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HomeMy WebLinkAbout259688 06/14/16 CITY OF CARMEL, INDIANA VENDOR: 00351028 a. '.4 � •1• ONE CIVIC SQUARE SIMON AND COMPANY INC CHECK AMOUNT: $*****3,434.88* CARMEL, INDIANA 46032 1660 L STREET NW,SUITE 501 CHECK NUMBER: 259688 WASHINGTON DC 20036 CHECK DATE: 06/14/16 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 601 5023990 052616 1,226.74 OTHER EXPENSES 651 5023990 052616 1,226.74 OTHER EXPENSES 1160 4340400 33441 MAY201G 981.40 PROF CONSULTING SERVI Prescribed by State Board of Accounts City Form No.201 (Rev 1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice or bill to be properly itemized must show, kind of service,where performed, dates of service rendered, by whom, rates per day, number of units, price per unit, etc. Payee 357028 SIMON &COMPANY INC. Purchase Order No. 1660 L Street NW, Ste 501 Terms Washