,3/16"Diameter,3" 2 2 0 12.63 25.26 Long, Packs of 10 Packs Per Pack . 3 308BA124 Low-Carbon Steel Round Shim,0.001"Thick,3/4" 3 3 0 6.63 19.89 ID, Packs of 10 Packs Per Pack Merchandise 62.99 Shipping 5.44 Total $68.43 Packing List Shipped Weight Carrier Tracking 2278418-01 10/19/17 3 Ib UPS Ground 1 ZO835200367742935 Federal ID 36-1458720 McMaster-Carr Supply Company Page 1 of 1 SP 520 FISHERS ISLAAD FERRYDISTRICT VENDOR 013588 MOHAWK NORTHEAST, INC. 1/21/2017 CHECK 4486 A FUND & ACCOUNT P.O.# INVOICE DESCRIPTION AMOUNT H7 ':5720.2.400.200 00001 DOLPHINS-/PILINGS-RPLCMNT 304,,408L73 TOTAL 1 304,408.73 A U. vj k jk zit pill,1v lir,igg gall ZIA, I'M 3 TERRYDIMICT`,''' 2 1 `iF ',M-- ISHERSISLA, -1,179 53095 MAIN ROAD,PO BOX ECK, " " "SOUTHOLDiNY-,1*1971-0§59 44,861: - '1' THE NA ION`Ak' HE -, -,CUTCHOGUE,NY 11935 DATE. AMOUNT 21 408.'73- 7-50-5461214- -,HUNDR- ]P -EIGHT AND 7 3/l ,THREE H Rt "YOUR,THOUSAND' FOUR y'I !o AY -,,MOHAWK 17,0,,-,CANAL, TO T STREET 0 bEk, P4 79 ­ LANTSVILLE, CT ,O 115004L,861IN 1:0 2 L4054641: P3 8 00LS02 lil, Vendor No. Check No. IND Town of Southold, New York - Payment Voucher ' '13588 _ Vendor Tax ID Number or Social Security Number Vendor Address Entered bb Mohawk Northeast Inc 170 Canal Street PO Box 37 Audit Date Vendor Telephone Number Plantsville,CT 06479 '.NOV- 2 12017 T ler Vendor Contact f Invoice Invoice Invoice Net Purchase Order Number Date Total Discount Amount Claimed Number Description of Goods or Services General Ledger Fund and Account Number 00001 9/30/2017 $304,408.73 $304,408.73 Fishers Island Dolphins&Pilins �SM5709'T'000:200: a $304 408.73 1 $304,408.73 Payee Certification Department Certification The undersigned(Claimant)(Acting on behalf of the above named claimant) I hereby certify that the materials above specified have been received by me does hereby certify that the foregoing claim is true and correct,that no part has in good condition without substitution,the services properly been paid,except as therein stated,that the balance therein stated is actually performed and that the quantities thereof have been verified with the exceptions due and owing,and that taxes from which the Town is exempt are excluded or discrepancies noted,and payment is approved SignatuSignature Company Name Fishers Island Ferry District Date 11/8/2017 Title fr? Y Date l/ APPUCATION AND CERTIFICATE FOR PAYMENT PAGE 1 OF 1 PAGES TO: Fishers Island Ferry District PROJECT NAME:Fishers Island Dolphin Replacement APPLICATION NO: 00001 PO Box 607 APPLICATION PERIOD TO:09/30/2017 Fishers Island NY 06390 PROJECT NO: 17013 CONTRACT DATE: FROM: Mohawk Northeast,Inc CERTIFYING AGENT: Docko,Inc. 170 Canal Street a Plantsville CT 06479-0037 CONTRACT FOR: Fishers Island Dolphin Replacement The Work covered by this Payment Requisition ORIGINAL CONTRACT AMOUNT $359,995.00 has been completed according to the contract. CHANGE ORDERS $3,713.73 (Firm) Mohawk N30h=i,Inc REVISED CONTRACT AMOUNT $363,708.73 TOTAL WORK COMPLETED AND STORED MATERIAL TO DATE $304,408.73 (Name) A41af Reinke I RETAINAGE: (Signature) (Date) (c IZ Worts Completed o % $0.00 /a, Stared Materials 0 % $0.00 �e Cs� 1 � � � (�JC� ��1�17 TOTAL $0.00 WORK COMPLETED AND STORED MATERIALS LESS TOTAL $304,408.73 RETAINAGE CERTIFICATION PREVIOUS CERTIFICATES FOR PAYMENT $0.00 I certify that the work covered by this Application for Payment has been AMOUNT DUE $304,408.73 completed according to the contract,and that the amount certified is: $304,408.73 REMAINING CONTRACT BALANCE(RETAINAGE INCLUDED) $59,300.00 Firm Mohawk Northeas Inc .00"t1 T141ai UMMARYOFCHANGES ADDS DEDUCTS Name Previous Totals $0.00 $0.00 F.xilda Gregory .r IS MONTH $3,713.73 $0.00 SI nature ®TA f d 3//1'J TOTALS $3,713.731 $0.00 ��� £0/2372011— AuSL+G APPLICATION FOR PAYMENT PAGE 1 oft PAGES APPLICATION NO.:00001 PERIOD TO:09/30/2017 PROJECT NO.:17013 A B C D E F G H i WORK COMPLETED WORK AND STORED BALANCE LINE SCHEDULED FROM PREVIOUS COMPLETED THIS STORED MATERIALS % TO ITEM ID DESCRIPTION VALUE APPLICATION PERIOD MATERIALS TO DATE COMPLETE FINISH RETAINAGE 1 Mobilization 56,500.00 $0.00 $6,500.00 $0.00 $6.500.00 100.0 $0.00 WAD 6500.0 LS $1.00 $0.00 $1.00 $0.00 $1.00 $0.00 $0.00 2 Demolition and Removals 30, 0.00 0,000.00 .000,000. 100.000 30000.0 IS $1.00 50.00 $1.00 $0.00 $1.00 50.00 $0.00 3 Compliance with Environmental Permits $13,250.00 $0.00 $13,250.00 $0.00 $1300.00 100.0 $0.00 $0.00 13250.0 LS $1.00 $0.00 $1.00 $0.00 $1.00 $0.00 $0.00 4 Rem 19 Pile Dolphin Install New 19 Pile $77,500.00 $0.00 $77,500.00 so.00 77,500.00 1=0 . Dolphin 77500.0 LS $1.00 $0.00 $1.00 $0.00 $1.00 $0.00 $0.00 5 Demobilization $11,000.00 $0.00 50.00 $0. . 11000.0 LS $1.00 $0.00 $0.00 $0.00 $0.00 $1.00 50.00 6 Additional Cost to Install Steel King Pile for $19,700.00 $0.00 $19,700.00 $O.DD $19,700.00 100.0 SO.00 $ .00 Item 4 19700.0 LS $1.00 50.00 $1.00 $0.00 $1.00 $0.00 $0.00 Alt.1 Replace One 55 Foot Class A SYP in o 13 $0.00 $0.00 $0.00 36.00 U Pile Dolphin 11000.0 Each $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $O.OD Alt.2 Pull au ve u6strucim WF03 Pile 16.670 0. ToW 0.6 SO.OD 50.00 1700.0 Each $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 SO.00 Alt.3 Use of a Certified Dive Team $7,975.00 $0.00 $7,975.00 $0.00 $7,975.00 100.0 $O.DO S0.00 APPLICATION FOR PAYMENT PAGE 2 of 2 PAGES APPLICATION NO.:00001 PERIOD TO:09130/2017 PROJECT NO.:17013 A B C D E F G H ! WORK COMPLETED WORK AND STORED BALANCE LINE SCHEDULED FROMPREVIOUS COMPLETEDTHIS STORED MATERIALS % TO ITEM 1D DESCRIPTION VALUE APPLICATION PERIOD MATERIALS TO DATE COMPLETE FINISH RETAINAGE 7975.0 Day $1.00 $0.00 $1.00 $0.00 $1.00 $0.00 50.00 Alt.4 Remove a 13 Pile Dolphin Construct a New $145,770.00 $0.00 $145,770.00 $0.00 $145,770.00 100.0 $0.00 $0.00 13 Pile Dolphin 48590.0 Each $3.00 $0.00 $3.00 $0.00 $3.00 $0.00 $0.00 Alt.5 Remove a 13 Pile Rphin Construct a New $0.00 $0.00 $0.00 $0.00 $0.00 0.0 $0.00 $0.00 19 Pile Dolphin 59700.0 Each $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Alt.6 13FINIM ChRins Strips CFn New eanag --M-4TdFW WN Piles per Each 1750.0 Each $14.00 $0.00 $0.00 $0.00 $0.00 $14.00 $0.00 Alt.7 Replace Fender Pte at WGf 1.oaation to be $23,800.00 $0.00 $0.00 $0.00 $0.00 0.0 $23,800.00 $0.00 Determined 5950.0 Each $4.00 $0.00 $0.00 $0.00 $0.00 $4.00 $0.00 Cot Additional Welding at Steel Pile Platform $3,713.73 $0.00 $3,713.73 $0.00 $3,713.73 100.0 $0.00 $0.00 3713.73 LS $1.00 $0.00 $1.005000 $1.00 $0.00 $0.E Totals 363706.730 0.000 304408.730 0.000 304406 0 59300.000 0.000 PAYROLL CERTIFICATION FOR PUBLIC WORKS PROJECTS Page 36 WEEKLY PAYROLL In accordance with Connecticut General Statutes, 31-53 Connecticut Department of Labor certified Payrolls with a statement of compliance Wage and Workplace Standards Division shall he submitted monthly to the contracting agency. 200 Folly Brook Blvd. - Wethersfield, CT 06109 WHAWK NORTHEAST 170 Canal Strt Plantsvll, CT 06479 FARMINGTON CASUALTY CO. I #DTFUB540M1491 1/1/17 through 12/31/17 Week ending:08-05-2017 Job: 17-013 Fishers Island Ferry-Dolphin R BRET C ARNESEN OSHA 10#: 1004637890 32 CLINTON DR SSN: xxx-xx-3451 Hourly Rate SO WINDSOR, CT 06074 07-30 07-31 08-01 08-02 08-03 08-04 08-05 Total Fringes $ Total Other Gross Check # Male Caucasian Sun Mon Tue Wed Thu Fri Sat Hours Cash $1/hr Fringe Rates Gross FICA FWH SWH Deducts This Job Net Pay Supervision Reg 4.00 4.00 58.90 1. 8.18 4. .16 2,371.00 181.38 311.12 127.84 40.41 235.60 66.46 2. 2.95 S. 5.21 1,710.25 3. .12 DARREN M COYLE OSHA 10#: 1100463787 43 CHERRY VALLEY RD SSN: xxx-xx-6331 Hourly-Rate COLUMBIA, CT 06237 07-30 07-31 08-01 08-02 08-03 08-04 08-05 Total Fringes $ Total Other Gross Check # Male Caucasian Sun Mon Tue Wed Thu Fri Sat Hours Cash $1/hr Fringe Rates Gross FICA FWH SWH Deducts This Job Net Pay Carpenter Reg 8.00 8.00 7.00 23.00 51.63 1. 8.18 4. .16 2,552.31 195.25 525.01 138.72 27.96 1,210.49 1118.26 2. 40.16 S. 1,665.37 23.00 3. .12 Carpenter OT 2.00 2.00 77.45 1. 8.18 4. ..1'6 156.89 97.24 2. 40.16 5. 2.00 3. .12 RENE R GALVAN OSHA 10#: 2282613 915 WORTHINGTON RIDGE SSN: xxx-xx-2260 Hourly Rate BERLIN, CT 06037 07-30 07-31 08-01 08-02 08-03 08-04 08-05 Total Fringes $ Total Other Gross Check # Male Caucasian Sun Mon Tue Wed Thu Fri Sat Hours Cash $1/hr Fringe Rates Gross FICA FWH SWH Deducts This Job Net Pay Laborer Reg 8.00 8.00 44.48 1. 8.18 4. .16 1,847.34 141.32 371.23 85.94 113.23 363.84 234.16 2. 20.81 S. .60 1,135.02 8.00 3. .12 ROBERT A LICHTY OSHA 10#: 1180111714 6B PLUMTREE DR SSN: xxx-xx-4302 Hourly Rate NORWICH, CT 06360 07-30 07-31 08-01 08-02 08-03 08-04 08-05 Total Fringes $ Total Other Gross Check # Male Caucasian Sun Mon Tue Wed Thu Fri Sat Hours Cash $1/hr Fringe Rates Gross FICA FWH SWH Deducts This Job Net Pay Supervision Reg 8.00 8.00 8.00 24.00 41.35 1. 8.18 4. .16 1,669.00 127.68 325.11 66.86 292.11 992.40 340.45 2. 2.07 S. 3.66 .60 856.64 3. .12 KEVIN J REZENDES OSHA 10#: 1100463787 49 ANSELMO DRIVE SSN: xxx-xx-3261 Hourly Rate PORTSMOUTH, RI 02871 07-30 07-31 08-01 08-02 08-03 08-04 08-05 Total Fringes $ Total Other Gross Check # Male Caucasian Sun Mon Tue Wed Thu Fri Sat Hours Cash $1/hr Fringe Rates Gross FICA FWH SWH Deducts This Job Net Pay Operator - Reg 8.00 8.00 7.00 23.00 72.86 1. 8.18 4. .16 3,011.10 230.36 490.61 163.14 39.59 1,698.78 848.70 2. 28.44 5. .60 2,086.80 23.00 3. .12 PAYROLL CERTIFICATION FOR PUBLIC WORKS PROJECTS Page 37 WEEKLY PAYROLL in accordance with Connecticut General Statutes, 31-53 Connecticut Department of Labor certified Payrolls with a statement of compliance Wage and workplace Standards Diviaion shall be submitted monthly to the contracting agency. 200 Folly Brook Blvd. Wethersfield, CT 06109 MOHAWK NORTHEAST 170 Canal Strt Plantsvll, CT 06679 FARMINGTON CASUALTY CO. #DTFUB540M1491 1/1/17 through 12/31/17 Week ending:08-05-2017 Job: 17-013 Fishers Island Ferry-Dolphin R CHRISTOPHER R. RODMAN OSHA 10#: 1100542240 89 HAWTHORNE ROAD SSN: XXX-XX-9013 Hourly Rate NEW LONDON, CT 06320 07-30 07-31 08-01 08-02 08-03 08-04 08-05 Total Fringes $ Total Other Gross check # Male Caucasian Sun Mon Tue Wed Thu Fri Sat Hours Cash $1/hr Fringe, Rates Gross FICA FWH SWH Deducts This Job Net Pay Laborer Reg 7.50 7.50 44.48 1. 3.14 4. .16 1,716.62 131.32 337.02 72.43 5.72 341.10 219.53 2. 25.85 S. .60 1,169.53 7.50 3. .12 Laborer OT 2.50 7.00 9.50 63.66 1. 3.14 4. -.16' 614.27 278.07 2. 25.85 5. 9.50 3. .12 I Date 8/16117 (b)WHERE FRINGE BENEFITS ARE PAID IN CASH I Allan R Heinke President ❑ — Each laborer or mechanic listed In the above referenced payroll has been paid, (Name of Signatory Party) (Title) as Indicated on the payroll,an amount not less than the sum of the applicable do hereby state: basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract,except as noted in section 4(c)below. (1)That 1 pay or supervise the payment of the persons employed by (c)EXCEPTIONS Mohawk Northeast,Inc. on the (Contractor or Subcontractor) EXCEPTION(CRAFT) EXPLANATION Fishers Island Ferry Dist-Dolphin Replacement ;that during the payroll period commencing on the (Building or Work) 30th day of July 2017 . and ending the 5th day of August 2017 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Mohawk Northeast,Inc. from the full (Contractor or Subcontractor) weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any penton,other than permissible deductions as defined in Regulations,Part 3(29 C.F.R.Subtitle A),issued by the Secretary of Labor under the Copeland Act,as amended(48 Stat.948, 63 Stat.108,72 Stat.967;76 Stat 357;40 U.S.C.§3145),and described below. REMARKS' (2)That any payrolls otherwise under this contract required to be submitted fort he above period are correct and complete;that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated Into the contract;that the classifications set forth therein for each taborer or mechanic conform with the work he performed. (3)That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United States Department of Labor,or if no such recognized agency exists in a State,are registered win the Bureau of Apprenticeship and Training,United States Department of Labor. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS NAME AND TITLE ® Allan R Heinke,President in addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR OR have been or Will be made to appropriate programs for the benefit of such employees, SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION.SEE SECTION 1001 OF TITLE 18 AND SECTION 231 OF TITLE except as noted in section 4(c)below. 31 OF THE UNITED STATES CODE. *FRINGE BENEFITS EXPLANATION(P): Bona fide benefits paid to approved plans,funds or programs,except those required by Federal or State Law(unemployment tax,worker's compensation,income taxes,etc.). Please specify the type of benefits provided: 1) Medical or hospital care x 4) Disability 2) Pension or retirement x 5) Vacation,holiday x 3) Life Insurance x 6) Other(please specify) CERTIFIED STATEMENT OF COMPLIANCE For the week ending date of 8/5/17 1, Allan Helnke of Mohawk Northeast,Inc . (hereafter known as Employer)in my capacity as President (title)do hereby certify and state: Section A: 1. All persons employed on said project have been paid the full weekly wages earned by them during the week in accordance with Connecticut General Statutes,section 31-53,as amended. Further,I hereby certify and state the following. a) The records submitted are true and accurate; b) The rate of wages paid to each mechanic,laborer or workman and the amount of payment or contributions paid or payable on behalf of each such person to any employee welfare fund,as defined in Connecticut General Statutes,section 31-53(h),are not less than the prevailing rate of wages and the amount of payment or contributions paid or payable on behalf of each such person to any employee welfare fund,as determined by the Labor Commissioner pursuant to subsection Connecticut General Statutes,section 31-53(d),and said wages and benefits are not less than those which may also be required by contract; c) The Employer has complied with all of the provisions in Connecticut General Statutes, section 31-53(and Section 31-54 if applicable for state highway construction); d) Each such person is covered by a worker's compensation insurance policy for the duration of his employment which proof of coverage has been provided to the contracting agency; e)The Employer does not receive kickbacks,which means any money,fee,commission,credit, gift,gratuity,thing of value,or compensation of any kind which is provided directly or indirectly,to any prime contractor;prime contractor employee,subcontractor,or subcontractor employee for the purpose of improperly obtaining or rewarding favorable treatment in connection with a prime contract or in connection with a prime contractor in connection with a subcontractor relating to a prime contractor;and 0 The Employer is aware that filing a certified payroll which he knows to be false is a class D felony for which the employer may be fined up to five thousand dollars,imprisoned for up to five years or both 2. OSHA—The employer shall affix a copy of the construction safety course,program or training completion document to the certified payroll required to be submitted to the contracting agency for this project on which such persons name first appears. t L� —President 1, 8/10/17 (Signature) (Title) Submitted on(Date) ***THIS IS A PUBLIC DOCUMENT*** ***DO NOT INCLUDE SOCIAL SECURITY NUMBERS*** CDSHA Thal card Wknaarte w that OM redplont has auecowuny cwvetad e 10-hour 0ocup tfonat eofety and Hum TMWRp Caur"to ConObUCtlon Safsty and Heallh Damn Coyle Dan Gorman 3.13-2018 (flamer nmr e-prtn1 or to") Thio mud eamaw�a9gaa 1Ref tM rodplont Ree ' e w how 0cMwG Md Balmy Mad HowiII Gotntro to ConobwoWn Sdt and l ooft Bret A msen mower nems- t of typo) -'f:cu�ce Bred dsto) !8-004638053 Ttae mrd ethnewlsd�ee mm 1Roredotnnt nee suooey oom�ed Com aro!Howm course fn Rene Galvan ally (hrbnsr nems=prinl ar type) (Canes 44 date) t . 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S. .60 1,282.75 22.00 3. .12 CHRISTOPHER R. RODMAN OSHA 10#: 1100542240 89 HAWTHORNE ROAD SSN: xxx-xx-9013 Hourly Rate NEW LONDON, CT 06320 08-06 08-07 08-08 08-09 08-10 08-11 08-12 Total Fringes $ Total _ Other Gross Check # Male Caucasian Sun Mon Tue Wed Thu Fri Sat Hours Cash $1/hr Fringe Rates Gross FICA FWH SWH Deducts This Job Net Pay Laborer Reg 6.00 8.00 14.00 44.48 1. 3.14 4. .16 1,408.72 107.77 260.04 53.23 5.72 636.72 409.78 2. 25.85 S. .60 981.36 14.00 3. .12 v � Date 8/16!17 (b)WHERE FRINGE BENEFITS ARE PAID IN CASH I Allan R Heinke President ❑ — Each laborer or mechanic listed in the above referenced payroll has been paid, (Name of Signatory Party) (Title) as indicated on the payroll,an amount not less than the sum of the applicable do hereby state: basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract,except as noted in section 4(c)below. (1)That 1 pay or supervise the payment of the persons employed by (c)EXCEPTIONS Mohawk Northeast,Inc. on the (Contractor or Subcontractor) EXCEPTION(CRAFT) EXPLANATION Fishers Island Ferry Dist-Dolphin Replacement •that during the payroll period commencing on the (Building or Work) 6th day of August 2017 , and ending the 12th day of August 2017 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Mohawk Northeast,Inc. from the full (Contractor or Subcontractor) weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person,other than permissible deductions as defined In Regulations,Part 3(29 C.F.R.Subtitle A),issued by the Secretary of tabor under the Copeland Act,as amended(48 Stat 948, 53 Stat.108,72 Stat.967;76 Stat.357;40 U.S.C.§3145),and described below: REMARKS: (2)That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete;that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract;that the classifications set forth therein for each laborer or mechanic conform with the work he performed. (3)That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United States Department of Labor,or if no such recognized agency exists in a State,are registered with the Bureau of Apprenticeship and Training,United States Department of Labor. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS NAMEAND TITLE SIG mAllan R Heinke,President in addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR OR have been or will be made to appropriate programs for the benefit of such employees, SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION.SEE SECTION 1001 OF TITLE 18 AND SECTION 231 OF TITLE except as noted in section 4(c)below. 31 OF THE UNITED STATES CODE. - r *FRINGE BENEFITS EXPLANATION(P): Bona fide benefits paid to approved plans,funds or programs,except those required by Federal or State Law(unemployment tax,worker's compensation,income taxes,etc.). Please specify the type of benefits provided- 1) Medical or hospital care x 4) Disability x 2) Pension or retirement x 5) Vacation,holiday 3) Life Insurance x 6) Other(please specify) CERTIFIED STATEMENT OF COMPLIANCE For the week ending date of 8112117 I, Allan Helnke of Mohawk Northeast,Inc (hereafter known as Employer)in my capacity as President (title)do hereby certify and state- Section A: 1. All persons employed on said project have been paid the full weekly wages earned by them during the week in accordance with Connecticut General Statutes,section 31-53,as amended. Further,I hereby certify and state the following: a) The records submitted are true and accurate; b) The rate of wages paid to each mechanic,laborer or workman and the amount of payment or contributions paid or payable on behalf of each such person to any employee welfare fund,as defined in Connecticut General Statutes,section 31-53(h),are not less than the prevailing rate of wages and the amount of payment or contributions paid or payable on behalf of each such person to any employee welfare fund,as determined by the Labor Commissioner pursuant to subsection Connecticut General Statutes,section 31-53(d),and said wages and benefits are not less than those which may also be required by contract; c) The Employer has complied with all of the provisions in Connecticut General Statutes, section 31-53(and Section 31-54 if applicable for state highway construction); d) Each such person is covered by a worker's compensation insurance policy for the duration of his employment which proof of coverage has been provided to the contracting agency; e)The Employer does not receive kickbacks,which means any money,fee,commission,credit, gift,gratuity,thing of value,or compensation of any kind which is provided directly or indirectly,to any prime contractor,prime contractor employee,subcontractor,or subcontractor employee for the purpose of improperly obtaining or rewarding favorable treatment in connection with a prime contract or in connection with a prime contractor in connection with a subcontractor relating to a prime contractor;and f)The Employer is aware that filing a certified payroll which he knows to be false is a class D felony for which the employer may be fined up to five thousand dollars,imprisoned for up to five years or both. 2. OSHA—The employer shall affix a copy of the construction safety course,program or training completion document to the certified payroll required to be submitted to the contracting agency for this project on which such persons name first appears. President 8/16/17 (Signe e) (Title) Submitted on(Date) ***THIS IS A PUBLIC DOCUMENT*** ***DO NOT INCLUDE SOCIAL SECURITY NUMBERS*** PAYROLL CERTIFICATION FOR PUBLIC WORKS PROJECTS Page 32 WEEKLY PAYROLL In accordance with Connecticut General statutes. 31-53 Connecticut Department of Labor M1 certified Payrolls with a statement of compliance Wage and Workplace Standards Division ' shall be submitted monthly to the contracting agency. 200 Folly Brook Blvd. Wethersfield. Cr 06109 :NORTHEAST 170 Ca 170 Canal Htrt Plantsvll, CT 06479 FARMINGTON CASUALTY CO. -*3 #DTFUB54OM1491 1/1/17 through 12/31/17 Week ending:08-19-2017 Job: 17-013 Fishers Island Ferry-Dolphsn R BRENDEN R GEMME OSHA 10#: CERT 65 LOCKWOOD ST SSN: xxx-xx-2999 Hourly Rate MANCHESTER, Cf 06040 08-13 08-14 08-15 08-16 08-17 08-18 08-19 Total Fringes $ Total Other Gross Check # Male Caucasian Sun Mon Tue Wed Thu Fri Sat Hours Cash $1/hr Fringe Rates Gross FICA FWH SWH Deducts This Job Net Pay Laborer Reg 3.50 8.00 8.00 19.50 44.48 1. 3.14 4. .16 1,317.36 100.79 217.73 45.53 886.86 551.27 2. 24.85 S. .60 952.71 19.50 3. .12 ROBERT A LICHTY OSHA 10#: 1180111714 6B PLUMTREE DR SSN: xxx-xx-4302 Hourly Rate NORWICH, CT 06360 08-13 08-14 08-15 08-16 08-17 08-18 08-19 Total Fringes $ Total Other Gross Check # Male Caucasian Sun Mon Tue Wed Thu Fri Sat Hours Cash $1/hr Fringe Rates Gross FICA FWH SWH Deducts This Job Net Pay Supervision Reg 3.50 8.00 8.00 19.50 41.35 1. 8.18 4. .16 1,669.01 127.68 325.11 71.85 292.11 806.33 276.62 2. 2.07 S. 3.66 .60 851.66 3. .12 KEVIN J REZENDES OSHA 10#: 1100463787 49 ANSELMO DRIVE SSN: xxx-xx-3261 Hourly Rate PORTSMOUTH, RI 02871 08-13 08-14 08-15 08-16 08-17 08-18 08-19 Total Fringes $ Total Other Groes Check # Male Caucasian Sun Mon Tue Wed Thu Fri Sat Hours Cash $1/hr Fringe Rates Gross FICA FWH SWH Deducts This Job Net Pay Operator - Reg 8.00 8.00 8.00 24.00 72.86 1. 8.18 4. .16 2,761.80 211.28 428.29 140.63 39.59 1,772.64 861.60 2. 27.44 S. .60 1,941.41 24.00 3. .12 JOSEPH TENNANT OSHA 10#: 1100463805 479 BEACH POND RD SSN: xxx-xx-9654 Hourly Rate VOLUNTOWN, CT 06384 08-13 08-14 08-15 08-16 08-17 08-18 08-19 Total Fringes $ Total Other Gross Check # Male Caucasian Sun Mon Tue Wed Thu Fri Sat Hours Cash $1/hr Fringe Rates Gross FICA FWH SWH Deducts This Job Net Pay Laborer Foreman Reg 3.50 8.00 7.50 19.00 44.98 1. 8.18 4. .16 1,411.86 108.01 260.83 51.32 3.84 873.62 527.63 2. 19.31 S. .60 987.26 19.00 3. .12 Laborer Foreman OT 50 .50 67.47 1. 8.18 4. .16 34.24 13.89 2. 19.31 5. .50 3. .12 Date August 23,2017 (b)WHERE FRINGE BENEFITS ARE PAID IN CASH I Allan R Heinke President ❑ — Each laborer or mechanic listed in the above referenced payroll has been paid, (Name of Signatory Party) (Title) as indicated on the payroll,an amount not less than the sum of the applicable do hereby state: basic hourly wage rate plus the amount of the required fringe benefits as listed In the contract,except as noted in section 4(c)below. (1)That I pay or supervise the payment of the persons employed by (c)EXCEPTIONS Mohawk Northeast,Inc. on the (Contractor or Subcontractor) EXCEPTION(CRAFT) EXPLANATION Fishers Island Ferry Dist-Dolphin Replacement ;that during the payroll period commencing on the (Building or Work) 13th day of August 2017 and ending the 19th day of August 2017 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Mohawk Northeast,Inc. from the full (Contractor or Subcontractor) weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person,other than permissible deductions as defined in Regulations,Part 63 Sat.108,72 Sat 929 C.F.R.Subtitle )67;76 Stat.issued 357;40 U.he S C.§3145),and describof Labor under the ed belowland t,as amended(46 Stat.948, REMARKS (2)That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete;that the wage rats for laborers or mechanics contained therein are not less than the applicable wage rats contained in any wage determination incorporated Into the contract;that the classifications set forth therein for each laborer or mechanic conform with the work he performed. (3)That any apprentices employed In the above period are duly registered In a bona fide apprenticeship program registered with a Sate apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United Sates Department of labor,or if no such recognized agency exists in a Sate,are registered with the Bureau of Apprenticeship and Training,United States Department of Labor. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS NAME AND TILE SI RE mAllan R Heinke,President { ` In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMEM MAY SUBJECT THE CONTRACTOR OR have been or will be made to appropriate programs for the benefit of such employees, SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION,SEE SECTION 1001 OF TITLE 18 AND SECTION 231 OF TILE except as noted in section 4(c)below. 31 OF THE UNITED STATES CODE. *FRINGE BENEFITS EXPLANATION(P): 4�3 Bona fide benefits paid to approved plans,funds or programs,except those required by Federal or State Law(unemployment tax,worker's compensation,income taxes,etc.) Please specify the type of benefits provided: l) Medical or hospital care x 4) Disability 2) Pension or retirement x 5) Vacation,holiday x 3) Life Insurance x 6) Other(please specify) CERTIFIED STATEMENT OF COMPLIANCE For the week ending date of _ 9/19/17 , 1 Allan Helnke of Mohawk Northeast,Inc (hereafter known as Employer)in my capacity as President (title)do hereby certify and state: Section A: 1. All persons employed on said project have been paid the full weekly wages earned by them during the week in accordance with Connecticut General Statutes,section 31-53,as amended. Further,I hereby certify and state the following: a) The records submitted are true and accurate; b) The rate of wages paid to each mechanic,taborer or workman and the amount of payment or contributions paid or payable on behalf of each such person to any employee welfare fund,as defined in Connecticut General Statutes,section 31-53(h),are not less than the prevailing rate of wages and the amount of payment or contributions paid or payable on behalf of each such person to any employee welfare fund,as determined by the Labor Commissioner pursuant to subsection Connecticut General Statutes,section 31-53(d),and said wages and benefits are not less than those which may also be required by contract; c) The Employer has complied with all of the provisions in Connecticut General Statutes, section 31-53(and Section 31-54 if applicable for state highway construction); d) Each such person is covered by a worker's compensation insurance policy for the duration of his employment which proof of coverage has been provided to the contracting agency; e)The Employer does not receive kickbacks,which means any money,fee,commission,credit, gift,gratuity,thing of value,or compensation of any kind which is provided directly or indirectly,to any prime contractor,prime contractor employee,subcontractor,or subcontractor employee for the purpose of improperly obtaining or rewarding favorable treatment in connection with a prime contract or in connection with a prime contractor in Connection with a subcontractor relating to a prime contractor;and t)The Employer is aware that filing a certified payroll which he knows to be false is a class D felony for which the employer may be fined up to five thousand dollars,imprisoned for up to five years or both. 2. OSHA—The employer shall affix a copy of the construction safety course,program or training completion document to the certified payroll required to be submitted to the contracting agency for this project on which such persons name first appears. C� �Pre�sldent 8!23/17 (Sig atu itle) Submitted on(Date) ***THIS IS A PUBLIC DOCUMENT*** ***DO NOT INCLUDE SOCIAL SECURITY NUMBERS*** I ma fill. certifies that E N ru"h EN G E M M E has successfully completed OSHA 10 Hour Construction and has earned I IACET CEUs and 10.3 Contact Hours. This course was developed and presented by ClickSafety com, Inc. LAC—ET I confirm that i personally took the Course 11siso 80ING, ` `rr. C13637920 4/5/2015 10.25 HOURS -------------- SIGNATURE COMPLETION DATE COURSE DURATION STUDENT SERIAL NUMBER I urm tw ft OSHA A5 anAUUMMd OSHA O&Wch TrOtV PMfdw,Ckkfth 0 �==4z:6authanom L OSHA "® 1 t-UL3838C152 Troo caro odmvwWqw do are moWm tura Buoo aduW awnyetgd a toftw ooapatlo w Sdaty mw Heald►TMw q cause m Joe Tennant (Tralna M=—Pdmatypa) I I i I I f I i I I I �I I i i I I I I PAYROLL CERTIFICATION FOR PUBLIC WORKS PROJECTS Page 30 WEEKLY PAYROLL in accordance with Connecticut General Statutes, 31-53 Connecticut Department of Labor entified Payrolls with a statement of compliance Wage and workplace Standards Division shall be submitted monthly to the contracting agency. 200 Folly Brook Blvd. Wethersfield, Cr 06109 IOHAWK NORTHEAST 170 Canal Strt Plantsvll, CT 06479 FARMI14GTON CASUALTY CO. #DTFUSS40M1491 1/1/17 through 12/31/17 week ending:08-26-2017 Job: 17-013 Fishers Island Ferry-Dolphin R DARREN M COYLE OSHA 10#: 1100463787 43 CHERRY VALLEY RD SSN: xxx-xx-6331 Hourly Rate :OLUMBIA, CT 06237 08-20 08-21 08-22 08-23 08-24 06-25 08-26 Total Fringes $ Total Other Grose Check # Male Caucasian Sun Mon Tue Wed Thu Fri Sat Hours Cash $1/hr Fringe Rates Gross FICA FWH SWH Deducts This Job Net Pay Carpenter Foremn Reg 8.50 9.00 17.50 52.63 1. 8.18 4. .16 1,852.21 141.70 331.97 80.20 27.96 938.53 815.85 2. 38.16 5. .60 1,269.78 17.50 3. .12 BRENDEN R GEMME OSHA 10#: CERT 65 LOCKWOOD ST SSN: xxx-xx-2999 Hourly Rate MANCHESTER, CT 06040 08-20 08-21 08-22 08-23 08-24 08-25 08-26 Total Fringes $ Total Other Gross Check # Male Caucasian Sun Mon Tue Wed Thu Fri Sat Hours Cash $1/hr Fringe Rates Gross FICA FWH SWH Deducts This Job Net Pay Laborer Reg 8.00 8.00 44.48 1. 3.14 4. .16 1,100.50 84.18 163.51 37.45 363.84 226.16 2. 24.85 5. .60 814.76 8.00 3. .12 Laborer OT 1.00 1.00 63.66 1. 3.14 4. .16 64.66 28.27 2. 24.85 S. 1.00 3. .12 ROBERT A LICHTY OSHA 10#: 1180111714 6B PLUMTREE DR SSN: xxx-xx-4302 Hourly Rate NORWICH, CT .06360 08-20 08-21 08-22 08-23 08-24 08-25 08-26 Total Fringes $ Total Other Gross Check # Male Caucasian Sun Mon Tue Wed Thu Fri Sat Hours Cash $1/hr Fringe Rates Gross FICA FWH SWH Deducts This Job Net Pay Supervision Reg 8.00 8.00 16.00 41.35 1. 8.18 4. .16 1,669.00 127.68 325.11 69.18 292.11 661.60 226.97 2. 2.07 5. 3.66 .60 854.32 3. .12 KEVIN J REZENDES OSHA 10#: 1100463787 49 ANSELMO DRIVE SSN: xxx-xx-3261 Hourly Rate PORTSMOUTH, RI 02871 08-20 08-21 08-22 08-23 08-24 08-25 08-26 Total Fringes $ Total Other Gross Check # Male Caucasian Sun Mon Tue Wed Thu Fri Sat Hours Cash $1/hr Fringe Rates Gross FICA FWH SWH Deducts This Job Net Pay Operator - Reg 8.00 8.00 16.00 72.86 1. 8.18 4. .16 2,205.50 168.72 289.21 104.73 39.59 1,181.76 574.40 2. 27.44 S. .60 1,602.65 16.00 3. .12 JOSEPH TENNANT OSHA 10#: 1100463805 479 BEACH POND RD SSN: xxx-xx-9654 Hourly Rate VOLUNTOWN, CT 06384 08-20 08-21 08-22 08-23 08-24 08-25 08-26 Total Fringes $ Total Other Grose Check # Male Caucasian Sun Mon Tue Wed Thu Fri Sat Hours Cash $1/hr Fringe Rates Gross FICA FWH SWH Deducts This Job Net Pay Laborer Foreman Reg 8.00 8.00 16.00 44.98 1. 8.18 4. .16 1,421.42 108.73 263.22 48.38 3.84 735.68 444.32 2. 19.31 5. .60 996.65 16.00 3. .12 Laborer Foreman OT .50 1.00 1.50 64.16 1. 8.18 4. .16 97.74 41.66 2. 19.31 S. 1.50 3. .12 Date August 31,2017 (b)WHERE FRINGE BENEFITS ARE PAID IN CASH Allan R Heinke President I. ❑ — Each laborer or mechanic listed in the above referenced payroll has been paid, (Name of Signatory Party) (Title) as indicated on the payroll,an amount not less than the sum of the applicable do hereby state: basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract,except as noted in section 4(c)below. (1)That I pay or supervise the payment of the persons employed by (c)EXCEPTIONS Mohawk Northeast,Inc. on the (Contractor or Subcontractor) EXCEPTION(CRAFT) EXPLANATION Fishers island Ferry Dist-Dolphin Replacement •that during the payroll period commencing on the (Building or Work) 20th day of August 2017 and ending the 26th day of August 2017en all persons employed on said project have bepaid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Mohawk Northeast,Inc. from the full (Contractor or Subcontractor) weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person,other than permissible deductions as defined in Regulations,Part 3(29 C.F.R.Subtitle A),issued by the Secretary of Labor under the Copeland Act,as amended(48 Stat.948, 63 Stat.108,72 Stat 967;76 Stat.357;40 U.S.C.§3145),and described below. REMARKS' (2)That any payrolls otherwise under this contract required to be submitted for t he above period are correct and complete;that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated Into the contract;that the classifications set forth therein for each laborer or mechanic conform with the work he performed. (3)That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United States Department of Labor,or if no such recognized agency exists In a State,are registered with the Bureau of Apprenticeship and Training,United States Department of Labor. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS NAME AND TITLE SIGtlyr<r4R6� 1 m Allan R Heinke,President l/\� \\1► in addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed In the contract THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR OR have been or will be made to appropriate programs for the benefit of such employees, SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION.SEE SECTION 1001 OF TITLE 18 AND SECTION 231 OF TiTLE except as noted in section 4(c)below. 31 OF THE UNITED STATES CODE. *FRINGE BENEFITS EXPLANATION(P): Bona fide benefits paid to approved plans,funds or programs,except those required by Federal or State Law(unemployment tax,worker's compensation,income taxes,etc.). Please specify the type of benefits provided: 1) Medical or hospital care x 4) Disability x 2) Pension or retirement x 5) Vacation,holiday x 3) Life Insurance x 6) Other(please specify) CERTIFIED STATEMENT OF COMPLIANCE For the week ending date of 8/26/17 1, Allan Heinke of Mohawk Northeast,Inc (hereafter known as Employer)in my capacity as President (title)do hereby certify and state: Section A: 1. All persons employed on said project have been paid the full weekly wages earned by them during the week in accordance with Connecticut General Statutes,section 31-53,as amended. Further,I hereby certify and state the following, a) The records submitted are true and accurate; b) The rate of wages paid to each mechanic,laborer or workman and the amount of payment or contributions paid or payable on behalf of each such person to any employee welfare fund,as defined in Connecticut General Statutes,section 31-53(h),are not less than the prevailing rate of wages and the amount of payment or contributions paid or payable on behalf of each such person to any employee welfare fund,as determined by the Labor Commissioner pursuant to subsection Connecticut General Statutes,section 31-53(d),and said wages and benefits are not less than those which may also be required by contract; c) The Employer has complied with all of the provisions in Connecticut General Statutes, section 31-53(and Section 31-54 if applicable for state highway construction); d) Each such person is covered by a worker's compensation insurance policy for the duration of his employment which proof of coverage has been provided to the contracting agency; e)The Employer does not receive kickbacks,which means any money,fee,commission,credit, gift,gratuity,thing of value,or compensation of any kind which is provided directly or indirectly,to any prime contractor,prime contractor employee,subcontractor,or subcontractor employee for the purpose of improperly obtaining or rewarding favorable treatment in connection with a prime contract or in connection with a prime contractor in connection with a subcontractor relating to a prime contractor;and f)The Employer is aware that filing a certified payroll which he knows to be false is a class D felony for which the employer may be fined up to five thousand dollars,imprisoned for up to five years or both. 2. OSHA—The employer shall affix a copy of the construction safety course,program or training completion document to the certified payroll required to be submitted to the contracting agency for this project on which such persons name first appears. VL��resident 8/31/17 (Signature) (Title) Submitted on(Date) ***THIS IS A PUBLIC DOCUMENT*** ***DO NOT INCLUDE SOCIAL SECURITY NUMBERS*** PAYROLL CERTIFICATION FOR PUBLIC WORKS PROJECTS Page 29 WEEKLY PAYROLL- In accordance with Connecticut General Statutes, 31-53 Connecticut Department of Labor Certified Payrolls with a statement of compliance wage and workplace Standards Division shall be submitted monthly to the contracting agency. 200 Folly Brook Blvd. Wethersfield, Cr 06109 MOBANK NORTHEAST 170 Canal Strt Plantsvll, CT 06479 FARMINGTON CASUALTY CO. #DTFUB540M1491 1/1/17 through 12/31/17 Week ending:09-02-2017 Job: 17-013 Fishers island Ferry-Dolphin R BRET C ARNESEN OSHA 10#: 1004637890 32 CLINTON DR SSN: xxx-xx-3451 Hourly Rate SO WINDSOR, CT 06074 08-27 08-28 08-29 08-30 08-31 09-01 09-02 Total Fringes $ Total Other Gross Check # Male Caucasian Sun Mon Tue Wed Thu Fri Sat Hours Cash $1/hr Fringe Rates Gross FICA FWH SWH Deducts This Job Net Pay Supervision Reg 8.00 8.00 58.90 1. 8.18 4. .16 2,371.00 181.38 311.12 109.91 40.41 471.20 132.92 2. 2.95 S. 5.21 .60 1,727.58 3. .12 DARREN M COYLE OSHA 10#: 1100463787 43 CHERRY VALLEY RD SSN: xxx-xx-6331 Hourly Rate COLUMBIA, CT 06237 08-27 08-28 08-29 08-30 08-31 09-01 09-02 Total Fringes $ Total Other Gross Check # Male Caucasian Sun Mon Tue Wed Thu Fri Sat Hours Cash $1/hr Fringe Rates Gross FICA FWH SWH Deducts This Job Net Pay Carpenter Foremn Reg -9.00 8.50 8.50 8.00 6.00 40.00 52.63 1. 8.18 4. .16 2,320.09 177.48 459.99 135.81 27.96 2,145.20 1864.80 2. 38.16 5. .60 1,518.25 40.00 3. .12 Carpenter Foremn OT 99� 2.00 2.00 78.95 1. 8.18 4. .16. 159.89 93.24 2. 38.16 S. 2.00 3. .12 ROBERT A LICHTY OSHA 10#: 1180111714 6B PLUMTREE DR SSN: xxx-xx-4302 Hourly Rate NORWICH, CT 06360 08-27 08-28 08-29 08-30 08-31 09-01 09-02 Total Fringes $ Total Other Gross Check # Male Caucasian Sun Mon Tue Wed Thu Fri Sat Hours Cash $1/hr Fringe Rates Gross FICA FWH SWH Deducts This Job Net Pay Supervision Reg 8.00 8.00 8.00 8.00 8.00 40.00 41.35 1. 8.18 4. .16 1,669.00 127.68 325.11 91.99 292.11 1,654.00 567.42 2. 2.07 5. 3.66 .60 631.51 3. .12 KEVIN J REZENDES OSHA 100: 1100463787 49 ANSELMO DRIVE SSN: xxx-xx-3261 Hourly Rate PORTSMOUTH, RI 02871 08-27 08-28 08-29 08-30 08-31 09-01 09-02 Total Fringes $ Total Other Gross Check # Male Caucasian Sun Mon Tue Wed Thu Fri Sat Hours Cash $1/hr Fringe Rates Gross FICA FWH SWH Deducts This Job Net Pay Operator - Reg 8.00 8.00 8.00 8.00 8.00 40.00 72.86 1. 8.18 4. .16 2,969.40 227.15 480.19 183.22 39.59 2,954.40 1436.00 2. 27.44 5. .60 2,038.65 40.00 3. .12 JOSEPH TENNANT OSHA 10#: 1100463805 479 BEACH POND RD SSN: xxx-xx-9654 Hourly Rate - VOLUNTOWN, CT 06384 08-27 08-28 08-29 08-30 08-31 09-01 09-02 Total Fringes $ Total Other Gross Check # Male Caucasian Sun Mon Tue Wed Thu Fri Sat Hours Cash $1/hr Fringe Rates Gross FICA FWH SWH Deducts This Job Net Pay Carpenter Reg 8.00 8.00 8.00 8.00 8.00 40.00 51.63 1. 8.18 4. .16 2,•262.09 173.05 487.36 134.23 3.84 2,105.20 1904.80 2. 39.16 S. .60 1,463.01 40.00 3. .12 Carpenter OT 1.00 .50 .50 2.00 77.45 i. 8.18 4. .16 156.89 ' 95.24 2. 39.16 5. 2.00 3. .12 Date September 6,2017 (b)WHERE FRINGE BENEFITS ARE PAID IN CASH I Allan R Heinke President ❑ — Each laborer or mechanic listed in the above referenced payroll has been paid, (Name of Signatory Party) (Title) as indicated on the payroll,an amount not less than the sum of the applicable do hereby state: basic hourly wage rate plus the amount of the required fringe benefits as listed In the contract,except as noted In section 4(c)below. (1)That I pay or supervise the payment of the persons employed by (c)EXCEPTIONS Mohawk Northeast,Inc. on the (Contractor or Subcontractor) EXCEPTION(CRAFT) EXPLANATION Fishers Island Ferry Dist-Dolphin Replacement •that during the payroll period commencing on the (Building or Work) 27th day of August 2017 , and ending the 2nd day of September 2017 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or w111 be made either directly or indirectly to or on behalf of said Mohawk Northeast, Inc. from the full (Contractor or Subcontractor) weekly wages earned by any person and that no deductions have been made either directly or Indirectly from the full wages earned by any person,other than permissible deductions as defined In Regulations,Part 3(29 C.F.R.Subtitle A),issued by the Secretary of Labor under the Copeland Act,as amended(48 Stat.948, 63 Stat.108,72 Stat.967;76 Stat.357,40 U.S.C.§3145),and described below. REMARKS* (2)That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete;that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract;that the classifications set forth therein for each laborer or mechanic conform with the work he performed. (3)That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United States Department of Labor,or if no such recognized agency exists in a State,are registered with the Bureau of Apprenticeship and Training,United States Department of Labor. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS NAMEANDTITLE SIG Allan R Heinke,President m — in addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR OR have been or will be made to appropriate programs for the benefit of such employees, SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION.SEE SECTION 1001 OF TITLE 16 AND SECTION 231 OF TITLE except as noted in section 4(c)below. 31 OF THE UNITED STATES CODE. *FRINGE BENEFITS EXPLANATION(P): Bona fide benefits paid to approved plans,funds or programs,except those required by Federal or State Law(unemployment tax,worker's compensation,income taxes,etc.). Please specify the type of benefits provided: 1) Medical or hospital care x 4) Disability z 2) Pension or retirement x 5) Vacation,holiday x 3) Life Insurance " 6) Other(please specify) CERTIFIED STATEMENT OF COMPLIANCE For the week ending date of 9/2/17 I Allan Heinke of Mohawk Northeast,Inc (hereafter known as Employer)in my capacity as President (title)do hereby certify and state: Section A: 1. All persons employed on said project have been paid the full weekly wages earned by them during the week in accordance with Connecticut General Statutes,section 31-53,as amended. Further,I hereby certify and state the following: a) The records submitted are true and accurate; b) The rate of wages paid to each mechanic,laborer or workman and the amount of payment or contributions paid or payable on behalf of each such person to any employee welfare fund,as defined In Connecticut General Statutes,section 31-53(h),are not less than the prevailing rate of wages and the amount of payment or contributions paid or payable on behalf of each such person to any employee welfare fund,as determined by the Labor Commissioner pursuant to subsection Connecticut General Statutes,section 31-53(d),and said wages and benefits are not less than those which may also be required by contract; c) The Employer has complied with all of the provisions in Connecticut General Statutes, section 31-53(and Section 31-54 if applicable for state highway construction); d) Each such person is covered by a worker's compensation insurance policy for the duration of his employment which proof of coverage has been provided to the contracting agency; e)The Employer does not receive kickbacks,which means any money,fee,commission,credit, gift,gratuity,thing of value,or compensation of any kind which is provided directly or indirectly,to any prime contractor,prime contractor employee,subcontractor,or subcontractor employee for the purpose of improperly obtaining or rewarding favorable treatment in connection with a prime contract or in connection with a prime contractor in connection with a subcontractor relating to a prime contractor;and f)The Employer is aware that filing a certified payroll which he knows to be false is a class D felony for which the employer may be fined up to five thousand dollars,imprisoned for up to five years or both. 2. OSHA—The employer shall affix a copy ofthe construction safety course,program or training completion document to the certified payroll required to be submitted to the contracting agency for this project on which such persons name first appears. \��awsident 9/6/17 (Signature) (Title) Submitted on(Date) ***THIS IS A PUBLIC DOCUMENT*** ***DO NOT INCLUDE SOCIAL SECURITY NUMBERS*** PAYROLL CERTIFICATION FOR PUBLIC WORKS PROJECTS Page 23 WEEKLY PAYROLL In accordance with Connecticut General Statutes, 31-53 Connecticut Department of Labor Certified Payrolls With a statement of compliance wage and workplace Standards Division shall be submitted monthly to the contracting agency. 200 Folly Brook Blvd. Wethersfield, Cr 06109 MOHAWK NORTHEAST 170 Canal Strt Plantsvll, CT 06479 FARMINGTON CASUALTY CO. #DTFUB540M1491 1/1/17 through 12/31/17 week ending: 09-09-2017 Job: 17-013 Fishers Island Ferry-Dolphin R DARREN M COYLE OSHA 10#: 1100463787 43 CHERRY VALLEY RD SSN: xxx-xx-6331 Hourly Rate COLUMBIA, CT 06237 09-03 09-04 09-OS 09-06 09-07 09-08 09-09 Total Fringes $ Total Other Gross Check # Male Caucasian Sun Mon Tue Wed Thu Fri Sat Hours Cash $1/hr Fringe Rates Gross FICA FWH SWH Deducts This Job Net Pay Carpenter Foremn Reg 8.00 8.00 8.00 8.00 32.00 52.63 1. 8.18 4. .16 2,261.48 173.01 443.58 109.39 27.96 1,716.16 1491.84 2. 38.16 5. .60 1,506.94 32.00 3. .12 Carpenter Foremn OT .50 1.00 1.00 .50 3.00 78.95 1. 8.18 4. .16 239.84 139.86 2. 38.16 5. 3.00 3. .12 ROBERT A LICHTY OSHA 10#: 1180111714 6B PLUMTREE DR SSN: xxx-xx-4302 Hourly Rate NORWICH, CT 06360 09-03 09-04 09-05 09-06 09-07 09-08 09-09 Total Fringes $ Total Other Gross Check # Male Caucasian Sun Mon Tue Wed Thu Fri Sat Hours Cash $1/hr Fringe Rates Gross FICA FWH SWH Deducts This Job Net Pay Supervision Reg 8.00 8.00 8.00 8.00 32.00 41.35 1. 6.18 4. .16 1,669.00 127.68 325.11 70.80 292.11 1,323.20 453.93 2. 2.07 S. 3.56 .60 852.70 3. .12 KEVIN J REZENDES OSHA 10#: 1100463787 49 ANSELMO DRIVE SSN: xxx-xx-3261 Hourly Rate PORTSMOUTH, RI 02871 09-03 09-04 09-05 09-06 09-07 09-08 09-09 Total Fringes $ Total Other Gross Check # Male Caucasian Sun Mon Tue Wed Thu Fri Sat Hours Cash $1/hr Fringe Rates Gross FICA FWH SWH Deducts This Job Net Pay Operatr - Grp #3 Reg 8.00 8.00 8.00 8.00 32.00 41.76 1. 8,18 4. .16 1,717.40 131.39 180.06 82.04 39.59 1,368.32 270.72 2. 5. .60 1,283.72 32.00 3. .12 CHRISTOPHER R. RODMAN OSHA 10#: 1100542240 46 MATTERN RD SSN: xxx-xx-9013 Hourly Rate PRESTON, CT 06365 09-03 09-04 09-05 09-06 09-07 09-08 09-09 Total Fringes $ Total Other Gross Check # Male Caucasian Sun Mon Tue Wed Thu Fri Sat Hours Cash $1/hr Fringe Rates Gross FICA FWH SWH Deducts This Job Net Pay Laborer Reg 8.00 8.00 16.00 44.48 1. 3.14 4. .16 1,173.05 89.74 201.12 37.98 5.72 727.68 452.32 2. 24.85 S. .60 837.89 16.00 3. .12 Laborer OT .50 1.00 1.50 63.66 1. 3.14 4. .16 96.99 42.41 2. 24.85 S. 1.50 3. .12 PAYROLL CERTIFICATION FOR PUBLIC WORKS PROJECTS Page 24 WEEKLY PAYROLL In accordance with Connecticut General Statutes, 31-53 Connecticut Department of Labor Certified Payrolls with a statement of compliance Wage and Workplace Standards Division shall be submitted monthly to the contracting agency. 200 Folly Brook Blvd. Wethersfield, CT 06109 MORPMK NORTHEAST 170 Canal 8trt Plantsvll, CT 06479 FAR14INGTON CASUALTY CO. #DTPUB540M1491 1/1/17 through 12/31/17 Week ending:09-09-2017 Job: 17-013 Fishers Island Ferry-Dolphin R JOSEPH TENNANT OSHA 10#: 1100463805 479 BEACH POND RD SSN: xxx-xx-9654 Hourly Rate VOLUNTOWN, CT 06384 09-03 09-04 09-05 09-06 09-07 09-08 09-09 Total Fringes $ Total Other Gross Check # Male Caucasian Sun Mon Tue Wed Thu Fri Sat Hours Cash $1/hr Fringe Rates Gross FICA FWH SWH Deducts This Jab Net Pay Carpenter Reg 8.00 8.00 16.00 51.63 1. 8.18 4. .16 959.75 73.42 147.80 46.25 3.84 842.08 761.92 2. 39.16 S. .60 687.84 16.00 3. .12 Carpenter OT 1.00 .50 1.50 77.45 1. 8.18 4. .16 117.67 71.43 2. 39.16 5. 1.50 3. .12 Data September 15,2017 (b)WHERE FRINGE BENEFITS ARE PAID IN CASH Allan R Heinke President ❑ — Foch laborer or mechanic listed in the above referenced payroll has been paid, (Name of Signatory Party) (Title) as indicated on the payroll,an amount not less than the sum of the applicable do hereby state: basic hourly wage rate plus the amount of the required fringe benefits as listed In the contract,except as noted in section 4(c)below. (1)That I pay or supervise the payment of the persons employed by (c)EXCEPTIONSMohawk Northeast,Inc. on the (Contractor or Subcontractor) EXCEPTION(CRAFT) EXPLANATION Fishers Island Ferry Dist-Dolphin Replacement ;that during the payroll period commencing on the (Building or Work) 3rd day of September 2017 , and ending the 9th day of September 2017 all pentons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Mohawk Northeast,Inc. from the full (Contractor or Subcontractor) weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person;other than permissible deductions as defined in Regulations,Part 3(29 C.F.R.Subtitle A),issued by the Secretary of Labor under the Copeland Act,as amended(48 Stat.948, 63 Stat.108,72 Stat.967;76 Stat.357;40 U.S.C.§3145),and described below. REMARKS. (2)That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete;that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated Into the contract;that the classifications set forth therein for each laborer or mechanic conform with the work he performed. (3)That any apprentices employed in the above period are duly registered In a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United States Department of Labor,or if no such recognized agency exists in a State,are registered with the Bureau of Apprenticeship and Training,United States Department of Labor. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS NAME AND TITLE 51GNpiCRS� �� mAllan R Heinke,President L/1� In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed In the contract THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR OR have been or will be made to appropriate programs for the benefit of such employees, SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION.SEE SECTION 1001 OF TITLE to AND SECTION 231 OF TITLE except as noted In section 4(c)below. 31 OF THE UNITED STATES CODE. ` w • , F *FRINGE BENEFITS EXPLANATION(P): Bona fide benefits paid to approved plans,funds or programs,except those required by Federal or State Law(unemployment tax,worker's compensation,income taxes,etc). Please specify the type of benefits provided: 1) Medical or hospital care x 4) Disability x 2) Pension or retirement " 5) Vacation,holiday x 3) Life Insurance x 6) Other(please specify) CERTIFIED STATEMENT OF COMPLIANCE For the week ending date of 9/9/17 , 1, Allan Helnke of Mohawk Northeast,Inc (hereafter known as Employer)in my capacity as President (title)do hereby certify and state: Section A: 1. All persons employed on said project have been paid the full weekly wages earned by them during the week in accordance with Connecticut General Statutes,section 31-53,as amended. Further,I hereby certify and state the following- a) The records submitted are true and accurate; b) The rate of wages paid to each mechanic,laborer or workman and the amount of payment or contributions paid or payable on behalf of each such person to any employee welfare fund,as defined in Connecticut General Statutes,section 31-53(h),are not less than the prevailing rate of wages and the amount of payment or contributions paid or payable on behalf of each such person to any employee welfare fund,as determined by the Labor Commissioner pursuant to subsection Connecticut General Statutes,section 31-53(d),and said wages and benefits are not less than those which may also be required by contract; c) The Employer has complied with all of the provisions in Connecticut General Statutes, section 31-53(and Section 31-54 if applicable for state highway construction); d) Each such person is covered by a worker's compensation insurance policy for the duration of his employment which proof of coverage has been provided to the contracting agency; e)The Employer does not receive kickbacks,which means any money,fee,commission,credit, gift,gratuity,thing of value,or compensation of any kind which is provided directly or indirectly,to any prime contractor,prime contractor employee,subcontractor,or subcontractor employee for the purpose of improperly obtaining or rewarding favorable treatment in connection with a prime contract or in connection with a prime contractor in connection with a subcontractor relating to a prime contractor;and 0 The Employer is aware that filing a certified payroll which he knows to be false is a class D felony for which the employer may be fined up to five thousand dollars,imprisoned for up to five years or both. 2. OSHA—The employer shall affix a copy of the construction safety course,program or training completion document to the certified payroll required to be submitted to the contracting agency for this project on which such persons name first appears. VL� President 9/15/17 (Signature) (Title) Submitted on(Date) ***THIS IS A PUBLIC DOCUMENT*** ***DO NOT INCLUDE SOCIAL SECURITY NUMBERS*** PAYROLL CERTIFICATION FOR PUBLIC WORKS PROJECTS Page 35 r WEEKLY PAYROLL , In accordance with Connecticut General Statutes, 31-53 Connecticut Department of Labor certified Payrolls with a statement of compliance Wage and Workplace Standards Division ,r shall be submitted monthly to the contracting agency. 200 Folly Brook Blvd. Wethersfield, Cr 06109 MOHAWK NORTBEAST FARMINGTON 170 Canal Strt Plantsvll, CT 06479 _ #DTFUB540M CASUALTY CO. #DTFUB590M1491 1/1/17 through 12/31/17 Week ending: 09-16-2017 Job: 17-013 Fishers Island Ferry Dolphin A DARREN M COYLE OSHA 30#: 1100463787 43 CHERRY VALLEY RD SSN: xxx-xx-6331 Hourly Rate COLUMBIA, CT 06237 09-10 09-11 09-12 09-13 09-14 09-15 09-16 Total Fringes $ Total Other Gross Check # Male Caucasian Sun Mon Tue Wed Thu Fri Sat Hours Cash $1/hr Fringe Rates Gross FICA FWH SWH Deducts This Job Net Pay Carpenter OT 6.00 6.00 103.26 1. 8.18 4. .16 3,200.98 244.88 706.64 189.30 27.96 625.56 285.72 2. 39.16 5. .60 2,031.60 6.00 3. .12 Carpenter Foremn Reg 8.00 8.00 8.00 3.00 7.00 34.00 52.63 1. 8.18 4. .16 1,823.42 1585.08 2. 38.16 5. 34.00 3. .12 Carpenter Foremn OT 50 .50 1.50 2.00 4.50 78.95 1. 8.18 4. .16 359.75 209.79 2. 38.16 S. 4.50 3. .12 Carpenter Foremn OT 1.50 1.50 105.26 1. 8.18 4. .16 159.39 69.93 2. 38.16 5. 1.50 3. .12 ROBERT A LICHTY OSHA 10#: 1180111714 6B PLUMTREE DR SSN: xxx-xx-4302 Hourly,Rate NORWICH, CT 06360 09-10 09-11 09-12 09-13 09-14 09-15 09-16 Total Fringes $ Total Other Groes Check # Male Caucasian Sun Mon Tue Wed Thu Fri Sat Hours Cash $1/hr Fringe Rates Gross FICA FWH SWH Deducts This Job Net Pay Supervision Reg 8.00 8.00 8.00 3.00 8.00 35.00 41.35 1. 8.18 4. .16 1,969.00 150.63 405.30 98.06 292.11 1,447.25 496.49 2. 2.07 5. 3.66 .60 1,022.30 3. .12 KEVIN J REZENDES OSHA 10#: 1100463787 49 ANSELMO DRIVE SSN: xxx-xx-3261 Hourly Rate PORTSMOUTH, RI 02871 09-10 09-11 09-12 09-13 09-14 09-15 09-16 Total Fringes $ Total Other Grose Check # Male Caucasian Sun Mon Tue Wed Thu Fri Sat Hours Cash $1/hr Fringe Rates Gross FICA FWH SWH Deducts This Job Net Pay Operator - Reg 8.00 8.00 72.86 1. 8.18 4. .16 2,242.20 171.53 298.39 104.31 39.59 59D.88 287.20 2. 27.44 5. .60 1,627.78 8.00 3. .12 JOSEPH TENNANT OSHA 10#: 1100463805 479 BEACH POND RD SSN: xxx-xx-9654 Hourly Rate VOLUNTOWN, CT 06384 09-10 09-11 09-12 09-13 09-14 09-15 09-16 Total Fringes $ Total Other Gross Check #_ Male Caucasian Sun Mon Tue Wed Thu Fri Sat Hours Cash $1/hr Fringe Rates Gross FICA FWH SWH Deducts This Job Net Pay Laborer Foreman Reg 8.00 8.00 8.00 3.00 8.00 35.00 44.98 1. 8.18 4. .16 2,008.43 153.65 416.34 106.21 3.84 1,609.30 971.95 2. 19.31 S. .60 1,327.79 35.00 3. .12 Laborer Foreman OT 1.00 .50 1.50 1.00 4.00 67.47 1. 8.18 4. .16 273.88 111.08 2. 19.31 5. 4.00 3. .12 PAYROLL CERTIFICATION FOR PUBLIC WORKS PROJECTS Page 36 WEEKLY PAYROLL in accordance with Connecticut General Statutes, 31-53 Connecticut Department of Labor Certified Payrolls with a statement of compliance wage and workplace Standards Division i shall be submitted monthly to the contracting agency. 200 Folly Brook Blvd. Wethersfield, Cr 06109 MOHAWK NORTHEAST 170 Canal Strt Plantavll, CT 06479 FARMINGTON CASUALTY CO. #DTFUB540M1491 1/1/17 through 12/31/17 Week ending:09-16-2017 Job: 17-013 Fishers Island Ferry-Dolphsn R MICHAEL J WARNER OSHA 10#: 1100463786 291 TORRINGFORD ST SSN: xxx-xx-6431 Hourly Rate TORRINGTON, CT 06790 09-10 09-11 09-12 09-13 09-14 09-15 09-16 Total Fringes $ Total Other Gross Check # Male Caucasian Sun Mon Tue Wed Thu Fri Sat Hours Cash $1/hr Fringe Rates Gross FICA FWH SWH Deducts This Job Net Pay Operator - Reg 8.00 8.00 8.00 24.00 72.86 1. 6.20 4. .16 3,765.47 288.06 736.21 221.07 19.52 1,772.64 861.60 2. 29.42 S. .60 2,500.01 24.00 3. .12 Operator - OT .50 1.50 1.00 3.00 109.29 1. 6.20 4. .16 330.87 107.70 2. 29.42 S. 3.00 3. .12 Operator - OT 7.50 7.50 145.72 1. 6.20 4. .16 1,100.40 269.25 2. 29.42 5. 7.50 3. .12 Date September 20,2017 (b)WHERE FRINGE BENEFITS ARE PAID IN CASH Allan R Heinke President 1, 13 — Each laborer or mechanic listed In the above referenced payroll has been paid, (Name of Signatory Party) (Title) as indicated on the payroll,an amount not less than the sum of the applicable do hereby state: basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract,except as noted in section 4(c)below. (1)That I pay or supervise the payment of the persons employed by (c)EXCEPTIONS Mohawk Northeast,Inc. on the (Contractor or Subcontractor) EXCEPTION(CRAFT) EXPLANATION Fishers Island Ferry Dist-Dolphin Replacement ;that during the payroll period commencing on the (Building or Work) 10th day of September 2017and ending the 16th day of September 2017 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Mohawk Northeast,Inc. from the full (Contractor or Subcontractor) weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person,other than permissible deductions as defined in Regulations,Part 3(29 C.F.R.Subtitle A),issued by the Secretary of Labor under the Copeland Act,as amended(48 Stat.946, 63 Stat.108,72 Stat.967;76 Stat.357;40 U.S.C.§3145),and described below. REMARKS: (2)That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete;that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination Incorporated into the contract,that the classifications set forth therein for each laborer or mechanic conform with the work he performed. (3)That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United States Department of Labor,or if no such recognized agency exists in a State,are registered with the Bureau of Apprenticeship and Training,United States Department of Labor. (4)That: NAME AND TITLE AT (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS Allan R Heinke,President m — In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR OR have been or will be made to appropriate programs for the benefit of such employees, SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION.SEE SECTION 1001 OF TITLE 18 AND SECTION 231 OF TITLE 31 OF THE UNITED STATES CODE except as noted In section 4(c)below. OSHA11.001637864 Thta eatd UknMWB=@mt ttto(aap eet tM aueeGW*mrrgttalad a 10 haur Gw4P 'OlVl 86 v oed"Sam Dom"cw"to caR9lrUe"n mw fFBrdm michael Warner Wn Gorman 3-13-2014 (iteh,e+rz3rra prtnt or MJv) (Co+rrea ane data) r PAYROLL CERTIFICATION FOR PUBLIC WORKS PROJECTS Page 34 WEEKLY PAYROLL in accordance with Connecticut General Statutes, 31-53 Connecticut Department of Labor :ertified Payrolls with a statement of compliance wage and workplace Standards Division _ ;hall he submitted monthly to the contracting agency. 200 Folly Brook Blvd. Wethersfield, CT 06109 40HAIWK NORTHEAST FARMINGTON 170 Canal Strt Plantevll, CT 06479 #DTFUB540M CASUALTY CO. #DTFUB590M1491 1/1/17 through 12/31/17 Aeek ending:09-23-2017 Job: 17-013 Fishers Island Ferry-Dolphin R DARREN M COYLE OSHA 10#: 1100463787 43 CHERRY VALLEY RD SSN: xxx-xx-6331 Hourly Rate COLUMBIA, CT 06237 09-17 09-18 09-19 09-20 09-21 09-22 09-23 Total Fringes $ Total Other Gross Check # Male Caucasian Sun Mon Tue Wed Thu Fri Sat Hours Cash $1/hr Fringe Rates Gross FICA FWH SWH Deducts This Job Net Pay Carpenter Foremn Reg 8.00 8.00 52.63 1. 8.18 4. .16 1,905.54 145.77 344.44 85.00 27.96 429.04 372.96 2. 38.16 5. .60 1,301.77 8.00 3. .12 ROBERT A LICHTY OSHA 10#: 1180111714 6B PLUM772E DR SSN: xxx-xx-4302 Hourly Rate NORWICH, CT 06360 09-17 09-18 09-19 09-20 09-21 09-22 09-23 Total Fringes $ Total Other Grose Check # Male Caucasian Sun Mon Tue Wed Thu Fri Sat Hours Cash $1/hr Fringe Rates Gross FICA FWH SWH Deducts This Job Net Pay Supervision Reg 8.00 8.00 41.35 1. 8.18 4. .16 1,669.02 127.67 324.25 73.74 292.11 330.80 113.48 2. 2.07 5. 3.66 .60 850.65 3. .12 KEVIN J REZENDES OSHA 10#: 1100463787 49 ANSELMO DRIVE SSN: xxx-xx-3261 Hourly Rate PORTSMOUTH, RI 02871 09-17 09-18 09-19 09-20 09-21 09-22 09-23 Total Fringes $ Total Other Grose Check # Male Caucasian Sun Mon Tue Wed Thu Fri Sat Hours Cash $1/hr Fringe Rates Gross FICA FWH SWH Deducts This Job Net Pay Operator - Reg 32.00 32.00 72.86 1. 8.18 4. .16 2,680.60 205.07 406.26 132.04 39.59 2,363.52 �a �o 1148.80 2. 27.44 S. .60 1,897.04 4.1, 32.00 3. .12 Operatr -\Grp #3 Reg (32.00 32.00 41.76 1. 8.18 4. .16 (1,368.32 270.72 2. 5: 32.00 3. .12 JOSEPH TENNANT OSHA 10#: 1100463805 479 BEACH POND RD SSN: xxx-xx-9654 Hourly Rate VOLUNTOWN, CT 06384 09-17 09-18 09-19 09-20 09-21 09-22 09-23 Total Fringes $ Total Other Gross Check # Male Caucasian Sun Mon Tue Wed Thu Fri Sat Hours Cash $1/hr Fringe Rates Gross FICA FWH SWH Deducts This Job Net Pay Laborer Foreman Reg B.OD 8.00 44.98 1. 8.18 4. .16 1,423.84 108.92 262.96 53.82 3.84 367.84 222.16 2. 19.31 5. .60 993.70 8.00 3. .12 MICHAEL J WARNER OSHA 10#: 1100463786 291 TORRINGFORD ST SSN: xxx-xx-6431 Hourly Rate TORRINGTON, CT 06790 09-17 09-18 09-19 09-20 09-21 09-22 09-23 Total Fringes $ Total Other Grose Check # Male Caucasian Sun Mon Tue Wed Thu Fri Sat Hours Cash $1/hr Fringe Rates Gross FICA FWH SWH Deducts This Job Net Pay Operator - Reg 8.00 8.00 72.86 1. 6.20 4. .16 2,296.91 175.71 349.28 109.52 19.52 590.88 287.20 2. 29.42 S. .60 1,642.28 8.00 3. .12 Date September 27,2017 (b)WHERE FRINGE BENEFITS ARE PAID IN CASH 1 Allan R Heinke President ❑ — Each laborer or mechanic listed in the above referenced payroll has been paid, (Name of Signatory Party) (Title) as indicated on the payroll,an amount not less than the sum of the applicable do hereby state: basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract,except as noted in section 4(c)below. (1)That 1 pay or supervise the payment of the persons employed by (c)EXCEPTIONS Mohawk Northeast,Inc. on the (Contractor or Subcontractor) EXCEPTION(CRAFT) EXPLANATION Fishers Island Ferry Dist-Dolphin Replacement •that during the payroll period commencing on the (Building or Work) 17th day of September 2017 , and ending the 23rd day of September 2017 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Mohawk Northeast,Inc. from the full (Contractor or Subcontractor) weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person,other than permissible deductions as defined In Regulations,Part 3(29 C.F.R.Subtitle A),issued by the Secretary of Labor under the Copeland Act,as amended(48 Stat 948, 63 Stat.108,72 Stat.967;76 Stat 357;40 U.S.C.§3145),and described below. REMARKS: (2)That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete;that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract;that the classifications set forth therein for each laborer or mechanic conform with the work he performed. (3)That any apprentices employed in the above period are duly registered In a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United States Department of Labor,or if no such recognized agency exists In a State,are registered With the Bureau of Apprenticeship and Training,United States Department of Labor. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS NAME AND TITLE SIG mAllan R Heinke,President In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR OR have been or will be made to appropriate programs for the benefit of such employees, SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION.SEE SECTION 1001 OF TITLE 18 AND SECTION 231 OF TITLE except as noted in section 4(c)below. 31 OF THE UNITED STATES CODE PAYROLL CERTIFICATION FOR PUBLIC WORKS PROJECTS Page 25 ' WEEKLY PAYROLL In accordance with Connecticut General Statutes, 31-53 Connecticut Department of Labor Certified Payrolls with a statement of compliance Wage and Workplace Standards Division shall be submitted monthly to the contracting agency 200 Folly Brook Blvd. Wethersfield, CT 06109 MOHAWK NORTHEAST 170 Canal Strt Plantsvll, CT 06479 FARMINGTON CASUALTY CO. #DTFUB540M1491 1/1/17 through 12/31/17 Week ending:09-30-2017 Job: 17-013 Fishers Island Ferry-Dolphin R DARREN M COYLE OSHA 10#: 1100463787 43 CHERRY VALLEY RD SSN: xxx-xx-6331 Hourly Rate COLUMBIA, CT 06237 09-24 09-25 09-26 09-27 09-28 09-29 09-30 Total Fringes $ Total Other Gross Check # Male Caucasian Sun Mon Tue Wed Thu Fri Sat Hours Cash $1/hr Fringe Rates Gross FICA FWH SWH Deducts This Job Net Pay Carpenter Foremn Reg 8.00 8.00 8.00 8.00 8.00 40.00 52.63 1. 8.18 4. .16 2,799.76 214.18 592.97 174.34 27.96 2,145.20 1864.80 2. 38.16 5. .60 1,789.71 40.00 3. .12 Carpenter Foremn OT 1.50 1.00 2.00 2.00 1.50 8.00 78.95 1. 8.18 4. .16 639.56 372.96 2. 38.16 5. 8.00 3. .12 BRENDEN R GEMME OSHA 10#: CERT 65 LOCKWOOD ST SSN: xxx-xx-2999 Hourly Rate MANCHESTER, CT 06040 09-24 09-25 09-26 09-27 09-28 09-29 09-30 Total Fringes $ Total Other Gross Check # Male Caucasian Sun Mon Tue Wed Thu Fri Sat Hours Cash $1/hr Fringe Rates Gross FICA FWH SWH Deducts This Job Net Pay Laborer OT 8.00 8.00 63.66 1. 3.14 4. .16 1,658.28 126.85 302.09 72.40 517.28 226.16 2. 24.85 5 .60 1,156.34 8.00 3. .12 ROBERT A LICHTY OSHA 10#: 1180111714 6B PLUMTREE DR SSN xxx-xx-4302 Hourly Rate NORWICH, CT 06360 09-24 09-25 09-26 09-27 09-28 09-29 09-30 Total Fringes $ Total Other Gross Check # Male Caucasian Sun Mon Tue Wed Thu Fri Sat Hours Cash $1/hr Fringe Rates Gross FICA FWH SWH Deducts This Job Net Pay Supervision Reg 8.00 8.00 8.00 8.00 8.00 40.00 41.35 1. 8.18 4. .16 1,969.00 150.63 403.97 111.87 292.11 1,654.00 567.42 2. 2.07 S. 3.66 .60 1,009.82 3. .12 CHRISTOPHER R. RODMAN OSHA 10#: 1100542240 46 MATTERN RD SSN: xxx-xx-9013 Hourly Rate PRESTON, CT 06365 09-24 09-25 09-26 09-27 09-28 09-29 09-30 Total Fringes $ Total Other Gross Check # Male Caucasian Sun Mon Tue Wed Thu Fri Sat Hours Cash $1/hr Fringe Rates Gross FICA FWH SWH Deducts This Job Net Pay Laborer OT 8.00 8.00 63.66 1. 3.14 4. 16 1,467.03 112,23 273.75 57.17 5 72 517.28 226 16 2. 24.85 5. .60 1,017.56 8.00 3. .12 JOSEPH TENNANT OSHA 10#: 1/00463805 479 BEACH POND RD SSN: xxx-xx-9654 Hourly Rate VOLtZ=WN, CT 06384 09-24 09-25 09-26 09-27 09-28 09-29 09-30 Total Fringes $ Total Other Gross Check # Male Caucasian Sun Mon Tue Wed Thu Fri Sat Hours Cash $1/hr Fringe Rates Gross FICA FWH SWH Deducts This Job Net Pay Laborer Foreman Reg 8.00 8.00 8.00 8.00 8.00 40.00 44.98 1. 8.18 4. .16 2,360.48 180.58 513.58 141.96 3.84 1,839.20 1110.80 2. 19.31 5. .60 1,519.92 40.00 3. .12 Laborer Foreman OT 1.50 1.00 2.00 2.00 1.50 9.00 64.16 1. 8.18 4. .16 521.28 222.16 2. 19.31 5. 8.00 3. .12 PAYROLL CERTIFICATION FOR PUBLIC WORKS PROJECTS Page 26 WEEKLY PAYROLL In accordance with Connecticut General Statutes, 31-53 Connecticut Department of Labor Certified Payrolls with a statement of compliance wage and Workplace Standards Division shall be submitted monthly to the contracting agency. 200 Polly Brook Blvd. Wethersfield, CT 06109 MOHAWK NORTHEAST 170 Canal Strt Plantsvll, CT 06479 FARMINGTON CASUALTY CO. - 1/1/17 through 12/31/17 Week ending:09-30-2017 Job: 17-013 Fishers Island Ferry-Dolphin R MICHAEL J WARNER OSHA 10#: 1100463786 291 TORRINGFORD ST SSN: xxx-xx-6431 Hourly Rate TORRINGTON, CT 06790 09-24 09-25 09-26 09-27 09-28 09-29 09-30 Total Fringes $ Total Other Gross Check # Male Caucasian Sun Mon Tue Wed Thu Fri Sat Hours Cash $1/hr Fringe Rates Gross FICA FWA SWH Deducts This Job Net Pay Operator - Reg 8.00 8,00 8.00 8.00 8.00 40.00 74 36 1 6,20 4. 16 5,409.92 413.86 1228.08 372.02 19.52 3,014.40 1436.00 2, 29,42 5. .60 3,375.84 40.00 3. .12 Operator - OT 1.50 1.00 2.00 2.00 1.50 8.00 16.00 148.72 1. 6.20 4. .36 2,395.52 574.40 2. 29.42 5. 16.00 3 12 -- — Date October 4,2017 — — —— — — -- -- — (b)WHERE FRINGE BENEFITS ARE PAID IN CASH I Allan R Heinke President ❑ — Each laborer or mechanic listed In the above referenced payroll has been paid, (Name of Signatory Party) (Title) as Indicated on the payroll,an amount not less than the sum of the applicable do hereby state. basic hourly wage rate plus the amount of the required fringe benefits as listed In the contract,except as noted In section 4(c)below. (1)That 1 pay or supervise the payment of the persons employed by Mohawk Northeast,Inc. (c)EXCEPTIONS an the (Contractor or Subcontractor) EXCEPTION(CRAFT) EXPLANATION Fishers Island Ferry Dist-Dolphin Replacement ,that during the payroll period Commencing on the (Building or Work) 24th day of September 2017 , and ending the 30th day of September 2017 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or Indirectly to or on behalf of said Mohawk Northeast,Inc. from the full (Contractor or Subcontractor) weekly wages earned by any person and that no deductions have been made either directly or Indirectly from the full wages earned by any person,other than permissible deductions as defined in Regulations,Part 3(29 C.F R.Subtitle A),Issued by the Secretary of Labor under the Copeland Act,as amended(48 Stat 94B, 63 Stat.108,72 Stat.967;76 Stat.357;40 U S.C.§3145),and described below. REMARKS (2)That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete,that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination Incorporated Into the contract,that the classifications set forth therein for each laborer or mechanic conform with the work he performed. (3)That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United States Department of Labor,or if no such recognized agency exists in a State,are registered with the Bureau of Apprenticeship and Training,United States Department of Labor. (4)That . (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS NAME AND TITLE SIorORE% m Allan R Heinke,President �� in addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR OR have been or Will be made to appropriate programs for the benefit of such employees, SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION SEE SECTION 1001 OF TITLE 18 AND SECTION 231 OF TITLE except as noted in section 4(c)below 31 OF THE UNITED STATES CODE 4 PAYROLL CERTIFICATION FOR PUBLIC WORKS PROJECTS Page 24 WEEKLY PAYROLL [n accordance with Connecticut General Statutes, 31-57 Connecticut Department of Labor - -entified Payrolls with a statement of compliance Wage and Workplace Standards Division ;hall be submitted monthly to the contracting agency. 200 Folly Brook Blvd. Wethersfield, CT 06109 90HAWK NORTHEAST L70 Canal Strt Plantsvll, CT 06479 FARMINGTON CASUALTY CO. - - - - - - - - - - - - - - - - - #DTFUB540M1491 - ----- -- - -- - - -- - - 1/1/17 through 12/31/17 leek ending: 10-07-2017 Job: 17-013 Fishers Island Ferry-Dolphin R BRET C ARNESEN OSHA 10#: 1004637890 32 CLINTON DR SSN: xxx-xx-3451 Hourly Rate SO WINDSOR, CT 06074 30-01 10-02 10-03 10-04 10-05 10-06 10-07 Total Fringes $ Total Other Gross Check # Male Caucasian Sun Mon Tue Wed Thu Fri Sat Hours Cash $1/hr Fringe Rates Gross FICA FWH SWH Deducts This Job Net Pay Supervision Reg 2.00 2.00 58.90 1. 8.18 4. .16 2,371.00 181.38 309.38 120.72 40.41 117.80 33.23 2. 2.95 S. 5.21 .59 1,718.52 3. .12 DARREN M COYLE OSHA 10#: 1100463787 43 CHERRY VALLEY RD SSN: xxx-xx-6331 Hourly Rate COLUMBIA, CT 06237 10-01 10-02 10-03 10-04 10-OS 10-06 10-07 Total Fringes $ Total Other Gross Check # Male Caucasian Sun Mon Tue Wed Thu Fri Sat Hours Cash $1/hr Fringe Rates Gross FICA FWH SWH Deducts This Job Net Pay Carpenter Foremn Reg 8.00 8.00 8.00 3.00 27.00 52.63 1. 8.18 4. .16 2,242.08 171.52 436.82 99.54 27.96 1,448.01 1258.74 2. 38.16 S. .60 1,505.64 27.00 3. .12 Carpenter Foremn OT 1.00 1.00 1.50 3.50 78.95 1. 8.18 4. .16 279.81 163.17 2. 38.16 S. 3.50 3. .12 ROBERT A LICHTY OSHA 10#: 1180111714 6B PLUMTREE DR SSN: xxx-xx-4302 Hourly Rate NORWICH, CT 06360 30-01 10-02 30-03 10-04 10-05 10-06 30-07 Total Fringes $ Total Other Gross Check # Male Caucasian Sun Mon Tue Wed Thu Fri Sat Hours Cash $1/hr Fringe Rates Gross FICA FWH SWH Deducts This Job Net Pay Supervision Reg 8.00 8.00 8.00 3.00 27.00 41.35 1. 8.18 4. .16 1,669.00 127.68 324.25 64.50 292.11 1,116.45 383.01 2. 2.07 5. 3.66 .60 859.86 3. .12 JOSEPH TENNANT OSHA 10#: 1100463805 479 BEACH POND RD SSN: xxx-xx-9654 Hourly Rate VOLUNTOWN, CT 06384 10-01 10-02 10-03 10-04 10-05 10-06 10-07 Total Fringes $ Total Other Gross Check # Male Caucasian Sun Mon Tue Wed Thu Fri Sat Hours Cash $1/hr Fringe Rates Gross FICA FWH SWH Deducts This Job Net Pay Laborer Foreman Reg 8.00 8.00 8.00 3.00 27.00 44.98 1. 8.18 4. .16 1,916.30 146.75 389.77 82.75 3.84 1,241.46 749.79 2. 19.31 5. .60 1,294.59 27.00 3. .12 Laborer Foreman OT 1.00 1.00 1.50 3.50 67.47 1. 8.18 4. .16 239.65 97.20 2. 19.31 5. 3.50 3. .12 PAYROLL CERTIFICATION FOR PUBLIC WORKS PROJECTS Page 25 WEEKLY PAYROLL rn accordance with Connecticut General Statutes, 31-53 Connecticut Department of Labor entified Payrolls with a statement of compliance Wage and Workplace Standards Division ti Shall be submitted monthly to the contracting agency. 200 Folly Brook Blvd. Wethersfield, Cr 06109 ,MHAWK NORTHEAST 170 Canal Strt Plantsvll, CT 06479 FARMINGTON CASUALTY CO. -- --- - - - -- - - --- - -- - - - -- - -- ------#DTFUB540M1491- - --- --- - 1/1/17 through 12/31/17 Week ending:10-07-2017 Job: 17-013 Fishers Island Ferry-Dolphin R MICHAEL J WARNER OSHA 10#: 1100463786 291 TORRINGFORD ST SSN: xxx-xx-6431 Hourly Rate TORRINGTON, CT 06790 10-01 10-02 10-03 10-04 10-05 10-06 10-07 Total Fringes $ Total Other Gross Check # Male Caucasian Sun Mon Tue Wed Thu Fri Sat Hours Cash $1/hr Fringe Rates Gross FICA FWH SWH Deducts This Job Net Pay Operator - Reg 8.00 8.00 8.00 3.00 27.00 74.36 1. 6.20 4. .16 3,052.48 233.51 538.17 163.75 19.52 2,034.72 969.30 2. 29.42 S. .60 2,096.93 27.00 3. .12 Operator - OT 1.00 1.00 1.50 3.50 148.72 1. 6.20 4. .16 524.02 125.65 2. 29.42 5. 3.50 3. .12 *to Date October 11,2017 (b)WHERE FRINGE BENEFITS ARE PAID IN CASH Allan R Heinke President ❑ — Each laborer or mechanic listed In the above referenced payroll has been paid, (Name of Signatory Party) (Title) as indicated on the payroll,an amount not less than the sum of the applicable do hereby state: basic hourly wage rate plus the amount of the required fringe benefits as listed In the contract,except as noted in section 4(c)below. (1)That I pay or supervise the payment of the persons employed by (c)EXCEPTIONS Mohawk Northeast,Inc. on the (Contractor or Subcontractor) EXCEPTION(CRAFT) EXPLANATION Fishers Island Ferry Dist-Dolphin Replacement •that during the payroll period commencing on the (Building or Work) 1st day of October 2017 and ending the 7th day of October 2017 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or wall be made either directly or indirectly to or on behalf of said Mohawk Northeast,Inc. from the full (Contractor or Subcontractor) weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person,other than permissible deductions as defined In Regulations,Part 3(29 C.F.R.Subtitle A),issued by the Secretary of Labor under the Copeland Act,as amended(48 Stat.948, 63 Stat.108,72 Stat.967;76 Stat.357;40 U S.C.§3145),and described below. REMARKS' (2)That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete;that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated Into the contract;that the classifications set forth therein for each laborer or mechanic conform with the work he performed. (3)That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United States Department of Labor,or if no such recognized agency exists in a State,are registered with the Bureau of Apprenticeship and Training,United States Department of Labor. r , (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS NAME AND TITLE SIG mAllan R Heinke,President in addition to the basic hourly wage rates paid to each laborer or mechanic fisted in the above referenced payroll, payments of fringe benefits as listed in the contract THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR OR have been or will be made to appropriate programs for the benefit of such employees, SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION.SEE SECTION 1001 OF TITLE 18 AND SECTION 231 OF TITLE except as noted in section 4(c)below. 31 OF THE UNITED STATES CODE PAYROLL CERTIFICATION FOR PUBLIC WORKS PROJECTS Page 23 _ WEEKLY PAYROLL In accordance with Connecticut General Statutes, 31-53 Connecticut Department of Labor ' Certified Payrolls with a statement of compliance wage and Workplace Standards Division shall be submitted monthly to the contracting agency. 200 Polly Brook Blvd. Wethersfield, Cr 06109 MOHAWK NORTHEAST 170 Canal Strt Plantsvll, CT 06479 FARMINGTON CASUALTY CO. ODTFUBS40MI491 , 1/1/17 through 12/31/17 1 Week ending:10-14-2017 Job: 17-013 Fishers Island Ferry-Dolphin R SETH GILBERT OSHA 10#: 14407000 20 WYNDHAM HILL DR SSN: xxx-xx-6109 Hourly Rate PLYMOUTH, MA 02360 10-08 10-09 10-10 10-11 10-12 30-13 10-14 Total Fringes $ Total Other Gross Check # Male Caucasian Sun Mon Tue Wed Thu Fri Sat Hours Cash $1/hr Fringe Rates Gross FICA FWH SWH Deducts This Job Net Pay Laborer Reg 2.50 2.50 44.48 1. 3.14 4. .16 1,674.83 128.13 184.97 s1.05 2.29 113.70 70.68 2. 24.85 5. .57 1,277.82 2.50 3. .12 ROBERT A LICHTY OSHA 10#: 1180111714 6B PLUMTREE DR SSN: xxx-xx-4302 Hourly Rate NORWICH, CT 06360 10-08 10-09 10-10 10-11 10-12 10-13 10-14 Total Fringes $ Total Other Gross Check # Male Caucasian Sun Mon Tue Wed Thu Fri Sat Hours Cash $1/hr Fringe Rates Gross FICA FWH SWH Deducts This Job Net Pay Supervision Reg 2.50 4.00 6.50 41.35 1. 8.18 4. .16 1,669.03 127.69 324.25 74.92 292.11 268.78 92.21 2. 2.07 S. 3.66 .60 849.46 3. .12 JOSEPH TENNANT OSHA 10#: 1100463805 479 BEACH POND RD SSN: x x-xx-9654 Hourly Rate VOLUNTOWN, CT 06384 10-08 10-09 10-10 10-11 10-12 10-13 10-14 Total Fringes $ Total Other Gross Check # Male Caucasian Sun Mon Tue Wed Thu Fri Sat Hours Cash $1/hr Fringe Rates Gross FICA FWH SWH Deducts This Job Net Pay Laborer Foreman Reg 2.50 4.00 6.50 44.98 1. 8.18 4. .16 1,590.99 121.70 304.74 69.83 3.84 298.87 180.51 2. 19.31 S. .60 1,090.28 6.50 3. .12 MICHAEL J WARNER OSHA 10#: 1100463786 291 TORRINGFORD ST SSN: xxx-xx-6431 Hourly Rate TORRINGTON, CT 06790 10-08 10-09 10-10 10-11 10-12 10-13 30-14 Total Fringes $ Total Other Gross Check # Male Caucasian Sun Mon Tue Wed Thu Fri Sat Hours Cash $1/hr Fringe Rates Gross FICA FWH SWH Deducts This Job Net Pay Operator - Reg 2.50 2.50 74.35 1. 6.20 4. .16 1,515.56 115.95 172.77 68.07 19.52 188.40 89.75 2. 29.42 S. .60 1,138.65 2.50 3. .12 rl 44 Date October 19,2017 (b)WHERE FRINGE BENEFITS ARE PAID IN CASH I Allan R Heinke President ❑ — Each laborer or mechanic listed in the above referenced payroll has been paid. (Name of Signatory Party) (Title) as Indicated on the payroll,an amount not less than the sum of the applicable do hereby state: basic hourly wage rate plus the amount of the required fringe benefits as listed In the contract,except as noted in section 4(c)below. (1)That I pay or supervise the payment of the persons employed by Mohawk Northeast,Inc. (c)EXCEPTIONS on the (Contractor or Subcontractor) EXCEPTION(CRAFT) EXPLANATION Fishers Island Ferry Dist-Dolphin Replacement ;that during the payroll period commencing on the (Building or Work) 8th day of October 2017 and ending the 14th day of October 2017 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Mohawk Northeast,inc. from the full (Contractor or Subcontractor) weekly wages earned by any person and that no deductions have been made either directly or Indirectly from the full wages earned by any person,other than permissible deductions as defined in Regulations,Part 3(29 C.F.R.Subtitle A),Issued by the Secretary of Labor under the Copeland Act,as amended(48 Stat.948, 83 Stat.108,72 Stat.967;76 Stat,357;40 U.S.C.§3145),and described below. REMARKS: (2)That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete;that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated Into the contract;that the classifications set forth therein for each laborer or mechanic conform with the work he performed. (3)That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United States Department of Labor,or it no such recognized agency exists in a State,are registered with the Bureau of Apprenticeship and Training,United States Department of Labor. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS NAME AND TITLE SIGNATURE mAllan R Heinke,President � in addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEZMAYSUBJECT THEC NTRAC OROR have been or will be made to appropriate programs for the benefit of such employees, SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION.SEE SECTION 1001 OF TITLE 1S AND SECTION 231 OF TITLE except as noted in section 4(c)below. 31 OF THE UNITED STATES CODE. 6 M,&K XIMIR,�N 1, M-49,114 LA ZINRI Ir. MIM MA - (�LR-T�Jffij.WIT10191 Nil f PAYROLL CERTIFICATION FOR PUBLIC WORKS PROJECTS Page 25 f WEEKLY PAYROLL In accordance with Connecticut General Statutes, 31-53 - Connecticut Department of Labor Certified payrolls with a statement Of compliance Wage and Workplace standards Division shall be submitted monthly to the contracting agency. 200 Folly Brook Blvd. Watherafield, Cr 06109 MOBANK NORTHEAST 110 Canal Strt Piantsvil, CT 06479 FARMINGTON CASUALTY CO. #DTPUB540M1491 1/1/17 through 12/31/17 Week ending:10-21-2017 Job: 17-013 Fishers Island Ferry-Dolphin R BRET C ARNESEN OSHA 100: 1004637690 32 CLINTON DR SSN: xxx-xx-3451 Hourly Rate 60 WINDSOR, CT 06074 10-15 20-16 10-37 10-18 10-19 10-20 10-21 Total Fringes $ Total Other Groes Check # Male Caucasian Sun Mon Tue Wed Thu Fri Sat Hours Cash $1/hr Fringe Rates Grose FICA FWH SWH Deducts This Job Net Pay Supervision Reg 4.00 4.00 58.90 1. 8.18 4. .16 2,371.00 181.38 309.38 113.90 40.41 235.60 66.46 2. 2.95 S. 5.21 .60 1,725.33 3. .12 DARREN M COYLE OSHA 10#: 1100463787 43 CHERRY VALLEY RD SEN: xxx-xx-6331 Hourly Rate COLUMBIA, CT 06237 10-15 10-16 10-17 10-18 10-19 10-20 10-21 Total Fringes $ Total Other Grose Check # Male Caucasian Sun Mon Tus Wed Thu Fri Sat Hours Cash $1/hr Fringe Rates Groes FICA FUN SRH Deducts This Job Net Pay Carpenter Foremn Reg 6.00 8.00 8.00 8.00 6.00 40.00 52.63 1. 8.18 4. .16 3,649.64 279.22 830.99 239.66 27.96 2,145.20 1864.80 2. 38.16 5. .60 2,271.41 40.00 3. .12 Carpenter Foremn OT 1.50 1.50 2.00 2.00 1.00 6.00 78.95 1. 8.18 4. .16 639.56 372.96 2. 38.16 S. 8.00 3. .12 Carpenter Foremn OT 8.00 8.00 105.26 1. 8.18 4. .16 850.08 372.96 2. 38.16 S. 8.00 3. .12 ROBERT A LICHTY OSHA 10#: 1180111714 6B PLUMTREE DR SSN: xxx-xx-4302 Hourly Rate NORWICH, CT 06360 10-35 30-16 10-17 10-18 10-19 10-20 10-21 Total Fringes $ Total Other Gross Check # Male Caucasian Sun Mon Tue Wed Thu Fri- Sat Hours Cash $1/hr Fringe Rates Gross FICA FWH SWH Deducts This Job Net pay Supervision Reg 8.00 6.00 8.00' 8.00 32.00 41.35 1. 8.18 4. .16 1,669.00 127,68 324.25 70.78 292.11 1,323.20 453.93 2. 2.07 5. 3.66 .60 853.58 3. .12 RUSSELL JR MCGILL OSHA 10#- 2 PINE DR SEN: xxx-lot-9350 Hourly Rate HOPKINTON. RI 02833 30-15 10-16 10-17 10-18 10-19 10-20 10-21 Total Fringes $ Total Other Orono Check # Male Caucasian Sun Mon Tue Wed Thu Fri Sat Hours Cash $1/hr Fringe Rates Groes FICA FWH OWN Deducts This Job Net Pay Laborer Reg 4.00 4.00 44.48 1. 3.14 4. .16 2,075.51 158.77 411.96 93.37 2.29 181.92 113.08 2. 24.85 S. .60 1,408.50 4.00 3. .12 Laborer OT 5.00 8.00 13.00 63.66 1. 3.14 4. .16 840.58 367.51 2. 24.85 S. 13.00 3. .12 PAYROLL CERTIFICATION FOR PUBLIC WORKS PROJECTS Page 26 WEEKLY PAYROLL 1n accordance with Connecticut General Statutes, 31-53 Connecticut Department of Labor &xtified Payrolls with a statement of compliance Wage and WorkPlace Standards Division shall be submitted monthly to the contracting agency. 200 Folly Brook Blvd. Wethersfield, Cr 06109 MDW="ORTEABT 170 Canal Strt Plantavll, CT 06479 FARMINGTON CASUALTY CO. BDTPUB540MI491 1/l/17 through 12/31/17 Week ending:20-21-2017 Job: 17-013 Fishers Island Ferry-Dolphin R J08BPH TENNANT OSHA 10#; 1100463805 479 BEACH POND RD SSN: xxx-xx-9654 Hourly Rate VOLUNTOWN, CT 06364 10-15 10-16 10-17 10-18 10-19 10-20 10-21 Total Fringes $ Total Other Groes Check M Male Caucasian Sun Mon Tue wed .Thu Fri Sat Hours Cash $1/hr, Fringe Rates Grose FICA FWH SWH Deducts This Job Net Pay Laborer Foreman Reg 6.00 8.00 8.00 8.00 8.00 40.00 44.98 1. 8.18 4. .16 2,881.76 220.46 659.54 184.08 3.84 1,839.20 1110.80 2. 19.31 S. .60 1,813.24 40.00 3. .12 Laborer Foreman OT 1.50 1.50 2.00 2.00 1.00 8.00 16.00 64.16 1. 8.18 4. .16 1,042.56 444.32 2. 19.31 5. 16.00 3. .12 MICHAEL J WARNER OSHA 100: 1100463786 291 TORRINGFORD ST SSN: xxx-xx-6431 Hourly Rate TORRINGTON, CT 06790 10-15 10-16 10-17 10-18 30-19 10-20 10-21 Total Fringes $ Total Other Groes Check N Male Caucasian Sun Mon Tue Wed Thu Fri Sat Hours Cash $1/hr Fringe Rates Groes FICA FWH SWH Deducts This Job Net Pay Operator - Reg 6.00 8.00 8.00 8.00 8.00 40.00 74.36 1. 6.20 4. .16 5.409.92 413.85 1228.08 372.02 19.52 3,'014.40 1436.00 2. 29.42 5. .60 3,375.85 40.00 3. .12 Operator - OT 1.50 1.50 2.00 2.00 1.00 8.00 16.00 148.72 1. 6.20 4. .16 2,395.52 574.40 2. 29.42 S. 16.00 3. .12 Date October 25,2017 (b)WHERE FRINGE BENEFITS ARE PAID IN CASH Allan R Heinke President 1, ❑ — Each laborer or mechanic listed in the above referenced payroll has been paid, (Name of Signatory Party) (Title) as indicated on the payroll,an amount not leas than the sum of the applicable do hereby state: basic hourly wage rate plus the amount of the required fringe benefits as Baled in the contract,except as noted In section 4(c)below. (1)That I pay or supervise the payment of the persons employed by (c)EXCEPTIONS Mohawk Northeast,Inc. an the , (Contractor or Subcontractor) EXCEPTION(CRAFT) EXPLANATION Fishers Island Ferry Dist-Dolphin Replacement •that during the payroll period commencing on the (Building or Work) 15th day of October 2017 and ending the 21st day of October 2017 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or Indirectly to or on behalf of sold Mohawk Northeast,Inc. from the full (Contractor or Subcontractor) weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person,other than permissible deductions as defined in Regulations,Part 3(29 C.F.R.Subtitle A),Issued by the Secretary of Labor under the Copeland Act,as amended(48 Stst 948, 63 Stat.108,72 Stat.967;78 Stet 357;40 U.S.C.§3145),and described below. REMARKS: (2)That any payrolls otherwise under this contract required to be submttted for the above period are correct and complete:that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained In any wage determination Incorporated Into the contract;that the classifications out forth therein for each laborer or mechanic conform wlth the work he performed. (3)That any apprentices employed in the above period are duly registered In a bona fide apprenticeship program registered with a state apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United States Department of Labor,or If no such recogntzed agency exists in a State,are registered with the Bureau of Apprenticeship and Training,United States Department of labor. (4)That: 810 (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS NAMEAND TITLEAllan R Heinke,President m — in addition to the basic hourly wage rates paid to each laborer or mechanic Noted In the above referenced payroll, payments of fringe benefits as listed In the contract THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR OR have been or will be made to appropriate programs for the benefit of such employees, SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION.SEE SECTION 1001 OF TITLE 1e AND SECTION 231 OF TITLE except as noted In section 4(c)below. 31 OF THE UNITED STATES CODE. 1.',�r+•y�`,1 1��I/"'►1' Ilt•!� 1.'',�,�►'"Ifhrl�'.�3`III'T/�'.��1 j'/�""^�\`1�f'1'/,��*\'F� r�r..w, .wr, •.�rrr ,= �. .�w..•. ^,. Iti , hl.,��.► L��, hl: `� ,I h. IA1 /i �1 If. / •f^. _�r•w, ��'.. ,ywy ft _-..., ♦W*i.f •rr•w ,f ,�•^• , `.,��^�,, rte • w 1 • w ,'- .••t w •il_.••.:/•-'S{.f.••-.!r .1...•: I•,.�1..•',:jai 15� ••• �5.. J+".•1,. ....✓ f•f.•5 -'rri�i�:. :rri ,.5 -1.f�ii� 'FIs •5f •-�'if .�,RRfLRf.,iR.��-1�}rr,/►cYlklt,/i i.1.11ft�r. w•t'4}1Rri• Li111�1ir"r"1'.•+ .►.*!•t.-•�•+:11-►•5.,1....',: r,�l.t5;,,..:� frii: •?.. ri►;'i.S .fl51.�:••. 1i !►� /5tiR1�} /.rl;av111.ltrr}�lll} 111•• .11}1•r1�lll(I 111►./R4�Iffler/` !•frr •r41111f}p � .a1.f J11.11J,.-•Ill l l_1..c.".sill 1.1 l-r r„alll.l l ll.,.x111-�1"l la,",a.l l 1111.-_.all{I-L,i.•.,rr,11.111111..►111 .. . J,.a,a fi_1ll l il.,,a,►11'1 VC a3.JllfalJ , I rt •` t, _. ..., - .. rte.• _ 11 #:frafleof r_ r Russell McGill Ir 1 '4 1J r'`�.'�• ,l :.,•■1•all. J '� 't � .' � � t e me for 1•f )� 1 OSHA 10 Hour Outreach Training Program - Construction 360training.com, Inc. is authorized by IACIETto offer CEUs for this program Credit Hours: 10.00 -Z4, cifALC'C°It2 EI'D I T'E,D`r o`'+ I Completion Date: 08/29/2017 .rr , 1 1 1 1 1 1�'�•. "As an OSHA authorized trainer, I verify that I have conducted this OSHA outreach training class in accordancOSHA Outreach Training Program requirements. I will document this class to my authorizing OSHA training organization. Upon successful review of my documentation, I will provide each student their completion card within 90 days of the end of the class." ",'f" ., .. • Inc.Isaccredited . Continuing :.lel•��. andIs authorizedtoIssue the .....''I'. ••fes a Burnet Austin, i 877.881.2235 's www.360training.com •Y`:.♦.' . 111 1.1-1,••'.!r 1 I 1114 ..a` ,r1 '►,y\;/,.� TL-11:I,I�I rTli 1'a'1%r•1I,f.1T.r4�v�11►1'.�1`f�••�rrf:,ll>'{}�::r�1.11T111�•!1 F,1{I rt1�,.r•111} 11�='+7i"}111.1,i-:"•rrlilt.F1•..,_,f..f 1'r. LT.n...rir a-.'•�-• ,. ,r ^11�L•l,5,:.•'r-_ii� !i..• �j • :� .,rte": ;'.Si..p.!/{,.1.1►`r`avr:+'I�l►`���:d1411 i+4� dIFPIIIIN��11TIW, :%�1F1'111,R. .+,Jt��1+.r4R,/'j,I I�1�•,�/�.' �•f ...y••..."�' • 1•••rl +5•,r/J�. .�1•. 1 ... •r• ♦.�� } •+�11•.r•+f'^3r.f..�-15•�.�/-�.•,��.11�f�,.^.,,�'.51•�Ir�-!14`1���/l-• �.�����f ff:f-l,,.d�,4�•� �r _ f• ,`_-_'.• •+ v_L• •i _ 1• •, :•:. f}i-• i5f��aJ,... _ 1• •r •_•1•••„a� _ _ .• •R ___ If •1 :.�.•.• ..r _ =r•• er-�-?.f.� _.., - �"^.•'::� •"�, •-:4iy-1- �-f:r'•�-•-�'.�� --r:s.�ra^.1-,-. -"-:-,��1+=.-"�,-'.—�frf r-a..-��.��.a'�' •'---.-•�+�f t- �� �a•�.�.�.•_. ` I. PAYROLL CERTIFICATION FOR PUBLIC WORKS PROJECTS Page 29 WEEKLY PAYROLL In accordance with Connecticut General Statutes, 31-53 Connecticut Department of Labor Certified Payrolls with a statement of compliance wage and workplace Standards Division shall be submitted monthly to the contracting agency. 200 Folly Brook Blvd Wethersfield, CT 06109 MOHAWK NORTHEAST P-3 170 Canal Strt Plantsvll, CT 06479 FARMINGTON CASUALTY CO.#DTFUB540M1491 1/1/17 through 12/31/17 Week ending: 10-20-2017 Job: 17-013 Fishers Island Ferry-Dolphin R DARREN M COYLE OSHA 10#: 1100463787 43 CHERRY VALLEY RD SSN- xxx-xx-6331 Hourly Rate COLUMBIA, CT 06237 10-22 10-23 10-24 10-25 10-26 10-27 10-28 Total Fringes $ Total Other Gross Check # Male Caucasian Sun Mon Tue Wed Thu Fri Sat Hours Cash $1/hr Fringe Rates Gross FICA FWH SWH Deducts This Job Net Pay Carr-enter Foremr. Reg 8.00 9.00 8.00 6.00 8.00 40.00 52.63 1. 8.18 4. .16 3,330.06 254.74 741.45 216 79 27.96 2,145.20 1864.60 2. 38.16 S. .60 2,088.52 40.00 3. .12 Carpenter Foremn OT 2.00 .50 1.00 1 00 .50 4.00 78.95 1. 8.18 4. .16 319.78_ 186.48 2. 38.16 5. 4.00 3. .12 Carpenter Foremn OT 8.00 8.00 105.26 1 8.18 4. .16 850.08 372.96 2. 38.16 S. 8.00 3 .12 ROBERT A LICIiTY OSHA 10#: 1180111714 6B PLUMTREL DF SSN: xxx-xx-4302 Hourly Rate NORWICH, rT 06360 10-22 10-23 10-24 1C-25 10-26 10-27 10-28 Total Fringes $ Total Other Gross Check # .:a10 Caucasian Sun Mon Tue. Wed Thu Fri Sat Hours Cash $1/hr Fringe Rates Gross FICA FWH SWH Deducts This Job NFt Pay Supervision Reg 8.00 8.00 41.35 1. 8.18 4. .16 1,969.00 150.63 403.97 91.14 292.11 330.80 113.48 2. 2.07 5. 3.666 .60 1,030.55 3. .12 RUSSELL JR MCGILL OSHA 10#: 1 PINE DR SSN: xxx-xx-9350 Hourly Rate HOPKINTON, RI 02833 10-22 10-23 10-24 10-25 10-26 10-27 10-26 Total Fringes $ Total Other Gross Check # Male Caucasian Sun Mon Tue Wed Thu Fri Sat Hours Cash $1/hr Fringe Rates Gross FICA FWH SWH Deducts This Job Net Pay Laborer Reg 8.00 8.00 8.00 8.00 8 00 40.00 44.48 1. 3.14 4. .16 2,595.12 198.53 557.48 159.36 2.29 1,819.20 1130.80 2. 24.85 5. .60 1,676.86 40.00 3. .12 Laborer OT 1.00 .50 1.00 1.00 50 8.00 12.00 63.66 1. 3.14 4. .16 775.92 339 24 2. 24.85 5. 12 00 3. .12 JOSEPH TENNANT OSHA 10#: 1100463605 479 BEACH POND RD SSN. xxx-xx-9654 Hourly Rate VOLUNTOWN, CT 06384 10-22 10-23 10-24 10-25 10-26 10-27 10-28 Total Fringes $ Total Other Gross Check # Male Caucasian Sun Mon Tue Wed Thu Fri Sat Hours Cash $1/hr Fringe Rates Gross FICA FWH SWH Deducts This Job Net Pay Laborer Foreman Reg 8.00 8.00 8.00 8 00 8 00 40.00 44.98 1. 8.18 4. .16 2,621.12 200.52 586.56 163.02 3.84 1,639.20 1110.80 2. 19.31 S. .60 1,666.58 40.00 3. 12 Laborer Foreman OT 1.00 .50 1.00 1.00 .50 8.00 12.00 64.16 1. 8.18 4. .16 781.92 333.24 2. 19 31 5. 12 00 3. .12 PAYROLL CERTIFICATION FOR PUBLIC WORKS PROJECTS Page 30 WEEKLY PAYROLL _ In accordance with Connecticut General statutes, 31-53 Connecticut Department of Labor Certified Payrolls with a statement of compliance Wage and Workplace Standards Division shall be submitted monthly to the contracting agency. 20D Folly Brook Blvd. MOBAWK NORTHEAST Wethersfield, CT 06109 170 Canal Strt Plantsvll, CT 06479 FARMINGTON CASUALTY CO. $DTFUB540M1491 Week ending: 10-28-2017 Job: 17-013 Fishers island Ferry-Dolphin R 1/1/17 through 12/31/17 MICHAEL J WARNER OSHA 10#: 1100463786 291 TORRINGFORD ST SSN: xxx-xx-6431 Hourly Rate TORRINGTON, CT 06790 10-22 10-23 10-24 10-25 10-26 10-27 30-28 Total Fringes $ Total Other Gross Check # Male Caucasian Sun Mon Tue Wed Thu Fri Sat Hours Cash $1/hr Fringe Rates Gross FICA FWH SWH Deducts This Job Net Pay Operator - Reg 8.00 8.00 8.00 8.00 8.00 40.00 74.36 1. 6.20 4. .16 4,811.04 368.05 1030.45 329.20 19.52 3,014.40 1436.00 2. 29.42 5. .60 3,063.22 40.00 3. .12 Operator - OT 1.00 .50 1.00 1 00 .50 8.00 12.00 148.72 1. 6.20 4. .16 1,796.64 430.80 2. 29.42 5. 12.00 3. .12 4k3 Date November 2,2017 (b)WHERE FRINGE BENEFITS ARE PAID IN CASH Allan R Hairlike President ❑ — Each laborer or mechanic listed In the above referenced payroll has been paid, (Name of Signatory Party) (Title) as indicated on the payroll,an amount not less than the sum of the applicable do hereby state: basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract,except as noted In section 4(c)below. (1)That I pay or supervise the payment of the persons employed by (c)EXCEPTIONS Mohawk Northeast,Inc. on the (Contractor or Subcontractor) EXCEPTION(CRAFT) EXPLANATION Fishers Island Ferry Dist-Dolphin Replacement ;that during the payroll period commencing on the (Building or Work) 22nd day of October 2017 and ending the 28th day of October 2017 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or Will be made either directly or indirectly to or on behalf of said Mohawk Northeast, Inc. from the full (Contractor or Subcontractor) weekly wages earned by any person and that no deductions have been made either directly or Indirectly from the full wages earned by any person,other than permissible deductions as defined in Regulations,Part 3(29 C.F.R.Subtitle A),Issued by the Secretary of Labor under the Copeland Act,as amended(48 Stat.948. 63 Stat 106,72 Stat.967;76 Stat.357;40 U S.C.§3145),and described below. REMARKS: (2)That any payrolls otherwise under this contract required to be submitted fort he above period are correct and complete;that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract,that the classifications set forth therein for each laborer or mechanic conform with the work he performed. (3)That any apprentices employed in the above period are duty registered in a bona fide apprenticeship program registered With a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United States Department of Labor,or if no such recognized agency exists in a State,are registered with the Bureau of Apprenticeship and Training,United States Department of Labor. (4)That. �v (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS NTITLE m Allanllan R R Heinke,President in addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the Contract THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR OR have been or will be made to appropnate programs for the benefit of such employees,' SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION SEE SECTION 1001 OF TITLE 18 AND SECTION 231 OF TITLE except as noted in section 4(c)below. 31 OF THE UNITED STATES CODE. PAYROLL CERTIFICATION FOR PUBLIC WORKS PROJECTS Page 28 WEEKLY PAYROLL In accordance with Connecticut General Statutes, 31-53 Connecticut Department of Labor Certified Payrolls with a statement of compliance Wage and Workplace Standards Division shall be submitted monthly to the contracting agency. 200 Folly Brook Blvd. Wethersfield, CT 06109 MOHAWK NORTHEAST 170 Canal Strt Plantsvll, CT 06479 FARMINGTON CASUALTY CO. #DTFUB540M149 1/1/17 through 12/31/17 Week ending.-Il-04-2017 Job: 17-013 Fishers Island Ferry-Dolphin R DARREN M COYLE OSHA 10#: 1100463787 43 CHERRY VALLEY RD SSN: xxx-xx-6331 Hourly Rate COLUMBIA, CT 06237 10-29 10-30 30-31 11-01 11-02 11-03 11-04 Total Fringes $ Total Other Gross Check # Male Caucasian Sun Mon Tue Wed Thu Fri Sat Hours Cash $1/hr Fringe Rates Gross FICA FWH SWH Deducts This Job Net Pay Carpenter Foremn Reg 7.50 8.00 8.00 8.00 31.50 52.63 1. 8.18 4. .16 1,976.83 151.23 362.55 104.97 27.96 1,689.35 1468.53 2. 38.16 S. .60 1,329.52 31.50 3. .12 Carpenter Foremn OT 1.50 1.00 2.50 78.95 1. 8.18 4. .16 199.86 116.55 2. 38.16 5. 2.50 3. .12 ROBERT A LICHTY OSHA 10#: 1180111714 6B PLUMTREE DR SSN: xxx-xx-4302 Hourly Rate NORWICH, CI 06360 10-29 30-30 10-31 11-01 11-02 11-03 11-04 Total Fringes $ Total other Gross Check # Male Caucasian Sun Mon Tue Wed Thu Fri Sat Hours Cash $1/hr Fringe Rates Gross FICA FWH SWH Deducts This Job Net Pay Supervision Reg 8.00 8.00 8.00 24.00 41.35 1. 8.18 4. .16 1,669.00 127.67 324.25 66.84 292.11 992.40 340.45 2. 2.07 S. 3.66 .60 857.53 3. .12 RUSSELL JR MCGILL OSHA 10#: 1 PINE DR SSN: xxx-xx-9350 Hourly Rate HOPKINTON, RI 02833 10-29 10-30 10-31 11-01 11-02 11-03 11-04 Total Fringes $ Total Other Gross Check # Male Caucasian Sun Mon Tue Wed Thu Fri Sat Hours Cash $1/hr Fringe Rates Gross FICA FWH SWH Deducts This Job Net Pay Laborer Reg 7.50 8.00 8.00 8.00 31.50 44.48 1. 3.14 4. .16 1,636.27 125.18 296.59 85.91 2.29 1,432.62 890.51 2. 24.85 5. .60 1,125.70 31.50 3. .12 Laborer OT 1.50 1.00 2.50 63.66 1. 3.14 4. .16 161.65 70.68 2. 24.85 S. 2.50 3. .12 JOSEPH TENNANT OSHA 10#: 1100463805 479 BEACH POND RD SSN: xxx-xx-9654 Hourly Rate VOLUNTOWN, CT 06384 10-29 10-30 10-31 11-01 11-02 11-03 11-04 Total Fringes $ Total Other Grose Check # Male Caucasian Sun Mon Tue Wed Thu Fri Sat Hours Cash $1/hr Fringe Rates Gross FICA FWH SWH Deducts This Job Net Pay Laborer Foreman Reg 7.50 8.00 8.00 8.00 31.50 44.98 1. 8.18 4. .16 1,659.27 126.94 321.81 88.24 3.84 1,448.37 874.76 2. 19.31 S. .60 1,117.84 31.50 3. .12 Laborer Foreman OT 1.50 1.00 2.50 64.16 1. 8.18 4. .16 162.90 69.43 2. 19.31 S. 2.50 3. .12 A PAYROLL CERTIFICATION FOR PUBLIC WORKS PROJECTS WEEKLY PAYROLL Page 29 in accordance with Connecticut General Statutes. 31-53 _ Certified Payrolls with a statement of Compliance Connecticut l.6partment of Labor shall be submitted monthly to the contracting agency. Maga and Workplace Standards DiViaion 200 Folly Brook Blvd. MORAMR NORTHEAST Methersfield, Cr 06109 170 Canal Strt Plantavll, CT 06479 FARMINGTON CASUALTY CO. #DTFUB540M1491 Week ending:11-04-2017 Job: 17-013 Fishers Island Ferry-Dolphin R 1/1/17 through 12/31/17 MICHAEL J WARNER OSHA 10#: 1100463766 291 TORRINGFORD ST SSN: XXX-XX-6431 Hourly Rate TORRINGTON, CT 0679D 10-29 30-30 10-31 11-01 11-02 11-03 11-04 Total Fringes $ Total Other Groes Check # Male Caucasian Sun Mon Tue Wed Thu Fri Sat Hours Cash $1/hr Fringe Rates Groes FICA FUN SWH Deducts This Job Net Pay Operator - Reg 7.50 8.00 8.00 8.00 31.50 74.36 1. 6.20 4. .16 2,969.20 227.15 517.35 168.72 19.52 2,373.84 1130.85 2. 29.42 5. .60 2,035.86 31.50 3. .12 Operator - OT 1.50 1.00 y:SO 148.72 1. 6.20 4. Ae 374,30 89.75 2. 29.42 5. 2.50 3. .12 47/q Date November 9,2017 (b)WHERE FRINGE BENEFITS ARE PAID IN CASH I Allan R Heinke President ❑ — Each laborer or mechanic listed in the above referenced payroll has been paid, (Name of Signatory Party) (Title) as indicated on the payroll,an amount not less than the sum of the applicable do hereby state basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract,except as noted in section 4(c)below. (1)That I pay or supervise the payment of the persons employed by (c)EXCEPTIONS Mohawk Northeast, Inc. on the (Contractor or Subcontractor) EXCEPTION(CRAFT) EXPLANATION Fishers Island Ferry Dist-Dolphin Replacement •that during the payroll period commencing on the (Building or Work) 29th day of October 2017 , and ending the 4th day of November 2017 all persons employed on said project have been paid the f ull weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Mohawk Northeast,Inc. from the full (Contractor or Subcontractor) weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person,other than permissible deductions as defined in Regulations,Part 3(29 C.F.R.Subtitle A),issued by the Secretary of tabor under the Copeland Act,as amended(48 Stat.948, 63 Stat,108,72 Stat.967;76 Stat,357;40 U.S.C.§3145),and described below, REMARKS: 12)That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete;that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained In any wage determination Incorporated Into the contract;that the classifications set forth therein for each laborer or mechanic conform with the work he performed. (3)That any apprentices employed in the above period are duly registered In a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United States Department of Labor,or if no such recognized agency exists In a State,are registered wrath the Bureau of Apprenticeship and Training,United States Department of Labor. ^] ` (4)That: NAME AND TITLE SIGN(7)L (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS Allan R Heinke,President — In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR OR have been or will be made to appropriate programs for the benefit of such employees, SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION.SEE SECTION 1001 OF TITLE Is AND SECTION 231 OF TITLE except as noted In section 4(c)below. 311 OF THE UNITED STATES CODE Southold Town Board-Letter Board Meeting of November 8,2017 CIO"* RESOLUTION 2017-944 Item# 5.29 a ADOPTED DOC ID: 13518 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO.2017-944 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON NOVEMBER 8,2017: RESOLVED that the Town Board of the Town of Southold hereby ratifies and approves the resolution of the Fishers Island Ferry District Board of Commissioners dated November 1, 2017 in regard to accepting the proposal of Mohawk Northeast., Inc. Elizabeth A. Neville Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Jill Doherty, Councilwoman SECONDER:William P. Ruland, Councilman AYES: Dinizio Jr, Ruland, Doherty, Ghosio, Evans, Russell Generated November 9, 2017 Page 50 FISHERS ISLAND FERRY DISTRICT November 1,2017 Dolphin and Piling Addendum RESOLUTION 2017-205 Whereas Dolphin and Pilings were replaced in 2017 in Silver Eel Cove;and Whereas the configuration of the replacement dolphins and pilings was revised and requires removal of a dolphin cluster to allow the District vessels to safely exit Silver Eel Cove; and Whereas Mohawk Northeast, Inc. has agreed to remove this dolphin cluster,and management recommends accepting the quote of$11,850 from Mohawk Northeast, Inc.; now therefore it is Resolved that the Board of Commissioners of the Fishers Island Ferry District accepts the quote from Mohawk Northeast, Inc.for$11,850 to remove the dolphin cluster in Silver Eel Cove directly across from the North Ramp; and be it further Resolved to authorize management to engage Mohawk Northeast, Inc.to perform this work in conjunction with the work approved June 12,2017 in Resolution 2017-99,the total cost of this additional work not to exceed$11,850 and the total payment to Mohawk Northeast, Inc. not to exceed $392,132. It is further Resolved to authorize management to execute all contract and ancillary documents for said additional work after review by District counsel. Moved by:Commissioner A.Ahrens Seconded by: Commissioner H. Burnham Ayes:A.Ahrens,W. Bloethe and H. Burnham Nays: None Nays:None Southold Town Board- Letter Board Meeting of April 25, 2017 ,oiFo RESOLUTION 2017-374 Item# 5.18 ADOPTED DOC ID: 12981 THIS IS TO CERTIFY THAT THE FOLLOWING"SOLUTION NO. 2017-374 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON APRIL 25,2017: RESOLVED that the Town Board of the Town of Southold hereby ratifies and approves the resolution of the Fishers Island Ferry District Board of Commissioners dated April 17, 2017 in regard to advertising for proposals for the main boarding ramp. Elizabeth A. Neville Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: William P. Ruland, Councilman SECONDER:Louisa P. Evans, Justice AYES: Dinizio Jr, Ruland, Doherty, Evans, Russell ABSENT: Robert Ghosio Generated April 27, 2017 Page 33 Southold Town Board- Letter Board Meeting of June 20, 2017 i i i SOLUTION 2017-570 Item# 5,29 ADOPTED DQC ID: 13178 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2017-570 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN ROARD, QN JUNE 20,2017; RESOLVED that the Town Board of the Town of Southold hereby ratifies and approves the resolution of the Fishers Island Ferry District Board of Commissioners dated June 12, 2017 in regard to the bid of Mohawk Northeast, Inc. E&abeth A. Neville Southold Town Clerk RESULT: ADOPTED [UNANIMOUS] MOVER: Jill Doherty, Councilwoman SECONDER:William P, R.uland, Councilman AYES: Dinizio Jr, Ruland, Doherty, Ghoslo, Evans, Russell Generated June 20, 2017 Page 39 FISHERS ISLAND FERRY DISTRICT June 12,2017 Dolphin and Piling Award RESOLUTION 2017-099 Whereas Dolphin and Pilings need to be replaced in Silver Eel Cove and an RFP was issued and duly advertised, and Whereas two bids were received and the bid from Mohawk Northeast, Inc. is the lowest responsible bid received,and whereas management recommends accepting the bid from Mohawk Northeast, Inc.;and whereas there may be unforeseen replacement Items requiring change orders, now therefore it is Resolved that the Board of Commissioners of the Fishers Island Ferry District accepts the bid from Mohawk Northeast, Inc.for$345,720 to replace the dolphins and pilings in Silver Eel Cove near the North Ramp;and be it further Resolved to authorize management to review and authorize change orders up to$34,572;the total cost not to exceed$380,292. It is further Resolved to authorize management to execute all contract and ancillary documents for this project after review by District counsel. Moved by:Commissioner P. Rugg Seconded by: Commissioner D.Shillo Ayes: Ayes:A.Ahrens, H. Burnham, P. Rugg and D. Shillo Nays: None FISHERS ISLAND FERRY DISTRICT April 17,2017 Legal-Silver Eel Cove Repair RESOLUTION 2017—069 it is hereby RESOLVED that the Board of Commissioners of the Fishers'island Ferry District requests proposals for the repair and/or replacement of the dolphins and pilings on.and about the main boarding ramp(North Ramp)at the Fishers Island Terminal in Silver'Eel Cove and directs management to advertise the request for proposals in a broadly circulated publication, Moved by:Commissioner P Rugg Seconded by:Commissioner W Bloethe Ayes:W. Bloethe,H.Burnham, P. Rugg Nays: None FISHERS ISLAND FERRYD'ISTRICT VENDOR 013282 MORRIS & MCVEIGH LLP ; 11/21/2017 CHECK 4487 FUND & ACCOUNT P.O.# INVOICE DESCRIPTION AMOUNT i SM .1420.4.000'.000 00010-52865 PROF.SVC-9/1-9/30/17395.00 a TOTAL 395.00 .. x waw:.... ...-,:i..„.-+=..2.ar.T.{:Tla erc-: .< es r,, yds a ..+• .. 'i i a 'vx ,.a. . .,e . ....-Fi^.., >r..r.a.< •.:'_. .ew .:x.=r:r :cx. ,•. :5:$:> ;:y •:;•^ } :+as 'SSG.rd °2:7o+Y. 1 :x'':41• I r 1 E F..Sii `v d' '✓:'.:•,. ''. lid S. 6y51' _ , '• :.y.. ,a : Ne."'”^,r,°'r:.^ :; ' .{ •:=:..w3' :•:.' c :. <..,_ ;"'.'..kCyt Y'x•.s1 `>' 'x,i-;..' ^,v>¢ '",r.•'.•='..A' r..,,..n,>F,i', ° „ fFt --SID•—I _ _ . - - - - - :. . z ,.qs r i FY7. - ',:' - - - ` : .'-`''mix - '11 ' Y•,( _ FISEERS ISLAND`FERRYDISTRICT; ; AUDITJ,11` z /i ' 63095 MAIN.ROADsPO BOX:1179,;u•• / , . SOUTHOLD,W'1197V0959- _ '•CHECYC.,,'NO". - •t44'8 T''° :THE SUoFbLK'C0.`NATIONAL`BAtJK-„' AMOUNTv CUTCHOGUE;NY-11935 i' DATE _ ;i/21/2017 - -- -_-_ -4395, 0 0 EN00/T :NN0'lDOLLARS' _ --;'-_- ' Ay. __' MOR'RIS f'& ,MCiIEIGH LLP` = o,-:TH RD,AV'ENUE`` - - = RUR_ - e OF, NEW„'YORK NY'':1'0 01'7, , '„ ' .. L<-S - ....W.2'•rJ;. _. ,=L. - ...ae-x..q-`_ - _p.._,....., .._ ,.,e. .. . - _- ...«.Y=.'...r-., ;—..a...>.,..-s.... . a.u,a.a.z u,a,. a _ae._;. ........ _. - - 1 ia t m-..+.,I•_-'ei. ._L'.au.a.._✓: ..t-sa.e. : :i °t 11500448 711' 1:0 2ym40 54641: G13 00 L 50 2 1'i' l .1 l .! I Vendor No. Check No. Town of Southold, New York - Payment Voucher 13282 Vendor Tax ID Number or Social Security Number Vendor Address Entered b 767 Third Avenue Vendor Name New York, New York 10017-2023 Audit Date Morris&McVeigh LLP Nov 2 112017 Vendor Telephone Number (212)418-0500 own 1'e J''y • Vendor Contact i i Invoice Invoice Invoice Net Purchase Order Number Date Total Discount Amount Claimed Number Description of Goods or Services General Ledger Fund and Account Number 2 229W-00010-52865 RJMA 10/13/2017 $44946 v#8:w Enabling Act Legislation 9/1$-30/17 SM1420.4.000.000 5,d $448.06 $448.06 ° Payee Certification Department Certification The undersigned(Claimant)(Acting on behalf of the above named claimant) I hereby certify that the materials above specified have been received by me does hereby certify that the foregoing claim is true and correct,that no part has in good condition without substitution,the services properly been paid,except as therein stated,that the balance therein stated is actually performed and that the quantities thereof have been verified with the exceptions due and owing,and that taxes from which the Town is exempt are excluded or discrepancies noted,and payment is approved Signature ` a,44,&= Title Signature Company Name Eishea Island FeM District 11/3/2017 Title Date l �� MORRIS & MCVEICI-I LLP ATTORNEYS AT LAW 767 THIRD AVENUE TELEPHONE(212)418-0500 TAx ID#13-5519786 NEW YORK,NEW YORK 10017.2023 FAX(212)755,4476 FAX(212)421-0922 October 13, 2017 Billed through 09/30/17 BILL NUMBER 229140- 00010 -52865 RJMA FISHERS ISLAND FERRY DISTRICT PETER RUGG - FISHERS ISLAND FERRY DISTRICT PO BOX 607 261 TRUMBULL DRIVE FISHERS ISLAND, NY 06390 BALANCE FORWARD FROM LAST BILL DATED 09/12/17 $6, 688.00 PAYMENTS APPLIED SINCE LAST BILL 0. 00 CR NET BALANCE FORWARD $6, 688 .00 FISHERS ISLAND FERRY DIS -GL FOR PROFESSIONAL SERVICES RENDERED: 09/11/17 RJM TELEPHONE CALL WITH GEB; FOLLOW-UP WITH 0. 50 hrs PRESERVATION LEAGUE OF NYS 09/15/17 RJM TELEPHONE CALL WITH B. MURPHY. 0.25 hrs 09/20/17 RJM EMAIL TO BRIAN MURPHY RE STATUS. 0.25 hrs TOTAL FEES FOR THIS MATTER $395.00 BILLING SUMMARY TOTAL FEES $395.00 INTEREST BILLED $53. 06 TOTAL CHARGES FOR THIS BILL $448 .06 NET BALANCE FORWARD $6, 688 .00 TOTAL BALANCE NOW DUE $7, 136.06 PLEASE REMIT PAYMENT TO: MORRIS & MCVEIGH LLP; 767 THIRD AVENUE; NEW YORK, NY 10017 ------------------------ FED WIRE PAYMENT OPTION: THE BANK OF NEW YORK MELLON; ABA # 021000018; CR: MORRIS & MCVEIGH LLP; A/C # 090201-8647 --- --------------------- FINANCE CHARGE OF 1% WILL BE APPLIED TO YOUR UNPAID BALANCE AFTER 60 DAYS Arena, Laura From: Diane Hansen <dhansen@fiferry.com> Sent: Wednesday, November 15, 2017 11:22 AM To: Arena, Laura Subject: RE: Morris & McVeigh Please hand-correct the voucher to $395 We will do the same with our copy.Thank you very much. Diane Hansen Accounting Supervisor Fishers Island Ferry District 860.442.0165 From: Arena, Laura [mailto:lauraa@southoldtownny.gov] Sent: Wednesday, November 15, 2017 10:43 AM To: Diane Hansen Cc: Gordon Murphy; Kasia Asmolov Subject: RE: Morris & McVeigh Hi Diane, If you and Gordon can give me the okay to change the amount being paid on the voucher to$395.00, 1 can adjust the voucher myself. If not please redo the voucher to reflect the corrected amount due. Thank You, Lmi.wwA► oncEl Account Clerk Typist Town of Southold PO Box 1179 Southold, NY 11971 PH: (631)765-4333 FX: (631)765-1366 From: Diane Hansen [ma ilto:dhansen@fiferry.com] Sent:Wednesday, November 15,2017 10:22 AM To:Arena, Laura<lauraa@southoldtownny.gov>; Kasia Asmolov<kasmolov@fiferry.com> Subject: RE: Morris& McVeigh Laura, Sorry, I did not see that interest was added. Please short pay the submitted invoice. Do you need a revised voucher? From: Arena, Laura [mailto:lauraa@southoldtownny.gov] Sent: Wednesday, November 15, 2017 10:08 AM To: Kasia Asmolov; Diane Hansen Subject: Morris &McVeigh 1 Hi Diane and Kasia, Please see attached. Can you please call Morris& McVeigh to have the interest removed from the bill. As a government agency we try to avoid paying interest and/or late fees. Normally the companies will waive them if they are asked. Also the previous check was sent out to you on 10/11/17 to cover that balance and I cannot recall them ever adding interest before. Thank You, La,wc(lArevia, Account Clerk Typist Town of Southold PO Box 1179 Southold, NY 11971 PH: (631)765-4333 FX: (631)765-1366 2 7 P K RIM Yr L 1-k FISHERS ISLAND FERRY DISTRICT VENDOR 013682 PETER MROWKA JR. 11/21/2017 CHECK 4488 A FUND & ACCOUNT P.O.# INVOICE DESCRIPTION AMOUNT SM .5709.2.000.100- 2873 TEST BOILER PRESSURE 1,35.78 TOTAL 135.78 sa ew ol o S `AWRYDISTRICl- AUDIT,.'l WSHER 53095 MAIN!130AD,- POBOX1179 -0959:""--,- -,-, , 1 - - %"NO ISOYT001-1);'NY 111971 44684" THE SUFFbLK'bO1'NATIbNAe'BANK, AMOUNT XUTCHOGUE,:NY,11935 'DATE 2 1,/-2 O!i7-',-- -'$12 5 7 8"," nu 50-546/214'' OkE,-l4UllJD99D THIRTT`F I :N6-'iB-1;100 LARS o"I v 2 1 PEITEA,-"Mk6WKA,Jk'.- 4EEt-INGkOUS ORDER E 017:% - ',I J .,I ,,, , , *,"i, -, -4 LEDYARD",CT,,0 6 33 0 119004L.88lls 1:0 d 0- "'l-S-0-2--i'llm 2 iLb s L.6 L,1: 0 P, - Vendor No. Check No. Town of Southold, New York - Payment Voucher 13682 Vendor Tax ID Number or Social Security I�Acy- Number Vendor Address Entered by —.� 95 Meetinghouse Lane !�� Vendor Name Ledyad, CT 06339 Audit Date 2 1 Zo11 Pete's Plumbing and Heating �Qv Vendor Telephone Number 860/287-3782 Cle k Vendor Contact Pete Invoice Invoice Invoice Net Purchase Order Number Date Total Discount Amount Claimed Number Description of Goods or Services General Ledger Fund and Account Number �25su r`e.- 2873 10/30/2017 $135.78 $135.78 Test the boiler that fell in freight transit SM5709.2.000.100 $135.78 $135.78 Payee Certification Department Certification The undersigned-( awaaaW(Acting on behalf of the above named claimant) I hereby certify that the materials above specified have been received by me does hereby certify that the foregoing claim is true and correct,that no part has in good condition without substitution,the services properly been paid,except as therein stated,that the balance therein stated is actually performed and that the quantities thereof have been verified with the exceptions due and owing,and that taxes from which the Town is exempt are excluded or discrepancies noted,and payment is approved. Signature itle Signature Ot .1001, Company Name FI Ferry District Date_ 11/7/2017 Title �Ff�s�Date dT Invoice Pete's Heating & Plumbing 95 Meetinghouse Urteice It Ledyard, CT o63_39 1 10/30/2017 1 2873 860.287.3782', Bill To Fishers Island Ferry District PO Box 1179 Southhold,NY 11971-0959 Description Amount Labor-pressure tested the boiler that fell in freight transit(per Gordon). tested 125.00 perfect 10.78 Tax Total $135.78 40126-MP q-j 7 'FISHERS ISLAND FERRY DISTRICT VENDOR 014290 NYS & LOCAL EMP RETIREMENT SYS 11/21/2017 CHECK ,4489 A N., FUND & ACCOUNT P.O.# INVOICE DESCRIPTION AMOUNT sm .9010.8.000.000 3002OE121317AC ERS PAYMENT DUE-12/15/17 111, 868.00 SM .480 3002OE121317AC ERS -PAYMENT DUEz-12/15/17 37,289-.-00 - TOTAL 149,157.00 4 0 0. ............. t. fz. 4-3" -%,x, -H, 41 y --------- - FISHERS'ISLAND-'FERRY Y PISMCT ROAD;PO,BOX-1 179 89_ ', SOUT90LIJ;,NY I 1971-0959 ,-CHECX­_ T o AMQUNT.­ '- ge,SUFFOLK CO.66.NA'ION L'BA ` ­CUTCHOGUE,NY,l 1935: it 60 21 -1,4 Nm-,H-Uob ED- FORTY-W-N 00/,1'0,0':'-DOLLARS '&C]I ­EMP', RETIRE SYS" HE T6,p 'STATE 0G, ALFREb','E,,'"SRI,tH, _OFC BL e 0TATE T_ 0 0 44" 001' B T- % 11000 L,LOB 9ilm 1:0a 001502 1110 2 IL,0 S L,G L,I: C3 1 Vendor No. Check No. Town of Southold, New York - Payment Voucher" 14290 Vendor Tax ID Number or Social Security Number Vendor Address Entered by Vendor Name 110 STATE STREET Audit Date NYS& LOCAL RETIREMENT SYSTEM ALBANY, NY 12244-0001 NOV 2 1 2017- Vendor Telephone Number 618-473-4132 FY171 FY18 i C Vendor Contact s Invoice Invoice Invoice Net Purchase Order Number Date Total Discount Amount Claimed Number Description of Goods or Services General Ledger Fund and Account Number ���a6Ela13i 11/13/2017 $149,157.00 $111,868.00 ERS Employer contribution FY2017 SM9010.8.000.000 $37,289.00 ERS Employer contribution FY2018 SM.480 i { Ff t $149,157.00 $149,157.00 Payee Certification Department Certification The undersigned(Claimant)(Acting on behalf of the above named claimant) I hereby certify that the materials above specified have been received by me does hereby certify that the foregoing claim is true and correct,that no part has to good condition without substitution,the services properly been paid,except as therein stated,that the balance therein stated is actually performed and that the quantities thereof have been verified with the exceptions due and owing,and that taxes from which the Town is exempt are excluded or discrepancies noted,and payment is approved. Signature �DAnit t Title Signature Company Name Date__41l �'�7 Title AAR Date 11/8/2017 New York State Comptroller-Employer Invoices on Internet TOWN OF SO 1 HOLD 30020 ERS- 2018 Annual Invoice Payment of this invoice must be received by the Retirement System on or before February 1, 2018.-If paying the prepay amount, payment must be received on or before December 15, 2017. Unpaid balances accrue interest at the rate of 7.0%. If you have questions, contact Patti Schachter at 518-474-7573 or the Employer Billing Unit at 518-474-4913 or 518-408-4214. Payment Due February 1, 2018 Prepayment 2017ecember 15, Total Amount $1,892,087 $1,876,153 Due: Contribution Details Tier ;Pian 117 Options Reparted Salary Rate ;Regular Pension Contribution * I GTL1 1 75I 417 $36,225 i 21.7%1 $7,71 45 3 A14 ',41i $4541400' 16.0%;_ $70,887 $1,818 41J $9,185,556, 16.0%' $1,432,947 $36,742 j 4 A15 _ _ 32, 4 5 �A15 41] $1,017,028 13.1%' $129,163 $4,0681 -6 A15 14131 $1,932,369 9.3%; $171,980 _ $7,729 1 -w, •6 AIS - _ ' 41J2 $310,670£w �9.3%'._. _._.. $27,650' $1,243; Sub Totals $12,936,248 $1,840,342 $51,745 "Regular Pension Bill without GTLI-Uses 3/31/2017 Salaries with Final Rates 2018 Regular Pension Contribution,Including GTLI $1,892,087 i Invoice Details Due February i, divide by Pre Pay December 2018 Payments factor 15, 2017 Payments f $0 0.000000 = $0 Total Adjustments and Installments $0 $0 2018 Regular Pension Contribution $1,892,087 1,008493 = $1,876,153 Total Amount Due $1,892,087 $1,876,153 https://nysosc9.osc.state.ny.us/product/inv.nsf/Summary?Open Form&IkupKey=30020 ERS&print=Yes 111 Town of Southold NYSRS Invoice Allocation Due 12/15/2017 Fund Gross Amt Discounted Account Code A $ 1,080,234 $ 1,071,138 A.9010.8.000.000 B 157,414 156,088 B.9010.8.000.000 DB 319,416 316,726 DB.9010.8.000.000 CM 27,879 n 27,645 CM.9010.8.000.000 SR 156,719 ;255,399 SR.9010.8.000.000 �� f y i FIFD 150,424 �K149,157 SM.9010.8.000.000 $ 1,892,087 $ 1,876,153 `� 31 Z Agrees to invoice ,.PFRS- Fund Gross Amt Discounted Account Code A $ 1,722,505.00 $ 1,707,999 A.9015.8.000.000 FISHERS ISLAND FERRY DISTRICT VENDOR 016723 PROGRESSIVE BENEFIT SOLUT. ,LLC 11/21/2017 CHECK 4490 FUND &: ACCOUNT P.O.# INVOICE DESCRIPTION AMOUNT SM '9060.8.000.000 PBS-HRA-1017 HRA TOTAL)UTITLZTN-10/17 8,611.97 SM .9060.8.000.000 41576 (20)MNTLY CRD ADMN-10/i7 90.00 TOTAL 8,701.97 01 .........._r g x. _3 K --v - - ------ -- ----- - 'ISLAAD' Efi AUD F !RY'DISYRI-C 2f _ _ FISHERS -53095-MAIN ROAD-.,PO:BOX 11791,7---­a, SOOTHOp"-hy 11971'0959 C 490 NATIONAL BANK' " ,, "; - ZUTCHOGUE,'NY,11935 DAT E AMOUNT 01 1,9 ,,50-54$/214 , BIG TTHOUSAND,",gEVEg-':,HUNDP-ED--,"bNE _-Xkb. DOLLARS, "Ii-00- J-2 4, D AY 7111 ;PROGRESSIVE 'BENtFit"'SoLidi. J, P TO 7HE- 14 BUSINESS-PARk,'_biiVkz-_ %: OF WORD.'CT- 0,'(5 4,0 5 j 4-, 'Cir I%,I 1111004490no 1:02oosir.6: G8 OOLS02 L Ila Vendor No. Check No. Town of Southold, New York - Payment Voucher 16723 L4 LAC10 Vendor Address Entered by 14 Business Park Dr#8 Branford, CT 06405 Audit Date Progressive Benefit Solutions(PBS) NOV 2 12017 Vendor Telephone Number Vendor Contact Invoice Invoice Invoice Net Purchase Order Number Date Total Discount Amount Claimed Number Description of Goods or Services General Ledger Fund and Account Number 4017 PBS-HRA 10/31/2017 $8,611.97 $8,611.97 HRA Total utilization Oct 2017 SM9060.8.000.000 41576 10/31/2017 $90.00 $90.00 Mo thl card administration Oct 2017 SM9060.8.000.000 $8,701.97 $8,701.97 Payee Certification Department Certification The undersigned(Claimant)(Acting on behalf of the above named claimant) I hereby certify that the materials above specified have been received by me does hereby certify that the foregoing claim is true and correct,that no part has in good condition without substitution,the services properly been paid,except as therein stated,that the balance therein stated is actually performed and that the quantities thereof have been verified with the exceptions due and owing,and that taxes from which the Town is exempt are excluded or discrepancies noted,and payment is approved c Signaturel,, Title Signature Company Name Fishers Island Ferry District Date 11/3/2017 Title Date �� 14 Business Park, #8 DATE: October 31, 2017 Branford, CT 06405 PH: 203-208-4800 FAX: 203-234-1139 FOR: 2017 HRA Utilization Invoice Bill To: Fishers Island Ferry District :DESCRIPTION:.. HEALTH REIMBURSEMENT PLAN UTILIZATION AMOUNT' t Required Funding Health Reimbursement Total Utilization $ 8,611.97 Make all checks payable to: Progressive Benefit Solutions 14 Business Park, #8 Branford, CT 06405 THANK YOU FOR YOUR BUSINESS! Total : '$ 8,611.97 Progressive Benefit Solutions LLC Invoice 14 Business Park, #8 Date Invoice# Branford, CT 06405 10/31/2017 41576 Bill To Fishers Island Ferry District Attn. Gordon Murphy P 0. Box 607 Fishers Isle,NY 06390 P.O. No. Terms Project Upon Receipt Quantity Description Rate Amount 20 Monthly Benny Card Administration 4.50 90 00 November 2017 Invoice(Active Participants thru 10/31/2017) Total $90.00 Ad- FISHERS ISLAND FERRY DISTRICT VENDOR 014022 RING'S END LUMBER, INC 11/21/2017 CHECK 4491 A FUND & ACCOUNT P.O.# INVOICE DESCRIPTION AMOUNT SM .5710.2.000.100 897547 MU-PNT TRY,RLLR POLE,CVR 68.64 SM .5716.2.000.100 897692 MU-ASST PAINT AND PRIMER 279.64 SM .5710.2.000.160 898628 MU-4/8 PROTECTIVE COVER 41.42 TOTAL 389.70 T ,J , r"A SOUTHOLMNY119710959 : 53096-MAIN flbAq; P'QB0X,1,,1,?9-: I ' ND AjWbIj FISHER SIM--A 'CHECK'"NO. 44 -THE 'NATIONAL BANK, AMOUNT-.,,, -CUTCHOGUE,-W 1 J` 017 ...... 50.5 61214 i11-[2 zAib 7,,o/fo 0,,bbtugs THREE O RING!S`END DUMBER',;. INC TH, _PO;'BOX_-`•7 14 ORDER`'; `NIANTTC f CT 06,5, 7:,­ of, vn J, 11000L.L,9 Lila 1:,0 2 1 4 0 5 L. 6 0: 66 001S02 Ili- Vendor No. Check No. Town of Southold, New York - Payment Voucher 14022 LA "4!3 1 Vendor Address Entered by PO BOX 714 Niantic, CT 06357 Audit Date ° " RING'S END NOV 2 12017 Vendor Telephone Number 860-739-5441 . Vendor Contact Invoice Invoice Invoice Net Purchase Order " Number Date Total Discount Amount Claimed Number Description of Goods or Services General Ledger Fund and Account Number' 897547 10/26/2017 $68.64 $68.64 MU paint supplies SM5710.2.000.100 . d f 897692 10/26/2017 $279.64 $279.64 MU paint and primer SM5710.2.000.100 898628 10/27/2017 $41.42 $41.42 MU 4X8 for protective cover SM5710.2.000.100 s r 3 } $389.70 $389.70 ` Payee Certification Department Certification The undersigned(Claimant)(Acting on behalf of the above named claimant) I hereby certify that the materials above specified have been received by me does hereby certify that the foregoing claim is true and correct,that no part has in good condition without substitution,the services properly been paid,except as therein stated,that the balance therein stated is actually performed and that the quantities thereof have been venfied with the exceptions due and owing,and that taxes from which the Town is exempt are excluded. or discrepancies noted,and payment is approved Signature (_—A. Title Signature G Company Name Fishers Island Ferry District Date 11/6/2017 Title Date l o / ®A®A®A RINGS END Since 1902 Bethel, CT Branford, CT Darien, CT Lewieboro, NY (203)797-1212 (203)488-3551 (203)655-2525 (914)533-2517 308 South Frontage Road (800)797-6511 (866)758-3551 (800)390-1000 (888)533-2517 New London CT -06385 T: 860-439-0155 F: 860-439-1369 New London, CT New Milford, CT Niantic, CT Wilton, CT (860)439-0155 (860)355-5566 (860)739-5441 (203)761-1000 (866)439-0155 (888)350-8966 (800)303-6526 (866)842-7883 TRANSACTION TYPE STORE Charge Invoice New London, CT BILL TO: SHIP TO: FISHERS ISLAND FERRY DIS P.O. BOX 607 FISHERS ISLAND NY 06390 Phone 860-442-0165 CUSTOMER TRANSACTION CUSTOMER CODE DATE NUMBER TIME PURCHASE ORDER NUMBER SALESPERSON EFISHIS 102617 897547 11:35 MUNN 275 Matthew Davis APPLY TO ORDER DATE ORD/QTE NO. TERMS TAX JURISDICTION 0 M 2% 15th, Net 25 Days 6.35% - CT SALES TAX ITEM ORDER QTY SHIP QTY LOC DESCRIPTION PRICING UNIT PRICING PER UOM NET AMOUNT AR11135 2 2 ARROW 6.5" MICROFIBER 3/8 1OPK 2.000 19.550 EACH 39.10 WZ95200 2 2 WHIZZ 19"-34" MINI RLR EXT POLE 2.000 7.920 EACH 15.84 ARRM007 4 4 ARROW 7" PLASTIC TRAY 4.000 2.400 EACH 9.60 RECEIVED IN GOOD CONDITION BY: R.J. BURNS SIGNATURE NOT REQUIRED MISC SALES REMAINING INVOICE NET AMT CHARGE FREIGHT TAR DEPOSIT TOTAL X 64.54 0.00 4.10 68.64 CUSTOMER COPY Page: 1 ANA ®h®h®h Page # 1 RING'S END Since 1902 Bethel, CT Branford, CT Darien, CT Lewisboro,NY (203) 797-1212 (203) 488-3551 (203) 655-2525 (914) 533-2517 308 South Frontage Road (800) 797-6511 (866) 758-3551 (800) 390-1000 (888) 533-2517 New London CT 06385 T: 860-439-0155 New London,CT New Milford, CT Niantic, CT Wilton,CT (860) 439-0155 (860) 355-5566 (860) 739-5441 (203) 761-1000 F: 860-439-1369 (866) 439-0155 (888) 350-8966 (800) 303-6526 (866) 842-7883 TRANSACTION TYPE STORE Charge Invoice * * * LIKE US ON FACEBOOK * * * New London, CT BILL TO: SHIP TO: FISHERS ISLAND FERRY DIS P.O. BOX 607 FISHERS ISLAND NY 06390 860-442-0165 CUSTOMER 'TRANSACTION CUSTOMER CODE DATE I NUMBER I TIME PURCHASE ORDER NUMBER SALESPERSON EFISHIS 10/26/20171 897547 11:35 MUNN 275 - Matthew Davis ORIGINAL APPLY TO ORDER DATE I ORD/OTE N0. I TERMS TAX JURISDICTION 0 1 897547 1 1 2% 15th, Net 25 Days 6.35% - CT SALES TAX ITEM ORDER QTY SHIP QTY LOC DESCRIPTION- PRICING UNIT PRICING PER UOM NETAMOUNT AR11135 2 2 ARROW 6.5" MICROFIBER 3/8 1OPK 2.000 19.550/EACH 39.10 WZ95200 2 2 WHIZZ 19"-34" MINI RLR EXT POLE 2.000 7.920/EACH 15.84 ARRM007 4 4 ARROW 7" PLASTIC TRAY 4.000 2.400/EACH 9.60 51 J� c _s.-4I„ J s i ti� ;ti r E' iiy 'n' t£Ydp'lid, li,i � 4' i,' RECEIVER IN GOOD CONDITION BY: SEE REVERSE SIDE FOR TERMS AND CONDITIONS R.J. BURNS MISC SALES REMAINING INVOICE NET AMT I CHARGE FREIGHT TAX DEPOSIT TOTAL X 64.541 0.001 4.101 68.64 CUSTOMER COPY The following terms and conditions govern the sales of The Seller,whether pursuant to oral or written orders to its representatives or salespeople. RETURNED GOODS Stock items, in original units or full packages, will be accepted for credit or exchange when returned in good condition. Within 30 days of purchase, AND ACCOMPANIED BY ORIGINAL SALES TICKET. A restocking charge will be assessed by the Seller on all returned goods. No special orders will be accepted for return or credit. TAXES Buyer shall pay to Seller the amount of any and all taxes, excises or other charges which Seller may be required to pay or to collect for any government, national,state or local, upon, or measured by the production,sale transportation, delivery or use of the merchandise sold hereunder. FORCE MAJEURE Delay in delivery or non-delivery in whole or in part by Seller shall not be a breach of this sale if performance is made impracticable by the occurrence of any one or more of the following contingencies,the non-occurrence of which is a basic assumption on which the agreement is made: (a) Fires, Floods, or other casualties; (b) Wars, Riots, Civil Commotion, Embargoes, governmental regulations or martial law; (c) Seller's inability to obtain necessary materials (finished or otherwise) from its usual sources of Supply; (d) Shortage of cars or trucks or delays in transit; (e) Existing or future strikes or other labor troubles affecting production or shipment, whether involving employees of Seller or employees of others and regardless of responsibility or fault on the part of the employer; and (f) Other contingencies of manufacture or shipment, whether or not of a class or kind mentioned herein and not reasonably within Seller's control. WARRANTY Seller agrees that any merchandise delivered hereunder found to be defective in material or workmanship will be repaired or replaced by the Seller without additional charge for the merchandise. This warranty is made in lieu of any other warranties or conditions including merchantability or fitness for a particular purpose. The remedies under this warranty are exclusive and by accepting this merchandise the Buyer agrees to these conditions and waives any other warranties conditions expressed or implied. All claims for damaged or defective material must be made within 5 days and we are limited to the purchase price of the materials sold or the replacement thereof at our option. We are not responsible for extra costs, indirect damages or consequential damages. Buyer assumes all risk and liability with respect to results obtained by the use of such merchandise whether used alone or in a combination with other products. No claims of any kind whatsoever, whether based on breach of warranty,the alleged negligence of seller, or otherwise, with respect to merchandise delivered or for failure to deliver any merchandise shall be greater in amount than the purchase price hereunder of the merchandise in respect of which damages are claimed; and failure of buyer to give written notice claim within 30 days after delivery of merchandise shall constitute a waiver of buyer of all claims with respect to such merchandise. TERMS AND CONDITIONS TO GOVERN THIS INVOICE CONSTITUTES THE ENTIRE CONTRACT WTH RESPECT TO THE SALE AND PURCHASE OF THE MERCHANDISE SPECIFIED HEREIN. No modification of this sale shall be effected by the acceptance or acknowledgement of purchase order forms specifying different conditions, and no modifications shall be effective unless in writing signed by the party claimed to be bound thereby. STATE OF JURISDICTION This sale shall be deemed to have been made in, and shall be construed in accordance with the laws of the State shown in the Seller's address. DELIVERY AND ACCEPTANCE OF TITLE OF GOODS Title to the materials shall pass from the Seller to Buyer upon delivery thereof to Buyer or his agent and thereafter shall be Buyer's risk. Claims for shortages, breakages or for any nonconformance with the terms and conditions of the order shall be noted on the Seller's delivery receipt by the Buyer at the time of delivery, otherwise,the Seller shall not be responsible for any such claims. If delivery is by common carrier, delivery by the Seller to the carrier at point of origin shall constitute delivery to the Buyer and thereafter the shipment shall be at Buyer's risk, and claims for loss or damage must be filed by the Buyer against the carrier. Title to goods loaded onto Buyer's conveyance at Seller's warehouse passes to the buyer at the Seller's loading dock. If upon delivery at job site,there is not present at the job site an employee of the Buyer authorized to accept delivery and sign a delivery document evidencing delivery of materials as listed on this invoice document,then the Seller reserves the right to deposit the material at the delivery area previously designated by the Buyer without obtaining a signed receipt therefore, and the Buyer agrees to liability for payment of this invoice as if it were signed by an authorized employee of the Buyer, unless the Buyer has previously instructed the Seller not to deposit material at the designated delivery area without obtaining a signed delivery receipt from an authorized employee of the Buyer. FINANCE All bills are payable on the 15th of the month following billing date and are past due after 30 days. Past due accounts are subject to a FINANCE CHARGE of 1 1/4% PER MONTH on the past due unpaid balance (which is an ANNUAL PERCENTAGE of 15%). MATERIALS SAFETY DATA SHEETS (MSDS) The occupational safety and Health Administration Hazard Communication Standard,the Superfund Amendments and Reauthorization Act of 1986 and many state right-to-know laws require that a material safety data sheet (MSDS) be provided with products containing hazardous chemicals. As a manufacturer, importer or distributor, you are required by law to ascertain which of your products require an accompanying MSDS and provide such. As a condition of this sale,you expressly warrant that you will comply with the provisions of the foregoing right-to-know-laws. HAZARD COMMUNICATION LABEL Alkaline Copper Quaternary (ACQ) Pressure Treated Wood Hazard warnings for treated wood are similar to those for untreated wood. • Airborne wood dust can cause respiratory, eye, and skin irritation. • Breathing excessive amounts of treated or untreated wood dust(primarily hardwood) has been associated with nasal cancer in some industries. • Handling may cause splinters. • High airborne levels of wood dust may burn rapidly in the air when exposed to an ignition source. • Some forms of components of the liquid preservative used to manufacture this product(arsenic and chromium) have caused lung, skin, and possibly other cancers in humans occupationally or environmentally overexposed. SUCH EXPOSURES HAVE NOT OCCURRED WITH TREATED WOOD. NOTE: Consult the Material Safety Data Sheet for additional information on this product. This Information is designed to address the label requirements of the OSHA Hazard Communication Standard with respect to treated lumber. DELIVERY All deliveries are priced and understood to be on a first floor/tailboard delivery basis. AMP, ®A®A RING'S END Since 19®2 Bethel, CT Branford, CT Darien, CT Lewisboro, NY (203)797-1212 (203)488-3551 (203)655-2525 (914)533-2517 308 South Frontasr Road (800)797-6511 (866)758-3551 (800)390-1000 (888)533-2517 New London CT -06385 T: 860-439-0155 F: 860-439-1369 New London, CT New Milford, CT Niantic, CT Wilton, CT (860)439-0155 (860)355-5566 (860)739-5441 (203)761-1000 (866)439-0155 (888)350-8966 (800)303-6526 (866)842-7883 TRANSACTION TYPE STORE Charge Invoice New London, CT BILL TO: SHIP TO: FISHERS ISLAND FERRY DIS P.O. BOX 607 FISHERS ISLAND NY 06390 Phone 860-442-0165 CUSTOMER TRANSACTION CUSTOMER CODE DATE NUMBER TIME PURCHASE ORDER NUMBER SALESPERSON EFISHIS 102617 897692 12:31 MUNN 275 Matthew Davis APPLY TO ORDER DATE ORD/QTS NO. TERMS TAX JURISDICTION 0 M 2% 15th, Net 25 Days 6.35% - CT SALES TAX ITEM ORDER QTY SHIP QTY LOC DESCRIPTION PRICING UNIT PRICING PER UOM NET AMOUNT P060101 2 2 SIS H/P ALKYD METAL PRIME WHT G 2.000 32.880 EACH 65.76 V13101 1 1 COROTECH UNIVERSAL METAL PRIMER 1.000 36.300 EACH 36.30 P221B01 2 2 URETHANE ALKYD GLOSS BASE 1 GL 2.000 32.300 EACH 64.60 PLATINUM GRAY HP283XOI 2 2 U/S HP DTM ACR GLOSS BASE 3 GAL 2.000 46.730 EACH 93.46 BUFF THAMES S1- 4.25 Wl- 4Y 29.25 Y2- 3Y 24.0 R3- 6.5 PCG PAINT CARE FEE - GALLON 3.00 RECEIVED IN GOOD CONDITION BY: NICK ESPOSITO SIGNATURE NOT REQUIRED MISC SALES REMAINING INVOICE NET AMT CHARGE FREIGHT TAR DEPOSIT TOTAL X 260.12 0 .00 16.52 279.6 CUSTOMER COPY Page: 1 Ad ®h®h®h Page # 1 DING'S END Since 1902 Bethel, CT Branford,CT Darien,CT Lewisboro, NY (203) 797-1212 (203) 488-3551 (203) 655-2525 (914) 533-2517 308 South Frontage Road (800) 797-6511 (866) 758-3551 (800) 390-1000 (888) 533-2517 New London CT 06385 T: 860-439-0155 New London, CT New Milford, CT Niantic, CT Wilton, CT (860) 439-0155 (860) 355-5566 (860) 739-5441 (203) 761-1000 F: 860-439-1369 (866) 439-0155 (888) 350-8966 (800) 303-6526 (866) 842-7883 TRANSACTION TYPE STORE Charge Invoice * * * LIKE US ON FACEBOOK * * * New London, CT BILL TO: SHIP TO: FISHERS ISLAND FERRY DIS P.O. BOX 607 FISHERS ISLAND NY 06390 860-442-0165 CUSTOMER TRANSACTION CUSTOMER CODE DATE NUMBER TIME P RCHAS ORDER NUMBER SALESPERSON EFISHIS 10/26/2017 897692 12:31 MUNN 5A/1 275 - Matthew Davis ORIGINAL APPLY TO ORDER DATE I ORDidTE NO. I TERMS TAX JURISDICTION 0 1 897692 2% 15th, Net 25 Days 6.35% - CT SALES TAX ITEM ORDER QTY SHIP QTY LOCI DESCRIPTION PRICING UNIT PRICING PER UOM NET AMOUNT P060101 2 2 SIS H/P ALKYD METAL PRIME WHT G 2.000 32.880/EACH 65.76 V13101 1 1 COROTECH UNIVERSAL METAL PRIMER 1.000 36.300/EACH 36.30 P221B01 2 2 URETHANE ALKYD GLOSS BASE 1 GL 2.000 32.300/EACH 64.60 PLATINUM GRAY HP283X01 2 2 U/S HP DTM ACR GLOSS BASE 3 GAL 2.000 46.730/EACH 93.46 BUFF THAMES S1- 4.25 W1- 4Y 29.25 Y2- 3Y 24.0 R3- 6.5 PCG PAINT CARE FEE - GALLON 3.00 71 ".I dh01'n; rm n., P•I,„ ,,,;;,",„ -, I, r II F _ a.pl ,,,,,;�I;Ir *'�I'ipll,l„ ,.,. I y,,1 n1,1 `j1,,,,,,,,,,,,6- �;yr l,. -, .. „n _ y.;lll le, RECEIVED IN GOOD CONDITION BY: SEE REVERSE SIDE FOR TERMS AND CONDITIONS NICK ESPOSITO MISC SALES REMAINING INVOICE NET AMT CHARGE FREIGHT TAX DEPOSIT TOTAL, X 260.12 3.00 0.00 16.521 279.64 CUSTOMER COPY The following terms and conditions govern the sales of The Seller,whether pursuant to oral or written orders to its representatives or salespeople. RETURNED GOODS Stock items, in original units or full packages, will be accepted for credit or exchange when returned in good condition. Within 30 days of purchase, AND ACCOMPANIED BY ORIGINAL SALES TICKET. A restocking charge will be assessed by the Seller on all returned goods. No special orders will be accepted for return or credit. TAXES Buyer shall pay to Seller the amount of any and all taxes, excises or other charges which Seller may be required to pay or to collect for any government, national, state or local, upon, or measured by the production,sale transportation, delivery or use of the merchandise sold hereunder. FORCE MAJEURE Delay in delivery or non-delivery in whole or in part by Seller shall not be a breach of this sale if performance is made impracticable by the occurrence of any one or more of the following contingencies,the non-occurrence of which is a basic assumption on which the agreement is made: (a) Fires, Floods, or other casualties; (b) Wars, Riots, Civil Commotion, Embargoes, governmental regulations or martial law; (c) Seller's inability to obtain necessary materials (finished or otherwise) from its usual sources of Supply; (d) Shortage of cars or trucks or delays in transit; (e) Existing or future strikes or other labor troubles affecting production or shipment, whether involving employees of Seller or employees of others and regardless of responsibility or fault on the part of the employer; and (f) Other contingencies of manufacture or shipment,whether or not of a class or kind mentioned herein and not reasonably within Seller's control. WARRANTY Seller agrees that any merchandise delivered hereunder found to be defective in material or workmanship will be repaired or replaced by the Seller without additional charge for the merchandise. This warranty is made in lieu of any other warranties or conditions including merchantability or fitness for a particular purpose. The remedies under this warranty are exclusive and by accepting this merchandise the Buyer agrees to these conditions and waives any other warranties conditions expressed or implied. All claims for damaged or defective material must be made within 5 days and we are limited to the purchase price of the materials sold or the replacement thereof at our option. We are not responsible for extra costs, indirect damages or consequential damages. Buyer assumes all risk and liability with respect to results obtained by the use of such merchandise whether used alone or in a combination with other products. No claims of any kind whatsoever, whether based on breach of warranty,the alleged negligence of seller, or otherwise, with respect to merchandise delivered or for failure to deliver any merchandise shall be greater in amount than the purchase price hereunder of the merchandise in respect of which damages are claimed; and failure of buyer to give written notice claim within 30 days after delivery of merchandise shall constitute a waiver of buyer of all claims with respect to such merchandise. TERMS AND CONDITIONS TO GOVERN THIS INVOICE CONSTITUTES THE ENTIRE CONTRACT WTH RESPECT TO THE SALE AND PURCHASE OF THE MERCHANDISE SPECIFIED HEREIN. No modification of this sale shall be effected by the acceptance or acknowledgement of purchase order forms specifying different conditions, and no modifications shall be effective unless in writing signed by the party claimed to be bound thereby. STATE OF JURISDICTION This sale shall be deemed to have been made in, and shall be construed in accordance with the laws of the State shown in the Seller's address. DELIVERY AND ACCEPTANCE OF TITLE OF GOODS Title to the materials shall pass from the Seller to Buyer upon delivery thereof to Buyer or his agent and thereafter shall be Buyer's risk. Claims for shortages, breakages or for any nonconformance with the terms and conditions of the order shall be noted on the Seller's delivery receipt by the Buyer at the time of delivery, otherwise,the Seller shall not be responsible for any such claims. If delivery is by common carrier, delivery by the Seller to the carrier at point of origin shall constitute delivery to the Buyer and thereafter the shipment shall be at Buyer's risk, and claims for loss or damage must be filed by the Buyer against the carrier. Title to goods loaded onto Buyer's conveyance at Seller's warehouse passes to the buyer at the Seller's loading dock. If upon delivery at job site,there is not present at the lob site an employee of the Buyer authorized to accept delivery and sign a delivery document evidencing delivery of materials as listed on this invoice document,then the Seller reserves the right to deposit the material at the delivery area previously designated by the Buyer without obtaining a signed receipt therefore, and the Buyer agrees to liability for payment of this invoice as if it were signed by an authorized employee of the Buyer, unless the Buyer has previously instructed the Seller not to deposit material at the designated delivery area without obtaining a signed delivery receipt from an authorized employee of the Buyer. FINANCE All bills are payable on the 15th of the month following billing date and are past due after 30 days. Past due accounts are subject to a FINANCE CHARGE of 1 114% PER MONTH on the past due unpaid balance (which is an ANNUAL PERCENTAGE of 15%). MATERIALS SAFETY DATA SHEETS (MSDS) The occupational safety and Health Administration Hazard Communication Standard,the Superfund Amendments and Reauthorization Act of 1986 and many state right-to-know laws require that a material safety data sheet(MSDS) be provided with products containing hazardous chemicals. As a manufacturer, importer or distributor, you are required by law to ascertain which of your products require an accompanying MSDS and provide such. As a condition of this sale, you expressly warrant that you will comply with the provisions of the foregoing right-to-know-laws. HAZARD COMMUNICATION LABEL Alkaline Copper Quaternary(ACQ) Pressure Treated Wood Hazard warnings for treated wood are similar to those for untreated wood. • Airborne wood dust can cause respiratory, eye, and skin irritation. • Breathing excessive amounts of treated or untreated wood dust(primarily hardwood) has been associated with nasal cancer in some industries. • Handling may cause splinters. • High airborne levels of wood dust may burn rapidly in the air when exposed to an ignition source. • Some forms of components of the liquid preservative used to manufacture this product(arsenic and chromium) have caused lung, skin, acid possibly other cancers in humans occupationally or environmentally overexposed. SUCH EXPOSURES HAVE NOT OCCURRED WITH TREATED WOOD. NOTE: Consult the Material Safety Data Sheet for additional information on this product. This Information is designed to address the label requirements of the OSHA Hazard Communication Standard with respect to treated lumber. DELIVERY All deliveries are priced and understood to be on a first floor/tailboard delivery basis. ®A®A®A RING'S END Since 1902 Bethel, CT Branford, CT Darien, CT Lewisboro, NY (203)797-1212 (203)488-3551 (203)655-2525 (914)533-2517 P, O. ,BOX 714 (800)797-6511 (866)758-3551 (800)390-1000 (888)533-2517 Niantic CT 06357 T: 860-739-5441 F: 860-739-5822 New London, CT New Milford, CT Niantic, CT Wilton, CT (860)439-0155 (860)355-5566 (860)739-5441 (203)761-1000 (866)439-0155 (888)350-8966 (800)303-6526 (866)842-7883 TRANSACTION TYPE STORE Charge Invoice Niantic, CT BILL TO: SHIP TO: FISHERS ISLAND FERRY DIS P.O. BOX 607 P.O. BOX 607 FI FERRY DOCK FISHERS ISLAND NY 06390 NEW LONDON CT 06320 Phone 860-442-0165 CUSTOMER TRANSACTION CUSTOMER CODE DATE NUMBER TIME PURCHASE ORDER NUMBER SALESPERSON EFISHIS 102717 898628 09:22 123 Claudia Vesey APPLY TO ORDER DATE ORD/QTE NO. TERMS TAX JURISDICTION 0 2% 15th, Net 25 Days 6.35% CT USE TAX ITEM ORDER QTY SHIP QTY LOC DESCRIPTION PRICING UNIT PRICING PER UOM NET AMOUNT 34UL 1 1 3/4" FIR T&G P&TS UNDERLAY 4X8 1.000 38.950 EACH 38.95 RECEIVED IN GOOD CONDITION BY: R.J. BURNS MISCSALES REMAINING INVOICE NET AMT CHARGE FREIGHT TAX DEPOSIT TOTAL X 38.95 0 .00 2.47 41.42 CUSTOMER COPY Page: 1 ( ®h®11®1! Page # 1 R:INGS Irl r L Since 19®2 Bethel, CT Branford, CT Darien, CT Lewisboro, NY (203) 797-1212 (203) 488-3551 (203) 655-2525 (914) 533-2517 P. 0. Box 714 (800) 797-6511 (866) 758-3551 (800) 390-1000 (888) 533-2517 Niantic CT 06357 T: 860-739-5441 New London, CT New Milford, CT Niantic, CT Wilton, CT (860) 439-0155 (860) 355-5566 (860) 739-5441 (203) 761-1000 F: 860-739-5822 (866) 439-0155 (888) 350-8966 (800) 303-6526 (866) 842-7883 TRANSACTION TYPE STORE Charge Invoice Niantic, CT BILL TO: SHIP TO: FISHERS ISLAND FERRY DIS P.O. BOX 607 P.O. BOX 607 FI FERRY DOCK FISHERS ISLAND NY 06390 NEW LONDON CT06320 860-442-0165 CUSTOMER TRANSACTION CUSTOMER CODE' DATE NUMBER TIME PURCHASE ORDER NUMBER SALESPERSON EFISHIS 10/27/20171 898628 09:22 123 - Claudia Vesey ORIGINAL APPLY TO ORDER DATE ORD/QTE NO. TERMS TAX JURISDICTION 0 110/26/20171 95972 1 6.35% CT USE TAX ITEM ORDER QTY SHIP QTY LOCI DESCRIPTION PRICING UNIT PRICING PER UOM NET AMOUNT 34UL 1 1 3/4" FIR T&G P&TS UNDERLAY 4X8 RECEIVED IN GOOD" CONDITION BY: SEE REVERSE SIDE FOR TERMS AND CONDITIONS R.J. BURNS MISC SALES REMAINING INVOICE NET AMT CHARGE FREIGHT TAX DEPOSIT TOTAL X DELIVERY COPY L !V l FISHERS ISLAND FERRY DISTRICT VENDOR 018752 PETER RUGG 11/21/2017 CHECK 4492 FUND & ACCOUNT P.O.# INVOICE DESCRIPTION AMOUNT, t;; SM .5712.4.000.000 111317 117 COMM MTG JUL-SEP(5) 250.00 TOTAL 250.00 'I tZi r kg- J o " RRY'DISTRIC .FisHmPE sisLAAD, 53095 MAIN ROAD,-PO BO: CHECK''NO SOUTHDCD, 7 4 - - THE SUFFOCk ,66 NATIONAL BANK - AM OUNT - q-T HOry .NY,11935DATE, a 50-546121# D'b 0/10,101 -DOLLARS' ::T*6:-'"DjzEb; FIFTY- SI 'rj _ 0 V --- Pd BOX!'-7 0 3 ...... 9RS" IS 0 Iff % 41 -00, x, 1:2- -b -"t.1,0 9 2 1 l:c'j2lLOSLGL%l: 68 'O O L SO 2 L Vendor No. Check No. . Town of Southold,-New York - Payment Voucher 18752 Un Entered by Vendor Name 136 E. 76TH STREET,APT 5A Audit Date Rugg, Peter NEW YORK, NY 10021 NOV 2 12017 Vendor Telephone Number Town Clerk Vendor Contact A Invoice Invoice Invoice Net Purchase Order Number Date Total Discount Amount Claimed Number Description of Goods or Services General Ledger Fund and Account Number 111` 1 11/13/2017 $250.00 $250.00 Commission Meeting SM5712.4.000.000 Jul-Sep 2017 5 Mt s @$50/mt .3 3 ji - S _ t $250.00 $250.00 Payee Certification Department Certification The undersigned(Claimant)(Acting on behalf of the above named claimant) I hereby certify that the materials above specified have been received by me does hereby certify that the foregoing claim is true and correct,that no part has in good condition without substitution,the services properly been paid,except as therein stated,that the balance therein stated is actually performed and that the quantities thereof have been verified with the exceptions due and owing,and that taxes from which the Town is exempt are excluded or discrepancies noted,and payment is approved Signature itle Signature �7— Company Name Fishers Island Ferry District_Date 11/10/2017 Title �— Date I ]'— BOC Meetings Rugg, Peter Ahrens, Andrew Shillo, Di Bloethe,W Burnham, H 10-Jul-17 X X X X X 5 24-Jul-17 X X X X X 5 7-Aug-17 X X X X X 5 18-Aug-17 X X X X X 5 5-Sep-17 X X X X 4 18-Sep-17 X X X X 4 29-Sep-17 X X X X 4 32 5 7 7 6 7 32 3017 $ 250 $ 350 $ 350 $ 300 $ 350 $ 1,600 $ - Page 1 \\fiserv1\D$\FD Network Directory\BOC\2017 Meetings-Commissioner Stipends 10/4/2017 Minutes of the Meeting of the Board of,Commissioners Fishers Island Ferry District September 29,2017 Commissioner Ahrens at the Fishers Island Community Center called to order a meeting of the'Board of Commissioners of the Fishers Island Ferry District("the Ferry District")on September 29,2017 at 1:00 PM. s Commissioners Heather Burnham, Peter Rugg and Dianna Shillo were present.Also in attendance were Geb Cook, RJ Burns, Diane Hansen and Deanna Ross. Marcia Marien of O'Connor Davies was present. Commissioner William Bloethe and Gordon Murphy were absent. Commissioner Ahrens established that a quorum was present. Everyone in attendance pledged alle- giance to the flag. Correspondence/Public Comment—Mr.Cook reported that no correspondence was received. There was no public comment. The BOC agreed to add an executive session to the September 29,2017 agenda. Moved by:Commissioner D.Shillo Seconded by:Commissioner A.Ahrens Ayes:A.Ahrens, H. Burnham, P. Rugg and D.Shillo Nays: None Warrants RESOLUTION 2017-177 RESOLVED,that the Board of Commissioners of the Fishers Island Ferry District hereby approves the Warrant dated September 29,2017 in the amount of$66,700.36. Moved by:Commissioner A.Ahrens Seconded by:Commissioner D.Shillo Ayes:A.Ahrens, H. Burnham, P. Rugg and D.Shillo Nays: None Audit Review-Ms. Marcia Marion,CPA for O'Connor Davies presented the Fishers Island Ferry District December 31,2016 Audit to the BOC. Audit RESOLUTION 2017-178 Whereas the 2016 financial audit was approved by the Board of Commissioners of the Fishers Island Fer- ry District. Minutes of the Meeting of the Board of Commissioners Fishers Island Ferry District August 18,2017 Commissioner Ahrens at the Fishers Island Community Center called a meeting of the Board of Commissioners of the Fishers Island Ferry District("the Ferry District")to order on August 18,2017 at 4:42 PM, Commissioners William Bloethe, Heather Burnham, Peter Rugg and D.Shillo were present.Also in attendance were Gordon Murphy,Jeb Cook and Deanna Ross.Several members of the public were present. Commissioner Ahrens established that a quorum was present. Everyone in attendance pledged allegiance to the flag. Members of the public were welcomed and the BOC congratulated Commissioner D.Shillo for winning the election. Correspondence/Public Comment— Mr.Cook received one letter from the Town of Southold thanking the FIFD for use of the ferry on Town of Southold Day.There is no public comment. Minutes RESOLUTION 2017-150 RESOLVED,that the Board of Commissioners of the Fishers Island Ferry District hereby approves the minutes of the June 26, 2017 meeting. Moved by:Commissioner P Rugg Seconded by:Commissioner W Bloethe Ayes:A.Ahrens,W. Bloethe, H. Burnham, P. Rugg and D.Shillo Nays: None RESOLUTION 2017-151 RESOLVED,that the Board of Commissioners of the Fishers Island Ferry District hereby approves the minutes of the July 10,2017 meeting. Moved by:Commissioner D Shillo Seconded by:Commissioner A Ahrens Ayes:A.Ahrens,W. Bloethe, H. Burnham, P. Rugg and D.Shillo Nays: None Budget Modification RESOLUTION 2017-152 Minutes of the Meeting of the Board of Commissioners Fishers Island Ferry District August 7,2017 Commissioner rens at the Fishers Island Community Center called a meeting of the Board of Commissioners`of the Fishers Island Ferry District("the Ferry District")to order on August 7,2017 at 4:30 PM. / Commissioners William Bloethe, Heather Burnham, Peter Rugg and D.Shillo were present.Also in attendance were Gordon Murphy, Geb Cook, Diane Hansen and Deanna Ross. No members of the public were present. Commissioner Ahrens established that a quorum was present. Everyone in attendance pledged allegiance to the flag. Correspondence/Public Comment— An email correspondence was received from Mr. Bob Evans stating that the airport lights are unnecessarily bright and invasive. The BOC has agreed that the lighting is in compliance with the FAA. Commissioner W. Bloethe questioned management regarding the refusal of accepting freight after 12:30pm on Saturdays at the New London Terminal. Management agrees that a mistake may have been made and will look into the matter further to avoid any future issues. Warrant RESOLUTION 2017-139 RESOLVED,that the Board of Commissioners of the Fishers Island Ferry District hereby approves the Warrant dated August 7,2017 in the amount of$58,685.99. Moved by:Commissioner P Rugg Seconded by:Commissioner A Ahrens Ayes:A.Ahrens,W. Bloethe, H. Burnham, P. Rugg and D.Shillo Nays: None Budget Modification RESOLUTION 2017—140 RESOLVED that the Board of Commissioners of the Fishers Island Ferry District hereby increases the 2017 Fishers Island Ferry District budget as follows: Revenues: SM.4960.50 FEMA AID-TRANSPORTATION S 12 055.00 Total $ 12,055.00 1 Minutes of the Meeting of the Board of Commissioners Fishers Island Ferry District July 24, 2017 Commissioner Ahrens at the Fishers Island Community Center called a meeting of the Board of Commissioners of the Fishers Island Ferry District ("the Ferry District")to order on July 24, 2017 at 4:32 PM. / J Commissioners William B14the, Heathe4urnham, Peter Rugg and D.Shillo were present. Also in attendance were Gordon Murphy,Geb Cook, Diane Hansen and Deanna Ross. RJ Burns was present via phone. No members of the public were present. Commissioner Ahrens established that a quorum was present. Everyone in attendance pledged allegiance to the flag. Correspondence/Public Comment—No correspondence was received.There is no public comment. Minutes RESOLUTION 2017-125 RESOLVED,that the Board of Commissioners of the Fishers Island Ferry District hereby approves the minutes of the May 30,2017 meeting. Moved by:Commissioner A.Ahrens Seconded by:Commissioner W. Bloethe Ayes:A.Ahrens,W. Bloethe, H. Burnham, P. Rugg and D.Shillo Nays: None Warrants RESOLUTION 2017-126 RESOLVED,that the Board of Commissioners of the Fishers Island Ferry District hereby approves an additional Warrant(D)dated July 10th in the amount of$388.19 for the MTA payment. Moved by:Commissioner H. Burnham Seconded by:Commissioner D.Shillo Ayes:A.Ahrens,W. Bloethe, H. Burnham, P. Rugg and D.Shillo Nays: None RESOLUTION 2017-127 RESOLVED,that the Board of Commissioners of the Fishers Island Ferry District hereby approves the Warrant dated July 24,2017 in the amount of$57,846.41. Minutes of the Meeting of the Board of Commissioners Fishers Island Ferry District July 10, 2017 Commissioner Ahf"ens at the Fishers Island Community Center called to order a meeting of the Board of Commissioners of the Fishers Island Ferry District("the Fer y District") on June 26, 2017 at 4:30 PM.- Commissioners M.Commissioners William Bloethe, Heateer Burnham, Peter Frugg and Di Shillo were present.Also in attendance were Gordon Murphy, Geb Cook and Deanna Ross. RJ Burns was present via phone. Several members of the public were present. Commissioner Ahrens established that a quorum was present. Everyone in attendance pledged allegiance to the flag. Correspondence/Public Comment—Mr. Cook received two pieces of correspondence via email regarding the hovercraft. One letter was received from Mr. Rich Bartels expressing his discontent with the hovercraft docking at Silver Eel Cove at 2:30am. Mr. Cook reached out to the captain of the Hovercraft and moving forward,they have agreed to not permit chartered trips that late.The second piece of correspondence was received from Ms. Lauren Calahan voicing noise complaints in Silver Eel Cove. Mr. Cook spoke with Ms. Calahan at length last Friday regarding her concerns, Mr. Peter Burr asked the BOC to reconsider resuming the half-priced fares for non residents during the peak season. Mr. Burr feels that it was a nice benefit in years past and the majority of passengers have not abused it. Discussion ensued among the BOC and members of the public.The BOC has agreed to revisit the current policy. A member of the public asked the BOC what the liability was for folks entering and exiting the hovercraft using the ladder on the dock. Mr. Cook informed everyone that both parties carry liability insurance and there will be consideration of a floating dock if the partnership with the hovercraft continues after the trial season. A question was brought to the attention of the BOC regarding the recourse for damaged freight. Mr. Burns informed all that the policy is that the FIFD will not accept damaged goods at the New London Terminal. In the event that freight is damaged, anyone receiving the freight should address that with a manager. Another question arose regarding times in which the Fishers Island freight shed is closed to process incoming freight. The BOC and management has agreed to ensure proper signage so customers are aware of closing times. 41-1 Management Reports SEC Dolphin Project-Mr. Burns updated the BOC. Mr. Burns and Mr. Cook reviewed the contract documents with Keith Neilsen of Docko,who has been in contact with Mohawk. The funding is in place and they are now waiting for a date to meet and sign the agreement to get the project underway for the ".SL' _ ;­'--""" 1 5 FISHERS ISLAND FERRY DISTRICT VENDOR 019269 DIANNA L. SHILLO 11/21/2017 CHECK 4493 A FUND & ACCOUNT P.O.# INVOICE DESCRIPTION k' SM .5712-.4.000.000, 111317 117 COMM MTG JUL-SEP(7) 350.00 TOTAL 350.00 "z o ----- -- --- - - W . -ZA, -1717RR, DISTRICT--, SlSL&M,,fERR 1-1/'2' 7':' FISHER AUDIT,,' -'530 5,_ 9 lMAlNrR0AD,f0'B0X,1179-- Y 11971-'0959 1, '- CHECKF 0 'S0UTH0Lp,',N t 44 THE OLK COA kTIONAL BA AWIUNT- TEI, '-CUTCHOGUE,'NY-,ll935 ,,' ,-, , -1- F__ DA y "11 '21/2017- '5Q-546!214,214 -C', TRR)RjE"'HUNDR v PAY SHILLO" pili.. TO THE' P tor 'o' % ''F Af V I A 11'00449311' 1.0 2 1 L-0 S L-G L-1: GB OOLS02 A"' 4 A .l . r Vendor No. Check No. Town of Southold, New York - Payment Voucher 19269 L q2) Vendor Address Entered by PO Box 161 Fishers Island, NY 06390 Audit Date Dianna Shillo NOV 2 1 2017 Vendor Telephone Number Town Clerk Vendor Contact Invoice Invoice Invoice Net Purchase Order Number Date Total Discount Amount Claimed Number Description of Goods or Services General Ledger Fund and Account Number 11 i99PHN W 11/13/2017 $360.00 $360.00 Commission Meeting SM6712.4.000.000 E 3 Jul-Sep 2017 7 @$60 per meeting $360.001 1 $360.00 Payee Certification Department Certification The undersigned(Claimant)(Acting on behalf of the above named claimant) I hereby certify that the materials above specified have been received by me does hereby certify that the foregoing claim is true and correct,that no part has in good condition without substitution,the services properly been paid,except as therein stated,that the balance therein stated is actually performed and that the quantities thereof have been verified with the exceptions due and owing,and that taxes from which the Town is exempt are excluded. or discrepancies noted,and payment is approved Signature 01-�-4"Mzli itle Signature Company Name Fishers Island Ferry District Date 11/10/2017 Title Date fJ / BOC Meetings Rugg, Peter Ahrens, Andrew Shillo, Di Bloethe, W Burnham, H 10-Jul-17 X X X X X 5 24-Jul-17 X X X X X 5 7-Aug-17 X X X X X 5 18-Aug-17 X X X X X 5 5-Sep-17 X X. X X 4 18-Sep-17 X X X X 4 29-Sep-17 X X X X 4 32 5 7 7 6 7 32 3Q17 $ 250 $ 350 $ 350 $ 300 $ 350 $ 1,600 $ - edc— Page 1 \\fiserv1\D$\FD Network Directory\BOC\2017 Meetings-Commissioner Stipends 10/4/2017 Minutes of the Meeting of the Board of Commissioners Fishers Island Ferry District July 10, 2017 Commissioner Ah fens at the Fishers Island CommunityCenter called to order a meeting of the Board of g Commissioners of the Fishers Island Ferry District("the Ferry District") on June 26, 2017 at 4:30 PM. Commissioners William Bloethe, Heater Burnham, Peter l;(ugg an Ship re present.Also in attendance were Gordon Murphy, Geb Cook and Deanna Ross. RJ B as present via phone. Several members of the public were present. Commissioner Ahrens established that a quorum was present. Everyone in attendance pledged allegiance to the flag. i Correspondence/Public Comment—Mr. Cook received two pieces of'correspondence via email regarding the hovercraft. One letter was received from Mr. Rich Bartels expressing his discontent with the hovercraft docking at Silver Eel Cove at 2:30am. Mr. Cook reached out to the captain of the Hovercraft and moving forward,they have agreed to not permit chartered trips that late.The second piece of correspondence was received from Ms. Lauren Calahan voicing noise complaints in Silver Eel Cove. Mr. Cook spoke with Ms. Calahan at length last Friday regarding her concerns. Mr. Peter Burr asked the BOC to reconsider resuming the half-priced fares for non residents during the peak season. Mr. Burr feels that it was a nice benefit in years past and the majority of passengers have not abused it. Discussion ensued among the BOC and members of the public.The BOC has agreed to revisit the current policy. A member of the public asked the BOC what the liability was for folks entering and exiting the hovercraft using the ladder on the dock. Mr.Cook informed everyone that both parties carry liability insurance and there will be consideration of a floating dock if the partnership with the hovercraft continues after the trial season. A question was brought to the attention of the BOC regarding the recourse for damaged freight. Mr.- Burns informed all that the policy is that the FIFD will not accept damaged goods at the New London Terminal. In the event that freight is damaged,anyone receiving the freight should address that with a manager. Another question arose regarding times in which the Fishers Island freight shed is closed to process incoming freight. The BOC and management has agreed to ensure proper signage so customers are aware of closing times. Management Reports SEC Dolphin Project-Mr. Burns updated the BOC. Mr. Burns and Mr. Cook reviewed the contract documents with Keith Neilsen of Docko,who has been in contact with Mohawk. The funding is in place and they are now waiting for a date to meet and sign the agreement to get the project underway for the Minutes of the Meeting of the Board of Commissioners Fishers Island Ferry District July 24, 2017 Commissioner Ahrens at the Fishers Island Community Center called a meeting of the Board of Commissioners of the Fishers Island Ferry District("the Ferry District")to order on July 24, 2017 at 4:32 PM. / Commissioners William Bloethe,Heather4urnham, Peter Rug D.Shil were present. Also in attendance were Gordon Murphy,Geb Cook, Diane Hansen an D a Ross. R1 Burns was present via phone. No members of the public were present. Commissioner Ahrens established that a quorum was present. Everyone in attendance pledged allegiance to the flag. Correspondence/Public Comment—No correspondence was received.There is no public comment. Minutes- RESOLUTION 2017-125 RESOLVED,that the Board of Commissioners of the Fishers Island Ferry District hereby approves the minutes of the May 30,2017 meeting. Moved by:Commissioner A.Ahrens Seconded by:Commissioner W. Bloethe Ayes:A.Ahrens,W. Bloethe, H. Burnham, P. Rugg and D.Shillo Nays: None Warrants RESOLUTION 2017-126 RESOLVED,that the Board of Commissioners of the Fishers Island Ferry District hereby approves an additional Warrant(D)dated July 10th in the amount of$388.19 for the MTA payment. Moved by:Commissioner H. Burnham Seconded by:Commissioner D.Shillo Ayes:A.Ahrens,W. Bloethe, H. Burnham, P. Rugg and D.Shillo Nays: None RESOLUTION 2017-127 RESOLVED,that the Board of Commissioners of the Fishers Island Ferry District hereby approves the Warrant dated July 24,2017 in the amount of$57,846.41. Minutes of the Meeting of the Board of Commissioners Fishers Island Ferry District August 7, 2017 Commissioner Ahrens at the Fishers Island Community Center called a meeting of the Board of Commissioners of the Fishers Island Ferry District("the Ferry District")to order on August 7,2017 at 4:30 PM. Commissioners William Bloethe, Heather Burnham, Peter Rugg and D. Shillo were present.Also in attendance were Gordon Murphy,Geb Cook, Diane Hansen and Deanna Ross. No members of the public were present. Commissioner Ahrens established that a quorum was present. Everyone in attendance pledged allegiance to the flag. Correspondence/Public Comment— An email correspondence was received from Mr. Bob Evans stating that the airport lights are unnecessarily bright and invasive. The BOC has agreed that the lighting is in compliance with the FAA. Commissioner W. Bloethe questioned management regarding the refusal of accepting freight after 12:30pm on Saturdays at the New London Terminal. Management agrees that a mistake may have been made and will look into the matter further to avoid any future issues. Warrant RESOLUTION 2017-139 RESOLVED,that the Board of Commissioners of the Fishers Island Ferry District hereby approves the Warrant dated August 7, 2017 in the amount of$58,685.99. Moved by:Commissioner P Rugg Seconded by:Commissioner A Ahrens Ayes:A.Ahrens,W. Bloethe, H. Burnham, P. Rugg and D. Shillo Nays: None Budget Modification RESOLUTION 2017—140 RESOLVED that the Board of Commissioners of the Fishers Island Ferry District hereby increases the 2017 Fishers Island Ferry District budget as follows: Revenues: SM.4960.50 FEMA AID-TRANSPORTATION S 12 055.00 Total $ 12,055.00 Minutes of the Meeting of the Board of Commissioners Fishers Island Ferry District August 18,2017 Commissioner Ahrens at the Fishers Island Community Center called a meeting of the Board of Commissioners of the Fishers Island Ferry District("the Ferry District")to order on August 18, 2017 at 4:42 PM. V. Commissioners William Bloethe, Heather Burnham, Peter Rugg and D.Shillo were present.Also in attendance were Gordon Murphy,Jeb Cook and Deanna Ross. Several members of the public were present. Commissioner Ahrens established that a quorum was present. Everyone in attendance pledged allegiance to the flag. Members of the public were welcomed and the BOC congratulated Commissioner D.Shillo for winning the election. , Correspondence/Public Comment— Mr. Cook received one letter from the Town of Southold thanking the FIFD for use of the ferry on Town of Southold Day.There is no public comment. Minutes RESOLUTION 2017-150 RESOLVED,that the Board of Commissioners of the Fishers Island Ferry District hereby approves the minutes of the June 26, 2017 meeting. Moved by:Commissioner P Rugg Seconded by:Commissioner W Bloethe Ayes:A.Ahrens,W. Bloethe, H. Burnham, P. Rugg and D.Shillo Nays: None RESOLUTION 2017-151 RESOLVED,that the Board of Commissioners of the Fishers Island Ferry District hereby approves the minutes of the July 10,2017 meeting. Moved by:Commissioner D Shillo Seconded by:Commissioner A Ahrens Ayes:A.Ahrens,W. Bloethe, H. Burnham, P. Rugg and D.Shillo Nays: None Budget Modification RESOLUTION 2017-152 Minutes of the Meeting of the Board of Commissioners Fishers Island Ferry District September 5,2017 Commissioner Ah'Ferfs at the Fishers Island Community Center called a meeting of the Board of Commissioners of the Fishers Island Ferry District("the Ferry District")to order on July 24,2017 at 4:30 PM. s� Commissioners William Bloethe, HeatherBurnham and D.Shillo were present.Also in attendance were Gordon Murphy,Jeb Cook, RJ Burns, Diane Hansen and Deanna Ross. Commissioner Ahrens established that a quorum was present. Everyone in attendance pledged allegiance to the flag. Correspondence/Public Comment—Mr.Cook received one email regarding a cancelled Hovercraft run due to weather but then running it because the weather improved and not notifying the initial passengers that were cancelled. Mr. Cook spoke with that customer and acknowledged the error. A letter was received from Friends of the Fisher's Island Theatre(FFIT)expressing that they are currently in the process of obtaining 501(c)(3)status and their desire to purchase the Fishers Island Theatre. In addition a letter of intent was received from Walsh Park regarding a feasibility study to lease the second floor of the freight shed and turn into affordable housing apartments. Warrants RESOLUTION 2017-154 RESOLVED,that the Board of Commissioners of the Fishers Island Ferry District hereby approves the Warrant dated September 5th,2017 in the amount of$26,132.18. Moved by:Commissioner D Shillo Seconded by:Commissioner A Ahrens Ayes:A.Ahrens,W. Bloethe, H. Burnham and D.Shillo Nays: None Management Reports SEC Dolphin Status-Mr. Burns updated the BOC. The lack of progress is due to difficulty with the bottom. Permission was granted to allow the contractor to move some of the dolphins in order to get good penetration of 12-20 feet. Estimated time of completion is set for the end of next week. RacePoint Insulation-Mr. Burns informed the BOC that RP will be dockside the last two weeks of October for the installation of the A-60 structural fire protection. Minutes of the Meeting of the Board of Commissioners Fishers Island Ferry District September 18,2017 Commissioner Ahrens at the Fishers Island Community Center called a meeting of the Board of Commis- sioners of the Fishers Island Ferry District("the Ferry District")to order on September 18, 2017 at 4:30 PM. Commissioners William Bloethe, Heather Burnham,and D.Shillo were present.Also in attendance were Geb Cook and Deanna Ross. Commissioner P. Rugg, RJ Burns and Diane Hansen were present via phone. Commissioner Ahrens established that a quorum was present. Everyone in attendance pledged alle- giance to the flag. Correspondence/Public Comment—Mr.Cook informed the BOC that a letter was received from Rev. Candy Whitman requesting if management and the BOC would consider changing the Sunday 7am boat departing from New London to Sam to accommodate guest speakers and musicians on Sunday morning church service at the Union Chapel which begins at 10am. Mr.Cook has agreed to evaluate over the next coming year. An email was received by Fishers Island School Principal,Christian Arsenault expressing thanks and gratitude to the ferry district and crew members for holding the annual ferry safety day. Chairman Ahrens reported to the BOC that he received a phone call from Mrs. Patty Faulkner requesting if someone was available to go to the utility office and explain the new two-way ticketing system to her and staff members. Mr.Cook agreed to take that responsibility.There is no public comment. Impending Weather-Mr. Burns informed the BOC that he has been in contact with Mr.Arsenault and the FI School. Mr. Burns does not foresee any upcoming cancellations with the current ferry schedule. The cargo run has been moved to Friday and will be on MV Munnatawket as it is a better sea boat and fits better in the cove.Additionally both barges will be removed from Silver Eel Cove due to impending weather. Minutes RESOLUTION 2017-166 RESOLVED,that the Board of Commissioners of the Fishers Island Ferry District hereby approves the `minutes of the July 24,2017 meeting. Moved by:Commissioner W. Bloethe Seconded,by:Commissioner A.Ahrens Ayes:A.Ahrens,W. Bloethe, H. Burnham and D.Shillo Nays: None RESOLUTION 2017-167 Minutes of the Meeting of the Board of Commissioners Fishers Island Ferry District September 29,2017 Commissioner Ahrens at the Fishers Island Community Center called to order a meeting of the Board of Commissioners of the Fishers Island Ferry District("the Ferry District")on September 29,2017 at 1:00 PM. Commissioners Heather Burnham, Peter Rugg and Dianna Shillo were present.Also in attendance were Geb Cook, RJ Burns, Diane Hansen and Deanna Ross. Marcia Marien of O'Connor Davies was present. Commissioner William Bloethe and Gordon Murphy were absent. Commissioner Ahrens established that a quorum was present. Everyone in attendance pledged alle- giance to the flag. Correspondence/Public Comment—Mr.Cook reported that no correspondence was received. There was no public comment. The BOC agreed to add an executive session to the September 29,2017 agenda. Moved by:Commissioner D.Shillo Seconded by:Commissioner A.Ahrens Ayes:A.Ahrens, H. Burnham, P. Rugg and D.Shillo Nays: None Warrants RESOLUTION 2017-177 RESOLVED,that the Board of Commissioners of the Fishers Island Ferry District hereby approves the Warrant dated September 29,2017 in the amount of$66,700.36. Moved by:Commissioner A.Ahrens Seconded by:Commissioner D.Shillo Ayes:A.Ahrens, H. Burnham, P. Rugg and D.Shillo Nays: None Audit Review-Ms. Marcia Marion,CPA for O'Connor Davies presented the Fishers Island Ferry District December 31,2016 Audit to the BOC. Audit RESOLUTION 2017-178 Whereas the 2016 financial audit was approved by the Board of Commissioners of the Fishers Island Fer- ry District. MW ""V 1vt Rm FISHERS ISLAND FERRY DISTRICT VENDOR 019711 STAPLES CONTRACT & COMMERCIAL, 11/21/2017 CHECK 4494 A FUND & ACCOUNT P.O.4 INVOICE 1 DESCRIPTION AMOUNT SM .5711.4.000.000 3355965425 JCS-COPY PAPER,2-ERASERS -37.94 SM .5709.2.000.200 1 '1632 NLT-BAND AID PACK . 3357327943 k SM .5710.4.000.-600/ 3357327943 2 CASES-PAPER TOWELS 77.28 ' 121 3357327947 LYSL WIPES,HAND SANITZER 57.78 SM .5710.4.090.600 SM .5711.4.000.0003358511377 1BX-FILE FOLDERS,1-TONER -39 66. SM ".5709 2.000.200 3358511380 BATTERY,FLOOR CHAIRMATI_ 50.74 -. SM .5111.4.000.000 3358511380 2BXS PENS,1PK-MEMo EOOJ S_ 7 8-6- TOTAL151 313.71 -) nt on 'w tj,, 2 ERRYDISTUCT F 53095 MAIN AOAD,,PO,BOX j47q_,.,, 9 - "-"'SOUTHOLD,NY 971-0959- F vsmRs'IsLOAD, I Cf) NATIONAL HAN&---' a. ES TH F O(K'T ,-AMOUNT,- .CUTCHOGUE,NY'11935 t, 11 ij.2,0 i J ,,,50-546/2 4 IV14REE HtMDREb ',,TH-IRTEEN-.AND'--7,1, 1:010 "DOLLARS, yt q -7,=Z, ,A ­,$TAPi , Co &T­RACT, &­COMMERC: e'i-,l TO TUE -2 5-e EbXT 4 1'5 -P,0 _,,,'pOSTON,,,,MA:,6224 i Z5-256' - n_ 11.00449°411'r 1:0 2 I40,54641: 68 00LS02 Lei' 1 f Vendor No. Check No. Town of Southold, New York - Payment Voucher 19711 1"i' Vendor Tax ID Number or Social Security Number Vendor Address Entered by Dept NY �& PO Box 415256 Audit Date STAPLES CONTRACT&COMMERCIAL Boston, MA 02241-5256 NOV 2 12017 Vendor Telephone Number 888-753-4107 Town Clerk Vendor Contact Invoice Invoice Invoice Net Purchase Order Number Date Total Amount Claimed Number Description of Goods or Services General Ledger Fund and Account Number yY ca� 3355965425 10/14/2017 $37.94 $37.94 Officb Sup lies FI SM5711.4.000.000 3357327943 10/28/2017 $93.60 $16.32 Band Aid Pak NLT SM5709.2.000.200 $77.28 Bounty Basic Paper towel 2ct SM5710.4.000.600 �y Sod WPR3,4)av-,&3anize-/ 3357327947 10/28/2017 $57.78 $57.78 Janitorial NLT N is Erases SM5710.4.000.600 3358511380 11/4/2017 $58.00 $50.14 Batte 1pk�floor chairmat SM5709.2.000.200 $7.86 Office Supplies 1-1 SM5711.4.000.000 3358511377 11/4/2017 $66.39 $66.39 Officce) upplies Nif SM5711.4.000.000 $313.71 $313.71 Payee Certification Department Certification The undersigned(Claimant)(Acting on behalf of the above named claimant) I hereby certify that the materials above specified have been received by me does hereby certify that the foregoing claim is true and correct,that no part has in good condition without substitution,the services properly been paid,except as therein stated,that the balance therein stated is actually performed and that the quantities thereof have been verified with the exceptions due and owing,and that taxes from which the Town is exempt are excluded or discrepancies noted,and payment is approved Signature M1 0114 ✓ Title Signature Company Name Fishers Island Ferry District Date 11/7/2017 Title Date Jj d STAPPIES 11*VOICE DATE, CUSTOMER SUMMARY xmvoiCe Business Advankige 10/14/17 NYC 1032952 8046878404 PLEASE PAY BY TERMS AMOUNT DUE 11/13/17 Net 30 Days 37.94 LAW010EDETAm staples Business Advantage Federal ID #:04-3390816 Bill to Account: 1017907 Ship to Account: FIFBRRY FISHERS ISLAND FERRY DISTRICT FISHERS ISLAND FERRY DISTRICT ATTN: ACCOUNTS PAYABLE ATTN: GORDON MURPHY PO BOX 607 261 TRUMBULL DR #PC67296 FISHERS ISLAND, NY 06390 FISHERS ISLAND, NY 06390-0607 Budget ctr 1010 invoice Number: 55965425 Budget Ctr Desc: order 7 84955042-000-001 P 0 Number FI TERMINAL ordered By GORDON MURPHY P 0 Desc order Date 10/11/17 Release Release Desc Order order B/o Unit ship Unit Extended Line Item Number Description Qty QtyMeas Qty Price Price 1 135848 STAPLES 8.5X11 COPY CS 0 1 0 CT 1 35.98 35.98 2 634797 DRY ERASE ERASER O 2 0 EA 2 .98 1.96 Freight: .00 Tax:( .0000 %) .00 sub-Total: 37.94 "A- Total: 37.94 ,�` customer service inquiries # 877-826-7755 Invoice Payment Inquiries 888-753-4107 Page: 1 Make checks payable to Staples Contract & Commercial, Dept NY Po Box 415256, Boston MA 02241-5256 To reach Customer Service, REFER TO THIS ORDER NO. FOR ALL IN UIRIEj{ please dial (877)285-8852. CUSTONM NO. I SHIM -DaTar ORDER NO, 0001032952 110/11/17 7184955042-000001 )?1=9`SE ORDER NO. �i��'LA3� X70SIAM woo on"' . FI TERMINAL a Ore HAPPEN- . COST M TT&R REQUISITIONER MAKE M Staples Business Advantage SHIPPING LOCATION:Putnam, CT FC CARRIER ROUTE:SP1/UPS /U2 FISHERS ISLAND FERRY DISTRICT GORDON MURPHY FISHERS ISLAND FERRY DISTRICT TOTAL PACKAGES: 2 261 TRUMBULL DR PO BOX 607 P. FISHERS ISLAND, NY 06390 #PC67296 Contact: (631) 788-7463 - GORDON MURPHY MO FISHERS ISLAND, NY 063900607 Ex PAGE: 1 SPECIAL INSTRUCTIONS THE NEW YORK STATE CONTRACT REQUIRES THAT OFF CONTRACT ITEMS BE PLACED ON A SEPARATE ORDER FROM CONTRACT ITEMS. YOU MAY BEGIN TO RECEIVE YOUR PURCHASES SPLIT INTO TWO ORDERS. True 3T3 2#f�SER TTEbS 10�}1fr �o� QTYS�Ek E3 IP RE4>A# NL MER I�RTiER 4S�P BTS 1 13-5848 STAPLES 8.5X11 COPY CS /135848-WH �j CT 1 1 0 2 634797 DRY ERASE ERASER /13612 •/ EA 2 2 0 C Check your order status online by MA1MMCMHAPPW' ' News selecting My Order Status from the & Previews- My Orders drop down. 001 Thank You For Your Order! Staples, Inc. STAPLES INVOICE DATE CUSTOMER SUMMARY INVOICE Business Advantage 10/28/17 NYC 1032952 8047099546 PLEASE PAY BY TERMS AMOUNT DUE 11/27/17 Net 30 Days 151.38 1"010E ,DETAIL Staples Business Advantage Federal ID #:04-3390816 Bill to Account: 1017907 Ship to Account: FIFERRY FISHERS ISLAND FERRY DISTRICT FISHERS ISLAND FERRY DISTRICT ATTN: ACCOUNTS PAYABLE ATTN: ORDERS FIFERRY PO BOX 607 261 TRUMBULL DR #PC67296 FISHERS ISLAND, NY 06390 FISHERS ISLAND, NY 06390.0607 Budget Ctr : 1010 Invoice Number: 3357327943 Budget Ctr Desc: Order 7185594892-000-001 P 0 Number NL TERMINAL Ordered By ORDERS FIFERRY P 0 Desc Order Date 10/23/17 Release Release Desc order order B/o unit ship unit Extended Line Item Number Description Qty Qty Meas Qty Price Price 1 485107 BAND AID VARITY PAK 280BX 11�1 4 0 BX 4 4.08 16.32 2 325791 BTY BASIC 30PK WH 44 SHEETS/RL 2 0 CT 2 38.64 77.28 Freight: .00 Tax:( .0000 %) .00 sub-Total: 93.60 Total: 93.60 customer service inquiries # 877-826-7755 Invoice Payment Inquiries 888-753-4107 Page: 1 make checks pay to stn les contract & comercial, De t NY PO Box 415256, Boston MA 02241-5256 To reach Customer Service, REFER TO THIS ORDER NO. FOR ALL INQUIRIES please dial (877)285-8852. Cty'S'1'fxMR v . I pHip DA== ORD..9A 900 0001032952 110/23117 7185594892-000001 NL TERMINAL PPEN� COST NTBR REQUISITIONS. MAKE rnOre"A Staples Business Advantage SHIPPING LOCATION:Putnam, CT FC CARRIER ROUTE:SP1/UPS /U2 FISHERS ISLAND FERRY DISTRICT ORDERS FIFERRY FISHERS ISLAND FERRY DISTRICT TOTAL PACKAGES: 3 261 TRUMBULL DR L PO BOX 607 FISHERS ISLAND, NY 06390 #PC67296 T Contact: (860) 442-0165 - ORDERS FIFERRY T FISHERS ISLAND, NY 063900607 U6 PAGE: 1 SPECIAL INSTRUCTIONS THE NEW YORK STATE CONTRACT REQUIRES THAT OFF CONTRACT ITEMS BE PLACED ON A SEPARATE ORDER FROM CONTRACT ITEMS. YOU MAY BEGIN TO RECEIVE YOUR PURCHASES SPLIT INTO TWO ORDERS. X3kSlC�} i UNI iaeTt bi�gCRll�`RI�i� Nt �� �Rs�xa € z/fix 9 1 485107 BAND AID VARITY PAK 280BX /4711 BX 4 4 0 2 325791 BTY BASIC 30PK WH 44 SHEETS/RL/92976 CT 2 2 0 /"',V J L� I re Check your order status online by News selecting My Order Status from the e Previews My Orders drop down. 001 Thank You For Your Order! Staples, Inc. STAPLES INVOICE DATE CUSTOMER SUMMARY INVOICE Business Advantage 10/28/17 NYC 1032952 8047099546 PLEASE PAY BY TERMS AMOUNT DUE 11/27/17 Net 30 Days 151.38 IATOICED.smm staples Business Advantage Federal ID #:04-3390816 Bill to Account: 1017907 Ship to Account: FIFERRY FISHERS ISLAND FERRY DISTRICT FISHERS ISLAND FERRY DISTRICT ATTN: ACCOUNTS PAYABLE ATTN: ORDERS FIFERRY PO BOX 607 261 TRUMBULL DR #PC67296 FISHERS ISLAND, NY 06390 FISHERS ISLAND, NY 06390-0607 Budget Ctr : 1010 invoice Number: 3357327947 Budget Ctr Desc: order 7185719149-000-001 P 0 Number NL TERMINAL Ordered By ORDERS FIFERRY P 0 Desc Order Date 10/25/17 Release Release Desc order order B/o unit ship unit Extended Line Item Number Description Qty Qty Meas Qty Price Price 1 048444 MR CLEAN MAGIC ERASER EXDU 7CT 1f 1 0 PK 1 8.80 8.80 2 674106 LYSOL SANITIZNG WIPE CITRUS110'Y 1 0 PK 1 7.61 7.61 3 607841 SANITIZER HAND PURELL 80Z ly 1 0 CT 1 41.37 41.37 Freight: .00 Tax:( .0000 %) .00 sub-Total: 57.78 Total: 57.78 customer service inquiries ffi 877-826-7755 Invoice Payment Inquiries 888-753-4107 Page: 1 Make checks a able to stn les Contract & commercial, Dept NY PO Box 415256, Boston MA 02241-5256 To reach Customer Service, REFER TO THIS ORDER NO. FOR ALL INQUIRIES please dial (877)285-8852. -CUS 'OM NO. SHIP VA= 09DRA go 0001032952 110/25/17 7185719149-000001 12,URt=,9j9 OkDaR NGtmRELEASE 900 NL TERMINAL m COST CazTER RZOVISITIONER mAKE orellAPPEN- Staples Business Advantage SHIPPING LOCATION:Putnam, CT FC CARRIER ROUTE:SP1/UPS /U2 FISHERS ISLAND FERRY DISTRICT H ORDERS FIFERRY FISHERS ISLAND FERRY DISTRICT TOTAL PACKAGES: 1 261 TRUMBULL DR La PO BOX 607 FISHERS ISLAND, NY 06390 #PC67296 Contact: (860) 442-0165 - ORDERS FIFERRY FISHERS ISLAND, NY 063900607 0 PAGE: 1 SPECIAL INSTRUCTIONS THE NEW YORK STATE CONTRACT REQUIRES THAT OFF CONTRACT ITEMS BE PLACED ON A SEPARATE ORDER FROM CONTRACT ITEMS. YOU MAY BEGIN TO RECEIVE YOUR PURCHASES SPLIT INTO TWO ORDERS. xxcscsQTY -qTy TMA Fa/4 �4ux L D $ 1 04.8444 MR CLEAN MAGIC ERASER EXDU 7CT/83906 PK 1 1 0 2 674106 LYSOL SANITIZNG WIPE CITRUS110/1920078849 PK 1 1 0 Material Safety Data Sleets (MSDS) may be found by visiting http://sds.E tar les.com/msds/674106.pdf 3 607841 SANITIZER HAND PURELL 8OZ /9652-12/GOJ9652 CT 1 1 0 Material Safety Data Sleets (MSDS) may be found by visiting http://sds.Etarles.com/msds/607841.pdf 05 MAKE mpg HAPPEN Check your order status online by News ' selecting My ,Order Status from the e Previews' My Orders drop down. 001 Thank You,For Your Order! Staples, Inc. STAPLES zoVo ce DATE 6tln6 tk"' - Business Advantage 11/04/17 NYC 1032952 8047229921 OLEASt k*BY _ lrtkmt ;� °.::r :`':;AMOVNT 7;3111E.7> .. 12/04/17 Net 30 Days 124.39 IhVOICEDETAm staples Business Advantage Federal ID #:04-3390816 Sill to Account: 1017907 Ship to Account: FIFERRY FISHERS ISLAND FERRY DISTRICT FISHERS ISLAND FERRY DISTRICT ATTN: ACCOUNTS PAYABLE ATTN: GORDON MURPHY PO BOX 607 261 TRUMBULL DR #PC67296 FISHERS ISLAND, NY 06390 FISHERS ISLAND, NY 06390-0607 Budget ctr : 1010 Invoice Number: 3358511380 Budget Ctr Desc: order 7186090437-000-001 P 0 Number FI TERMINAL Ordered By GORDON MURPHY P 0 Desc Order Date 10/31/17 Release Release Desc order order B/o Unit ship unit Extended Line Item Number Description Qty t Meas Qty Price Price 1 503573 COPPERTOP 9 VOLT BATTERY 1 0 PK 1 14.56 14.56 2 1174251 SBG 36x48 FLOOR CHAIRMAT BLK 17 T 1 0 EA 1 35.58 35.58 3 2072180 REMARX CHISEL BLK 12PK 0 1 0 DZ 1 5.62 5.62 4 200014 MEMO BOOK 6X4 SIDE OPEN 5PK 0 1 0 PK 1 2.24 2.24 Freight: .00 Tax:( .0000 %) .00 sub-Total: 58.00 Total: 58.00 Customer service inquiries # 877-826-7755 Invoice Payment In uiries 888-753-4107 Page: 1 Make checks payable to staples contract & commercial, De t NY PO Box 415256, Boston MA 02241-5256 I TG reach Customer Service, REFER TO THIS ORDER NO. FOR ALL INQUIRIES please dial (877)285-8852. CUSTO=R NO. SHIP DAA. ORDPA goy 0001032952 10/31/17 7186090437-000001 vukcFisa ORDER No. A=9A8Ig • FI TERMINAL OrewAPPEN� COST MUTER �tEQVISITIONER -;AKS°►� Staples Business Advantage SHIPPING LOCATION: Putnam, CT FC CARRIER ROUTE:SP1/FDX /F2 FISHERS ISLAND FERRY DISTRICT GORDON"MURPHY FISHERS ISLAND FERRY DISTRICT TOTAL PACKAGES: 2 261' TRUMBULL DR PO BOX 607 FISHERS ISLAND, NY 06390 #PC67296 Contact: (631) 788-7463 - GORDON MURPHY FISHERS ISLAND, NY 063900607 PAGE: 1 CIAL INSTRUCTIONS. THE NEW -YORK STATE CONTRACT REQUIRES THAT OFF CONTRACT ITEMS BE- PLACED,-ON A 'SEPARATE ORDER FROM CONTRACT ITEMS. YOU MAY BEGIN TO -RECEIVE YOUR PURCHASES SPLIT INTO TWO ORDERS. CITY QTY HSE# qct �ESOxa� ON l Nsn t�2t oxa SRS 503 'h;3 COPPERTOP 9 VOLT BATTERY MN16RT4Z PK 1 1 / 0 Ia't` yl";,afety Data S1.eets (MSDS) may be found by visiting http://sds. tar les.com/ s/503573.pdf SBG 36X48 FLOOR CHAIRMAT BLK /26990 EA q" 1 0 i X07218,01-r REMARX CHISEL BLK 12PK /29211 DZ 1 0 Material Safety Data Sleets (MSDS) may be found by visiting http://sds. to les.com/ s s/2072180.pdf 200014 MEMO BOOK 6X4 SIDE OPEN 5PK /11495 PK 1 1 0 our Check , order status online b mcraNnva�x�., _ Y Y selecting My Order Status from the ,e aewe My Orders drop down. - 001 Thank You For Your Order! Staples, Inc. STAPLES INVOICE DATE CUSTOMW :..."m �. :.;, �� suMMARY NV6icE Business Advantage 11/04/17 NYC 1032952 8047229921 Pt fiE PAY BY T Elt?I$ MOill T 1* 12/04/17 Net 30 Days 124.39 INVOICE DETAm staples Business Advantage Federal ID #:04-3390816 Bill to Account: 1017907 Ship to Account: FIFERRY FISHERS ISLAND FERRY DISTRICT FISHERS ISLAND FERRY DISTRICT ATTN: ACCOUNTS PAYABLE ATTN: DIANE HANSEN PO BOX 607 261 TRUMBULL DR #PC67296 FISHERS ISLAND, NY 06390 FISHERS ISLAND, NY 06390-0607 Budget Ctr : 1010 Invoice Number: 3358511377 Budget Ctr Desc: Order 7185954907-000-001 P 0 Number DIANE ordered By DIANE HANSEN P 0 Desc Order Date 10/29/17 Release Release Desc Order order 9/0 Unit Ship unit Extended Line item Number Description Qty QtyMeas Qty Price Price 1 1051099 SEB REMAN TNR BRO TN750 HY BLK 10 1 0 EA 1 51.26 51.26 2 221689 FOLDR 1/3CUT LTR MANILA 250 0 1 0 BX 1 15.13 15.13 Freight: .00 'rax:( .0000 %) .00 sub-Total: 66.39 Total: 66.39 customer service inquiries # 877-826-7755 Invoice Payment Inquiries 888-7S3-4107 Page: 1 Make checks a able to Staples Contract & commercial, Dept NY PO Box 415256, Boston MA 02241-5256 To reach Customer Service, REFER TO THIS ORDER NO. FOR ALL INQUIRIES please dial (877)285-8852. CUSTOMER NO.. SHIP ]DATE 09DBR No 0001032952 10/30/17 7185954907-000001 PIR,M A$9 ORDER NO. RgLEAgE SO DIANE ore HAPPEN COST CENTER REQVIsITTON R MAKE m Staples Business Advantage SHIPPING LOCATION:Putnam, CT FC CARRIER ROUTE:SP1/UPS /U2 FISHERS ISLAND FERRY DISTRICT DIANE HANSEN O FISHERS ISLAND FERRY DISTRICT TOTAL PACKAGES: 1 261 TRUMBULL DR L PO BOX 607 8 FISHERS ISLAND, NY 06390 #PC67296 T Contact: (631) 788-7463 - DIANE HANSEN T FISHERS ISLAND, NY 063900607 fx � PAGE: 1 SPECIAL INSTRUCTIONS THE NEW YORK STATE CONTRACT REQUIRES THAT OFF CONTRACT ITEMS BE PLACED ON A SEPARATE ORDER FROM CONTRACT ITEMS. YOU MAY BEGIN TO RECEIVE YOUR PURCHASES SPLIT INTO TWO ORDERS. il@ XCE 3 NL�M$7 XTO 4 QTY qTy 7�Q Litl+ nL$GR2 PP$b2 f Xit1MBXR (>MZRJM oltrpv= 1 1051099 SEB REMAN TNR BRO TN750 HY BLK/SEBTN750R EA �1 1 0 Material Safety Data Sleets (MSDS) may be found by visiting http://sds.E;tarles.com/msds/1051099.pdf 2 221689 FOLDR 1/3CUT LTR MANILA 250 /221689 BX ✓ 1 1 0 I� Check your order status online by News selecting My Order Status from the & Previews My Orders drop down. 001 Thank You For Your Order! Staples, Inc. " ., aii .G."':T a-r`.•t.:Y t' `.i i+-_- f :SSS ;,y ra+,S"tt m« 3_ 9" Ly.a' gyG:1 N xa 77'{'•Sr`,.' ,_ i r.'iq, FISHERS ISLAND FERRYDISTRICT VENDOR ;019719 STAPLES CREDIT PLAN 11/21/2017 CHECK 4495 FUND & ACCOUNT P.O.# INVOICE ' DESCRIPTION AMOUNT 'G}£ SM .5709:2.000.200 _ 191964304 CREDIT CARD CLEANING KIT 9.99 SM .5710.4.000.60.0 191964304 2 CASES—TISSUES TOTAL / 21.98 :c \ '1 V «.j I ;t< ,: rx a..:>,. .> -.vaZ.:Y..K«•.C,4 .::^fix`r. ,n... .,' ' .;t {'' lq fv,L y .%'•_,: x_.*4 ",xx,^'-r-n , T. 'v&, `ss:' .4 _ i 1'. • -.I ' 9. .`:Irw..axr ww....<," .e, a_+,".r6x-d.,a,+ w E:. 'jam o•:•:V :i °:C'''E:^' i::;C,:;' Y '`S% ,.d'<- • _ d{g•:t ::::Sai':•: ':iVr'ifN$` ::t:fi'.. .:kcb':•:i! :tg ``1' _ •F : }y \' I;a - Y- ' 1 t . ,flySam K. ,, •, .-,1yF _ _, , - I - }•,,#_ ' < <, ;,- - y: ` "F RRYDIS7RICT-''-"- ',' a FISHERS';ISLAAD E AUDIT' ,2.1%17 53095, AIN AOAD,PO'BOX 1179 _ SOUT,HOLD,NY 1.1971-0959 = CHECK` 'DTO:_ ,"44 s, h `=TY4,s F &O cO.NATIONAL BANK,' CUTCHOGUE,,NY,11935 ,,`DATE, 21'/2017Y` 2'1`•:;9 8'c 60.5 6/2 TWE -TY ONE-,'''AND A98 1`00'DOT,LARS AY' STAPLEkSREDIT .PLAN 1•'1`! I f , TO'THE =°;'DEPT:51' = ,78'2'0657673'` _ _ ,RDER I = , L- to s PO`=BOX, 7,8004,: OF'' 'PHOENIX. AZ' 8004 -- i'•'%!a5- ._..._X„='•- -W` ='x= -- k_f-"" .4:.......,'-i,. '- +.r_. .c: .:.:,,d»+-'_y-,.. '.e-.3..+.< —_u._., ',.1, ,s:ti t-...4 N,..sH.. ...i..a+,.i:.:n' ✓-.t<......a- ..... <.._ ._.:_w- +r -d,+ --.- 11•004495illi0 2 140 54641: 6r8 00 150 2 Lu' { Vendor No. Check No. Town of Southold, New York - Payment Voucher 19719 5 Vendor Tax ID Number or Social Security Number Vendor Address Entered by Dept 51-7820657673 PO Box 78004 Audit Date STAPLES CREDIT PLAN Phoenix,AZ 85062-8004 NOV 2 12017 Vendor Telephone Number 800-767-1291 n Clerk Vendor Contact • � Invoice Invoice Invoice Net Purchase Order Number Date Total Amount Claimed Number Description of Goods or Services General Ledger Fund and Account Number 191964304 10/13/2017 $21.98 $9.99 Credit card cleaning kit SM6709.2.000.200'-, $11.99 Facial tissue 2 10bxcase SM5710.4.000.600 $21.98 $21.98 Payee Certification Department Certification The undersigned(Claimant)(Acting on behalf of the above named claimant) I hereby certify that the materials above specified have been received by me does hereby certify that the foregoing claim is true and correct,that no part has in good condition without substitution,the services properly been paid,except as therein stated,that the balance therein stated is actually performed and that the quantities thereof have been verified with the exceptions due and owing,and that taxes from which the Town is exempt are excluded. or discrepancies noted,and payment is approved Signature Title Signature Company Name Fishers Island Ferry Date 11/7/2017 Title Date Kasia Asmolov From: Staples <support@orders.staples.com> Sent: Tuesday, November 07, 2017 11:00 AM To: Kasia Asmolov Subject: Staples Order 9761517155:Transaction Details Summary Hello Gordon Murphy, Below you will please find the payment transaction details you requested. Staples Order 9761517155 Order Date: Thursday, October 12, 2017 Invoice#: 191964304 CHARGED on Friday,October 13,2017 Item(s) Shipped Item# Item Description Price Quantity Discounts You Paid 646825 Clea Card International Credit Card Cleaning Kit $999 1 -$000 $9.99 887832 Sustainable Earth By Staples Facial Tissue 2ply $11.99 1 -$0.00 $11.99 Flat Box 100 Sheetsbx 10 Bxcase Seb20195cc Method"of Payment' Subtotal:,. $21'.98" 'Staples Card Ending in, 7673 $21.98 Discounts: .:$0.00 Shipping/fees': $0.00. Tax: $0.00 Total:°. . , $21.98' Have a question?Visit our Help Center -Free Delivery Free Returns Price Match Guarantee Free next-day delivery on Not 10,0% satisfied? Pay the lowest price every time orders over$49.99 for Return items easily you shop.We'II Match any Rewards@ members online. :competitor with an online and retail Order by 5:00 pm local time. store. Excludes weekends and holidays. Eligible items only. ; Questions about your order? REFER_ TO THIS ORDER NO. f6k ALL IN UIR.«o Visit our Help Center at C`i1'S',L'f5M7MR NQSI aFIP VA= O9D9R NO. www.stapies.com/help-center 4051825224 10/12/17 9761517155-000001 � f COST MNTBR RBQMSTTTONzR MAKE MOre HAPPEN" Staples Make More Happen SHIPPING LOCATION:Putnam, CT FC CARRIER ROi7TE:SPl/FDX /F2 FISHES ISLAND FERRY � TOTAL PACKAGES: 1 GORDON MURPHY 261 TRUMBULL DR L P FISHERS ISLAND, NY 063908021 Contact: (631)788-7463 - GORDON MURPHY SPECIAL INSTRUCTION'S Y' t ¢(Yg3y3x QTY Staples Zctended XTEX.?# �' M b fJS3 k1 ISL$CRSI�'FS.Ol�f f N Eif - �� fJR7iEItSII SHIPPED Amount 1 646825 Clean Card International Credi/CC23 PK 1 1 9.99 9.99 2 887832 Sustainable Earth by Staples f/SEB20195-CC PK 1 1 11.99 11.99 M rc andise Total. . . . . . . . 21.98 D li ery. . . . . . . .00 T . . . . . . . . . . . .00 ------------- Check your order statuE online by going to www.Staples.com and clicking on "Track rder" . .MMMOM"°'"F" Need to return something? Visit News www.staples.com/returns. For store TOTAL VALUE a Previews returns, bring this pack slip. PAYMENT METHOD: OF ORDER: 21.98 001 Thank You For Your Order! Staples, Inc. THIS IS NOT ANINVOICE 77 _77W OF FISHERS ISLAND FERRY DISTRICT VENDOR 019823 SULLY'S MOBIL MART-_ 11/21/2017 -,CHECK -4496 A INVOICE AMOUNT P.O.# DESCRIPTION FUND & ACCOUNT SM .5710.,2.000.100 569000 8.572 GAL GAS-11/6 23.82 TOTAL 23.82 - X, ., k.n,t 4:,,... ..- . <. .-...... w..._.„ .,,, ,. ..F yw+.- nf; r..c;;M1 ;@::;;s:•' :;;. 3,t i _ ril Q xze, t. ------ -------- - v f -MAIN ROAD,PO-,60X,1,,17p,:t -,',-,' ',.,- 53096 SOLITHOLD;.Nyl-1971-0959 6 B6. NK r AMOUNT ---T4 NATIONAL B;k F ";' FISHERS.ISLAIVD``EERRXD _TROT 7 T % AUD 1 7, t 4 9 qUTCHOGUE,'NY 11935, _,,DA E, 0 60 -5461214' D 'ANf)"82 :TWENTY -HPE -/16+0 DOLLARS SUL] Y.1 S,-MOBIL ; MARS: PA 0'6' T, 'bNDbk,'C cs TO THE _ 3,8 2, VA 1 $TREEt" T_XHAI;L ORDER OF' ?l, 00 IS02 1110 usooL,L.q Lum 1:0 2 0,0SL, P3 1,1: Ga Vendor No. Check No. Town of Southold, New York - Payment Voucher 19823LPA 9 } Vendor Address Entered by 382 Vauxhall Street Vendor Name New London,CT 06320 Audit Da-e Sull 's Mobil NOV 2 12017 Vendor Telephone Number 860-443-5938 own Clerk Vendor Contact Invoice Invoice Invoice Net Purchase Order Number Date Total Discount Amount Claimed Number Description of nods or Services General Ledger Fund and Account Number 569000 11/6/2017 $23.82 $23.82 8.572 al 50 gas MU-SY SM5710.2.000.100 $23.821 1 $23.82 Payee Certification Department Certification The undersigned(Claimant)(Acting on behalf of the above named claimant) I hereby certify that the materials above specified have been received by me does hereby certify that the foregoing claim is true and correct,that no part has in good condition without substitution,the services properly been paid,except as therein stated,that the balance therein stated is actually performed and that the quantities thereof have been verified with the exceptions due and owing,and that taxes from which the Town is exempt are excluded or discrepancies noted,and payment is approved Signature 2.,jL_ Title Signature ^ Company Name Fishers Island Ferry District Date 11/8/2017 Title Date �l i SULL.1 S 19900EL 3 HBO 382 Vauxhall Street 1Nvw London, CT 06320 SLD P'Y DATE r + N14ME ADDRESS CASH I COD I CHARGE ON ACCT. = Gals. Gasoline P.Oa . .. _ Stock i � r RECEIVED BY (' All claims and returned goods MUST be accompanied by this bill IV F �QQ `Thank _T >:3; !,J FISHERS ISLAND FERRY DISTRICT VENDOR 020729 TRAVELERS 11/2112017 CHECK 4497 pt A FUND & ACCOUNT P.O.# INVOICE DESCRIPTION AMOUNT SM .1910.4.000.100 00,0529513 LEFEVRE—A.D.CLAIM 4,200.00 V TOTAL 4,2 0 0.0'0 tM 5$:.'•;11:0'> X. 0, lZ 4 ------- --- 4J FISFIERS AD" ISMIC - .ktJDIT il2i/iR 53095 MAIN ROAD" PO BO o. SO UTHOLD,NY-11971 71 95 _414ECi NG 4,97,' CO. 'j 'THE SUFFOLKTI il BANK -DATE- CIJTCHOGUE,'NY 11'35' oo..00 11/21/2 7 $4" :2 F 0 THOUSAND,TWO:-,HUND`R EU;;AND,,0Q-/-iOit6 PAY :TRAVELER'S ' 'CL-­REMITTANCt- CENTER ORDgR PO, BOX' i:66'317 LAS 'TX, 75266-031'7,:s, 19, umooL,49 Iii' 1:0 2 11,0 54610: 68 001502, Lig' Vendor No. Check No. Town of Southold, New York - Payment Voucher 20729 L-11-R- 7 Vendor Tax ID Number or Social Security Number Vendor Address Entered 6y, Vendor Name 13607 Collections Center Drive Audit Date Travelers Chicago, IL 60693 Lvov 12017 Vendor Telephone Number 860-277-9781 Clerk Vendor Contact Invoice Invoice Invoice Net Purchase Order Number Date Total Discount Amount Claimed Number Description of Goods or Services General Ledger Fund and Account Number 000529513 10/31/2017 $4,200.00 $4,200.00 R Lefevre Age Discrim SM1910.4.000.100 i f F f f i $4,200.00 $4,200.00 F Payee Certification Department Certification The undersigned(Claimant)(Acting on behalf of the above named claimant) I hereby certify that the materials above specified have been received by me does hereby certify that the foregoing claim is true and correct,that no part has in good condition without substitution,the services properly been paid,except as therein stated,that the balance therein stated is actually performed and that the quantities thereof have been verified with the exceptions due and owing,and that taxes from which the Town is exempt are excluded or discrepancies noted,and payment is approved Signature' - C iMk -�tt(e Signature > Company Name Fishers Island Ferry District Date 11/10/2017 Title Date r TRAVELERS J� PAGE 1 DEDUCTIBLE / SELF-INSURED INVOICE POLICY :ER ACCOUNT NUMBER BILL DATE BILL NUMBER PAYMENT DUE TOTAL 15T70751-ZLP 9583Y4085 10/31/2017 000529513 11/15/2017 4,885.00 MAIL PAYMENT TO: PAYER: TRAVELERS TOWN OF SOUTHOLD 13607 COLLECTIONS CENTER DRIVE P 0 BOX 1179 CHICAGO, IL 60693 SOUTHOLD NY 11971 RETURN THIS PORTION WITH YOUR CHECK MADE PAYABLE TO TRAVELERS. PLEASE WRITE THE POLICY & ACCOUNT NUMBER ON YOUR CHECK. TRAVELERS PAGE 1 THE TOTAL DUE INCLUDES PAST DUE CHARGES. PLEASE REVIEW YOUR ACCOUNT IMMEDIATELY. FOLICY NUMBERBILL -DATE BILL, NUMBER PAYMENT DUE TOTAL DUE, 15T70751-ZLP 9583Y4085 10/31/2017 000529513 11/15/2017 4,885.00 CURRENT CHARGES CLAIM#: ESV1703 DATE OF LOSS: 10/15/2015 DESCRIPTION: CLAIMANT, RAYMOND LEFEVRE ALLEGES AGE DISCRIMINATION IN FIRING FROM FI CLAIMANT: RAYMOND LEFEVRE EXPENSE 4,200.00 CLAIM TOTAL 4,200.00 PAST DUE CHARGES CLAIM#: ESV1703 DATE OF LOSS: 10/15/2015 DESCRIPTION: CLAIMANT, RAYMOND LEFEVRE ALLEGES AGE DISCRIMINATION IN FIRING FROM FI CLAIMANT: RAYMOND LEFEVRE EXPENSE 685.00 CLAIM TOTAL 685.00 TOTAL CLAIMS) DUE $4,885.00 TRAVELERS NON-FUNDED DEPARTMENT ONE TOWER SQUARE -9CR HARTFORD, CT 06183 01052 37688 TOWN OF SOUTHOLD P 0 BOX 1179 SOUTHOLD NY 11971 W 0 N O O O N O Q O O Y TRAVELERS.AI , PAGE 2 DEDUCTIBLE / SELF-INSURED INVOICE j POLICY NUMBER ACCOUNT NUMBER BILL DATE BILL NUMBER PAYMENT DUE TOTAL DUE, 15T70751-ZLP 9583Y4085 10/31/2017 000529513 11/15/2017 4,885.00 ACCOUNT SUMMARY CURRENT CHARGES 4,200.00 INSURED NAME: TOWN OF SOUTHOLD PAST DUE CHARGES 685.00 AGENT NAME: ROY H REEVE AGENCY INC UNAPPLIED PAYMENTS 0.00 AGENT PHONE: (631) 298-4700 TOTAL DUE 4,885.00 DISPUTED ITEMS 0.00 ACCOUNT BALANCE 4,885.00 CONTACT YOUR AGENT LISTED ABOVE IF YOU HAVE QUESTIONS RELATED TO YOUR POLICY OR COVERAGE. FOR BILLING QUESTIONS, PLEASE CONTACT YOUR ACCOUNTING SPECIALIST ROSA TORRES AT 1-860-277-3284 OR EMAIL RTORRES@TRAVELERS.COM TRAVELERS NON-FUNDED DEPARTMENT ONE TOWER SQUARE -9CR HARTFORD, CT 06183 01052 37687 TOWN OF SOUTHOLD P 0 BOX 1179 SOUTHOLD NY 11971 co 0 N 0 O O O N Q O O rr :.p:,,', ,„,,, :. c tY p •, ^_ ' " .• ..t •, r »... ,1 i .-.,Tr ^,c+ ca,•y;.c;4x: , -;.,! ^,t I ! `F FISHERS ISLAND FERRY DISTRICT VENDOR 020730 TRAWLWORKS, INC. 11/21/2017 CHECK 4498 r; FUND & ACCOUNT P.O.# INVOICE DESCRIPTION AMOUNTh SM .5709.2.000.200 53055 NLT/FI–CHAIN,SPAS–RAMPS 301.22 i \ TOTAL 301.22 s du , / ,-s ' • a r .,....:x.,w. area -w•..a... .... ..... ..::..r'"':.:.." 4 _ -f; .. s.<. >. .... ...,..ru._.w-n.<«a- < .«<>r y `-1:9:. ".a' '°w`<,yyx•^;-, $",t"' - :f .Yir. 3St 'S p$:L: nab. rvj : :•'rY>? . .. .rte;: '. .:rt•:L:'4"• y _,. ... - ,...:rr` • .,x`:'•s;»''k., •:eta%:_.;,::., ;a, - '✓ W<^^" '" ..5• i hnT' =' •• ' k<i:<F: u``♦x4D,crc< : r"Zw.' .,w«`rm'r n-• Str..a`S f. •f 1 -i 4•y`f - I FISHERS.ISLANDFEIZRY'DISTRIGT'- -:AUDIT 21 ,21: ; - -,'CHECK,N-,-- 44,98,;,': _ ',THE•SUF OLK CO.NATIONAL BANK' DATE ='CUTCHOGUE,NY•1-7935- AMOUNT,,;: a 2 01,7,",, 22 ,r .50.5461214" ! / ONE'AND _22 .100;•'DOLLARS'/ _ TRAWLWORKS;, ZINC. TOAY THE' `3 0'-_WALTS OF, 342" NARRAGANSETT 'RI 02882 - -- f"'+..d t4 ..- _ _- .. _ •5Y„ -.Y i - --..- - -4<-✓-i w. -1.+J:..>,',: +t. :.{'.-s.^.:<-:- ins-i{ ...a i x. •.._,-,s ':•{'--• . 4'r 00+44^9,R 1'0 21140 5464!: 68 OOmL 5012 /ill', "s J Vendor No. Check No. Town of Southold, New York - Payment Voucher 20730 'A liq F Vendor Address Entered by P.O. Box 342 Vendor Name Narragansett, RI 02882 Audit Date Trawlworks, Inc. NOV 2 1 2017 Vendor Telephone Number 401-789-3964 wn Clerk , Vendor Contact 0.1". ._ . (Rif Invoice Invoice Invoice Net Purchase Order Number Date Total Discount Amount Claimed Number Description of Goods or Services General Ledger Fund and Account Number 53055 11/8/2017 $301.22 $301.22 NLT/FI ramps SM5709.2.000.200 $301.22 $301.22 Payee Certification Department Certification The undersigned(Claimant)(Acting on behalf of the above named claimant) I hereby certify that the materials above specified have been received by me does hereby certify that the foregoing claim is true and correct,that no part has in good condition without substitution,the services properly been paid,except as therein stated,that the balance therein stated is actually performed and that the quantities thereof have been venfied with the exceptions due and owing,and that taxes from which the Town is exempt are excluded or discrepancies noted,and payment is approved Signature (3�.�. p, Title Signature Company Name Fishers Island Ferry District Date_ 11/8/2017 Title ate1 ///7 TRAWLWORKS, INC. Invoice PO BOX 342 NARRAGANSETT,RI 02882 Date Invoice# 401-789-3964 11/8/2017 53055 Bill To Ship To Fisher's Island Ferry Fisher's Island Ferry PO Box 607 New London Terminal Fisher's Island,NY 06390-0607 5 Waterfront Park New London,CT 06320 P.O.Number Terms Ship Via F.O.B. Net 30 11/7/2017 UPS GROUND NARRAGANSETT Quantity Description Price Each Amount 33.5 FT 1/2"ACCO TRLX CHAIN-8 x 24 links ea 545 182.58 4 3/4"SPAS 19.00 7600 1 SHIPPING 42.64 4264 `j r Total $301:22 Payments/Credits $000 Balance Due $301.22 FISHERS ISLAND FERRY DISTRICT VENDOR 021506 UNITED PARCEL SERVICE 11/21/2017 CHECK 4499 A FUND & ACCOUNT P.O.# INVOICE DESCRIPTION AMOUNT SM .5710.4.000.700 26639437 WE 10/27/17 91.45 SM .5i7.10.4.000.700 26639447' WE 11/03/17 I 190_85/ TOTAL 282.30 zi 10 "jn. gaErLY aPP agmi" wrow-mirlm 'Tor; NA laraw- wt m. ISLA S AVEERRYDISTRICT- '- ,AbD, FISHER T,,:'j,-j 2`1 17- POBOX11'79­,- ',':44'991;, 959" . , 53095 MAIN-ROAD,I SOUTHOLD,NY 11971-0 ` "_".' CK HE 'bFP6LK'IfWNXTIO ALBANk'-' '_' - ry IL- i' H -SL _F T CpTCHOGUEJNY-11935 DA AMOUNT`— TE' 82 "Al il-/21/20 -,5 -546/2 4, TWO,"HUNDREb TAND J"0j,10 3 !UN PAT I TE]j^PARCEL kVICE- -SE PO- BOX-7,24' 6p 'ro Tiii i' O 4 PHILADELPHTA, RA `3.;917 0` IDD 01 T- r 6 0 0 L,Lo 9 9 no 1:0 2140SLIGLO: GIB 001-S02 11 Vendor No. Check No. Town of Southold, New York- Payment Voucher 21506 'Lill LA q 9 Vendor Address Entered 6 P.O. Box 7247-0244 Vendor Name UPS Philadelphia, PA 19170-0001 Audit Dae United Parcel Service NOV 2 12017, Vendor Telephone Number Vendor Contact T r Clerk , Vendor Contact ' Invoice Invoice Invoice Net Purchase Order Date Total Discount Amount Claimed Number Description of Goods or Services General Ledger Fund and Account Number 26639437 10/28/2017 $91.45 $91.45 WE 10/27/17 SM5710.4.000.700, 26639447 11/4/2017 $190.85 $190.85 WE 11/3/17 SM5710.4.000.700 $282.30 $282.30 Payee Certification Department Certification The undersigned(Claimant)(Acting on behalf of the above named claimant) I hereby certify that the materials above specified have been received by me does hereby certify that the foregoing claim is true and correct,that no part has in good condition without substitution,the services properly been paid,except as therein stated,that the balance therein stated is actually performed and that the quantities thereof have been verified with the exceptions due and owing,and that taxes from which the Town is exempt are excluded or discrepancies noted,and payment is approved Signature ytQuJ Title Signature Company Name Fishers Island Ferry District Date 11/8/2017 Title G11— Date �� Y Delivery Service Invoice Invoice Date October 28, 2017 Shipped from: Invoice Number 0000026639437 FISHERS ISLAND FERRY Shipper Number 026639 U6. ACCOUNTS PAYABLE Control ID 837T 1 STATE ST Page 1 of 4 NEW LONDON,CT 06320 g Sign rap for electronic billing today! 0736A00000266394 77366040022644 Visit ups.com/billing AB 01 028764 89148 H 79 A For questions about your-invoice,call: (800)811-1648, Ifllll°°II°�II°1®VIII°I��II°I°I°�I�°I'OI°I'°l0°III�III�aIIIII°II Monday-Friday, - ® FISHERS ISLAND FERRY 8:®®a m.-9:00 p.m.E.T. ACCOUNTS PAYABLE- orwriW:'• P® BOX 607 UPS FISHERS ISLAND, NY 06390-0607 P.O.Box 7247-0244 Philadelphia,PA 191170-000111 Account Status Summary Thank you for easing UPS Weekly Payment Plan Summary of Charges , Amount Due This Period $91.45 Amount Outstanding(prior invoices) $414.14 Page Charge Outbound Total Amount Outstanding $505.59 3 UPS WorldShip $75.55 Please include the Return Portion of each outstanding invoice with 3 Adjustments&Other Charges $3.00 your payment.See Account Status for details. Service Charges $ .901 IiolldaV helps Amount due this period -- - - - $91.45 The busiest shopping and shipping seasons are close at hand. Will you be ready?Get key shipping dates,packaging tips and UPS payment terms require payment of this invoice by November answers to frequently asked holiday shipping questions at 19,2017. ups.com/holidays. Payments received late are subject to a late payment fee of 6%of = the Amount Due This Period.(see Tarifflrerms and Conditions of Service at ups.com for details) — Note.-This invoice may contain a fuel surcharge as described at ups corn.For snore information,please visit upscom. Delivery Service Invoice Invoice Date October 28,2017 Invoice Number 0000026639437 Shipper Number 026639 Page 2 of 4 Account Status Weekly Payment Plan Payments Applied Invoice Number Invoice Date Amount Paid 0000026639377 09/16/2017 $28.80 0000026639387 09/23/2017 $437.26 Account Status Weekly Payment Plan Amount Outstanding(prior invoices): Please include theReturn Portionof each outstanding invoice with your payment. Invoice Number Invoice Date Balance Due 0000026639397 09/30/2017 $126.89 0000026639407 10/07/2017 $53.78 0000026639417 10/14/2017 $197.35 0000026639427 10/21/2017 $36.12 'total $414.14 Outstanding balances reflect any payments received as of 10/27/2017.Please ignore this message if a recent payment has been made for any outstanding invoices. Delivery Service In voice Invoice Date October 26,2017 Invoice Number 0000026639437 Shipper Number 026639 n - Page 3 of 4 Outbound UPS WorldShip Pickup Pickup ZIP Billed Date Record Entry Tracking Number Service- Code Zone Weight Charge 10/24 6853513612 1 IZO266390348938419 Ground Residential 34450 5 22 1724 Customer Weight 9.4 Residential Surcharge 3.40 Delivery Area Surcharge 325 Fuel Surcharge -1.43 Customer Entered Dimensions= 21 x 13 x 11 in Total 25.32` C� E 1st ref:FINY-PATTY FAULKNER 2nd ref:FINY-PATTY FAULKNER Sender :ACCOUNTS PAYABLE Receiver: JUDI IMBRIGLIO 1394 SOUTH STERLING DRIVE INVERNESS FL 34450 Message Codes:r Total for Pickup Number: 6853513612 1 Package(s) 25.32 10/27 6853513623 1 1ZO266390346225228 Ground Residential 14895 3 3 9.06 Residential Surcharge 3.40 Delivery Area Surcharge-Extended 4.20 Fuel Surcharge 1.00 Total 17.66 ` 1st ref:FINY-DEB DOUCETTE 2nd ref:FINY-DEB DOUCETTE Sender :ACCOUNTS PAYABLE Receiver: DONNA COLE 2431 MESERVEY HILL ROAD _ WELLSVILLE NY 14895 ®_ 2 1Z0266390348739830 Ground Commercial 43224 4 18 12.86 Customer Weight 17.2 Fuel Surcharge 0.77 Customer Entered Dimensions= 26 x 24 x 4 in Total 13.6 1st ref:FINY-JARED TOLDO 2nd ref:FINY-JARED TOLDO — Sender :ACCOUNTS PAYABLE Receiver: WASSERSTROM RESTAURANT SUPPPLY 2560 VALUE WAY \� \4j\� COLUMBUS OH 43224 Message Codes:r (j �� 3 1ZO266390346246241 Ground Commercial 44483 4 29 17.87 Customer Weight 11.6 Fuel Surcharge 1.07 / Customer Entered Dimensions= 25 x 13 x 12 in Total 18-94 1st ref:FINY-JARED TOLDO 2nd ref:FINY-JARED TOLDO Sender :ACCOUNTS PAYABLE Receiver: CHAMPION ACE HARDWARE 4319 MAHONING AVE NW WARREN OH 44483 Message Codes:r Total for Pickup Number: 6853513623 3 Package(s) 50.23 Total UPS WorldShip 4 Package(s) 75.55 Total Outbound 4 Package(s) 75.55 028764 2/2 Delivery Service Invoice Invoice Date October 28, 2017 Invoice Number 0000026639437 Shipper Number 026639 Page 4 of 4 Adjustments &Other Charges Adjustments &Other Charges Miscellaneous Billed Explanation Charge WEEKLY PRINTER SERVICE FEE 3.00 FOR 1 PRINTERS AT$3.00 EACH FOR 27-OCT-2017 Total Miscellaneous 3.00/ Total Adjustments&Other Charges 3.00 Invoice Messaging Code Message r Dimensional weight applied 6 Delivery Service In voice Invoice Date November 4, 2017 Shipped from: Invoice Number 0000026639447 FISHERS ISLAND FERRY Shipper Number 026639 "' ACCOUNTS PAYABLE Control ID 939T 1 STATE ST NEW LONDON,CT 06320-6336 Page 1 of 3 Sign up for electronic billing today! 0736A00000266394 77366010023808 Visit ups.comfbilling ®_ AB 01 029066 94924 H 81 B For questions about your invoice,call: 111111°11�111°I111°Illllel{111111°I'I1111�0111'�'I11°010'�1'�I'1' (800)811-1648 Monday-Friday FISHERS ISLAND FERRY 8:00 am.-9:00 p.m.E.T. ACCOUNTS PAYABLE or write: ® PO BOX 607 UPS FISHERS ISLAND, NY 06390-0607 P.O.Box 7247-0244 Philadelphia,PA 19170-0001 Account Status Summary Thank you for using HIPS. Weekly Payment Plan Summary of Charges Amount Due This Period $190.85 Amount Outstanding(prior invoices) $505.59 Page Charge Outbound Total Amount Outstanding $696.44 3 UPS WorldShip $174.95 Please include the Return Portion of each outstanding invoice with 3 Adjustments&Other Charges $3.001--l- your 3.001--l-your payment See Account Status for details. Service Charges $12.90 ✓c= Holiday help Amount due this period $190.85 The busiest shopping and,shipping seasons are close at hand. Will you be ready?Get key shipping dates,packaging tips and UPS payment terms require payment of this invoice by November answers to frequently asked holiday shipping questions at 26,2017. ups.com/holidays. Payments received late are subject to a late payment fee of 601.of the Amount Due This Period.(see Tarifffrerms and Conditions of Service at ups.com for details) Note:This invoice may contain a fuel surcharge as described at ups.com.For more information,please visit ups.com. Delivery Service Invoice Invoice Date November 4, 2017 Invoice Number 0000026639447 Shipper Number 026639 na Page 2 of 3 Account Status Weekly Payment Plan Amount Outstanding(prior invoices): Please include theReturn Portion of each outstanding invoice with your payment. Invoice Number Invoice Date Balance Due 0000026639397 09/30/2017 $126.89 0000026639407 10/07/2017 $53.78 0000026639417 10/14/2017 $197.35 0000026639427 10/21/2017 $36.12 0000026639437 10/28/2017 $91.45 Total $505.59 Outstanding balances reflect any payments received as of 11/03/2017.Please ignore this message if a recent payment has been made for any outstanding invoices. Delivery Service Invoice Invoice Date November 4, 2017 1 Invoice Number 0000026639447 Shipper Number 026639 Page 3 of 3 Outbound UPS WorldShip Pickup Pickup ZIP Billed Date Record Entry Tracking Number Service Code Zone Weight Charge 11/02 6853513634 1 120266390347269886 Ground Commercial 33462 6 81 52.71 Customer Weight 34 Additional Handling 10.85 Fuel Surcharge 3.16 Customer Entered Dimensions= 31 x 20 x 18 in Total 66.72 1st ref:FINY-SUE SCHUTZ 2nd ref:FI NY-SUE SCHUTZ Seceder :ACCOUNTS PAYABLE Receiver:ATTN:CINDY _-1 UPS EAGLE 1438 WEST LANTANA ROAD LAKE WORTH FL 33462 Message Codes:r 2 11Z0266390347395294 Ground Commercial 33462 6 50 40.75 �® \ Customer Weight 24.2 Additional Handling 10.85 Fuel Surcharge 2.45 Customer Entered Dimensions= 33 x 16 x 13 in Total 54.05 1st ref:FINY-SUE SCHUTZ 2nd ref:FI NY-SUE SCHUTZ Seceder :ACCOUNTS PAYABLE Receiver:ATTN:CINDY / UPS EAGLE 1438 WEST LANTANA ROAD LAKE WORTH FL 33462 Message Codes:r . 3 1ZO266390347816507 Ground Commercial 33462 6 53 40.88 ®_ Customer Weight 39.4 Additional Handling 10.85 Fuel Surcharge 2.45 Customer Entered Dimensions= 26 x 20 x 14 in Total 54.18 1st ref:FINY-SUE SCHUTZ 2nd ref:FINY-SUE SCHUTZ Sender :ACCOUNTS PAYABLE Receiver:ATTN:CINDY UPS EAGLE 1438 WEST LANTANA ROAD LAKE WORTH FL 33462 Message Codes:r Total for Pickup Number: 6853513634 3 Package(s) 174.95 Total UPS WoridShip 3 Package(s) 17495 Total Outbound 3 Package(s) 174.95 Adjustments &Other Charges Miscellaneous Billed Explanation Charge WEEKLY PRINTER SERVICE FEE 3.00 FOR 1 PRINTERS AT$3.00 EACH Cd FOR 03-NOV-2017 Total Miscellaneous 300 Total Adjustments&Other Charges 3.00 Invoice Messaging Code Message r Dimensional weight applied 029066 2/2 FISHERS ISLAND FERRY DISTRICT VENDOR 025037 Z & S CONTRACTING, INC. 11/21/2017 CHECK 4500 FUND & ACCOUNT P.O.# INVOICE DESCRIPTION — AMOUNT SM .1930.4.000.000 091917 j CLAIM-DAMAGED OIL BOILER 11,759.80 'ic' 1,759.80 TOTAL "Va Jil" 4 1 kv Z. kr VA o a 0110MOIGM CT, ­ ERRYDISM 7 FISHERSISLAMF K:­ off,." 53095 MAIN ROAD;fPO'EIOX,11179 SPUTHOLD;,Ny. 11971-0059 CH ' THE SU FOLK Cb. A CUTCHOGUE'NY'11 935 E­ AMOUNT.,1,1,,',,.% Y- 'ONE THOUSAND_,S,'EVE'N'J1U'k 15kED,'FIFTY -C Jbki PAY INC'. Sc -P ,Box,-=2 0'2 '­'x b TO THE -.4, FISHERS- I,S rj T 0 0 L, S 0 0 V 1:0 2 L L,0 S 1,C3 Ls 1: G 13 OOLS02 'N .'1 t a . Vendor No. Check No. Town of Southold, New York - Payment Voucher 25037 - LA5W Vendor Tax ID Number or Social Security Number Vendor Address Entered by P.O. Box 202 Vendor Name Fishers Island, NY 06390 Audit Da Z&S Contracting, Inc. Vendor Telephone Number — -- ----- ` CI rk Vendor Contact 0" Invoice Invoice, Invoice Net Purchase Order Number Date Total Discount Amount Claimed Number Description of Goods or Services General Ledger Fund and Account Number QUO 9/19/2017 1,759.80 1,759.80 FIFD damaged oil boiler SM1930.4.000.000 1,759.80 1,759.80 Payee Certification Department Certification The undersigned(Claimant)(Acting on behalf of the above named claimant) I hereby certify that the materials above specified have been received by me does hereby certify that the foregoing claim is true and correct,that no part has in good condition without substitution,the services properly been paid,except as therein stated,that the balance therein stated is actually performed and that the quantities thereof have been verified with the exceptions due and owing,and that taxes from which the Town is exempt are excluded jscrepancies noted,and payment is approved \ / Signature �tn� — rtle Signature Company Name—f)f b Date "' -q 11-7 Title In to V �OQggFFU(,FC RESOLUTION 2017-903 ag� ADOPTED DOC ID: 13484 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2017-903 WAS ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON OCTOBER 24,2017: RESOLVED that the Town Board of the Town of Southold hereby ratifies and approves the resolution of the Fishers Island Ferry District Board of Commissioners dated September 29, 2017 in regard to the Z & S Contracting Settlement. Elizabeth A.Neville Southold Town Clerk i RESULT: ADOPTED [UNANIMOUS] MOVER: Robert Ghosio, Councilman SECONDER:Louisa P. Evans, Justice AYES: Dinizio Jr, Ruland, Doherty, Ghosio, Evans, Russell FISHERS ISLAND FERRY DISTRICT September 29, 2017 Z&S Contracting Settlement RESOLUTION 2017- 181 WHEREAS, the District was presented with a claim by Z&S Contracting for the sum of $1,759.80 as reimbursement for damage to a furnace caused by the error of District staff; and WHEREAS, the Board of Commissioners of the Fishers Island Ferry District has determined that it is in the best interests of the District to resolve this claim to avoid the expense and uncertainties of litigation; be it RESOLVED, that the Board of Commissioners of the Fishers Island Ferry District approves the settlement of this claim in exchange for the damaged equipment, and directs management to make payment of the settlement amount of$1,759.80 subject to the approval of District counsel and the Southold Town Attorney. Moved by: H. Burnham Seconded by: A. Ahrens Ayes: A.Ahrens, H. Burnham, P. Rugg Nays: None Abstain: D.Shillo aME COURT OF THE STATE OF NEW YORK SUPREME � COUNTY OF X In the Matter of the Claim of } d -against- NOTICE OF CLAIM I ❑ Village M/Town Town ❑ City ❑ County of X TO: ❑ Village Town ❑ City n County ofcu�7®! /��� gr��L� -F�rr•� �,3�,c� PLEASE TAKE NOTICE that the claimant herein hereby makes claim and demand against i you as follows: 1. The name and post-office address of the claimant and of his/her attorney is: Claimant Claimant's Attorney Al Y 1116,390 2. The nature of the claim: 3. The time when, t e place where and the manner in which the claim aros The incident occurred on �" j , 20®7, at or about 1,q:ig❑ a.m. p.m., 4. The items of damage or injuries claimed are: That said claim and demand is hereby presented for adjustment and payment. You are hereby notified that unless it is adjusted and paid within the time provided by law from the date of presentation to you, the claimant intends to commence an action on this claim. Dated: 9/--.)02 , 20�_7 s 6s , New York i Signature £ Print Name . I r f STATE OF NEW YORK ) ss.: COUNTY OF ) i t am the Claimant in the above-entitled action. I have read the foregoing complaint and know the contents thereof. The contents are true to my own knowledge except as to matters therein stated to be alleged upon information and belief, and as to those matters, I believe them to be true. i {E I Signature I' Sworn to before me on this day of , 20 I Notary Public r I s i - E i t d E f k . I j F ..,.,,..., Invoice - THE GRANITE 09/21/17 10262014-00 i IfIR-3, GFROU1= SOLID AS OUR NAME GAILIARD 1 of 1 6 Storrs Street REMIT ' Concord,NH 03301 The Granite Group (860)629-7700 PO lCo X 2004 co d,NH 03302-2004 •VIEW ONLINE GO TO: CUST#: 25180 http-11thegran itegroup.billtrust com BILL TO: QRW DKV QQ13 SHIP TO: Z&S CONTRACTING INC GENERAL ACCOUNT P 0 BOX 202 Z&S CONTRACTING INC FISHERS ISLAND,NY 06390 FISHERS ISLAND,NY 06390 i r SHIP VIA l i INSTRUCT16N9 SHIP POINT ONLY THOMAS TO CHRIS Groton OUR TRUCK 09/21/17 ar 2%10thN30 i LINE PR06LJCT QUANTITY QT.,Y. ,�QUANTITY QTY UNIT AMOUNT NO. AND DESItRIPTION ORDERED SHIPPED B.0. Ulm PRICE (NET) i -1- WMPWG03CB r,_ `-'1 - 1 'b EACH -1759.80 1759.80 P-WGO-3 PKG BLR LBURNER 386-700-828 Serialized product. Serial#.CP7590469 _1 Lines Total Qty Shipped Total 1 Total 1759.80 " Invoice Total 1759.80 I Cash Discount 35 20 If Paid By 10/10/17 Import your invoices directly in to your accounting systeml!! 9 a Never print another invoice again Stay organized by managing your bills in our online portal. Please visit us at: ~= http•f/thegranitegroup billtrust com TERMS:A 2%per month service charge will be added to all invoices past due 30 days or more.This is an annual rate of 24%.All claims must be made within 20 days,no material may be returned without prior permission.Material must be accompanied by the invoice number and returned to original purchase location Returns may be subject to restocking charges j THIS CONTRACT IS GOVERNED BY AND SUBJECT TO THE GRANITE GROUP WHOLESALERS,LLC'S STANDARD"TERMS AND CONDITIONS'LOCATED AT WWW. THEGRANITEGROUP.COMrrERMSANDCONDITIONS/THE"TERMS AND CONDITIONS"LOCATED AT WWW.THEGRANITEGROUP.COMfTERMSANDCONDITIONS//ARE HEREBY INCORPORATED BY REFERENCE INTO THIS DOCUMENT BY PURCHASING GOODS FROM THE GRANITE GROUP WHOLESALERS,LLC,YOU ACKNOWLEDGE YOU HAVE READ THE"TERMS AND CONDITIONS"AND AGREE TO AND INTEND TO BE BOUND BY THE"TERMS AND CONDITIONS"LOCATED AT WWW. THEGRANITEGROUP.COM/TERMSANDCONDITIONS.BOTH PARTIES AGREE THAT THESE"TERMS AND CONDITIONS"ARE SUBJECT TO CHANGE i 3 i I REALEASE OF ALL CLAIMS KNOW ALL BE#THESE PRESENTS: Thatthe undersigned,being of lawful age,for sole consideration of one thousand seven hundred fifty-nine dollars and eighty cents ($1,759.80)tolbe paid to Z&5 Contracting,inc do/does hereby and for my/ourlits executors,administrators,successors and assigns release, acquif and forver discharge fl HERS ISLAND RRY DISI RIOT and his,her,their or its agents,servants,successors,heirs,executors, administrators and ali,other persons;firms,corporations,assocl2M0` s-onparmerships4and from any and al.claims,actions,causes of action, demands,righis,damages,casts,loss of service,expenses and compensation whatsoever,which the undersigned now has/have to which may hereafter accrue on account of or in any way growing out of any and all known and unknown,foreseen and unforeseen bodily and person Injuries and property damage and the consequences thereof resulting or to result from the actident,casualty or event which occurred on the 19th day of September,2017,at or near the Fishers Island freight area. r � it is`understood and agreed that this settlement is the comprise of a doubtful and disputed claim,and that the payment made is not to be construed as an admission of liability on the part of the party or parties hereby released,and that said released parties deny liability and Intend merely to avoid litigation and buytheir peace,Furthermore,this release Is Intendedonly to operate as a release of whatever claims the undersigned►nay have against the released parties € Any,and all claims against parties not specifically released herein,If any,hereby-assigned in full to the parties hereby released.the released partes reserve any and all claims they may have against the undersigned,or any others. The,undersigned hereby declare(s)and represent(s)that the injuries sustained are or maybe permanent and progressive and that recovery there from is uncertain and indefinite and making this Release it is understood and agreed,that the undersigned rely(ies)wholly upon the undersigned's judgment,belief and knowledge of the nature,extent,effect and duration of said Injuries and liability therefore and is made without reliance upon any statement or representation of party or parties hereby released or their representatives or by any physician or surgeon by6e� employed. The undersigned further declare(s)and represent(s)that no promise,Inducement or agreement not herein expressed has been made to the undersigned,and that his Release contains the entire agreement between the parties hereto,and that the terms of this release are contractual andnot a mere recital. The undersigned has read the forgoing release and indemnity agreement and fully understands it. Signed,sealed�lnd delivered this day of ( d/ - ZO S[GNATURE r F i Witness ' 'Signature Witness Signature Date i i • c i 4. r 7 s '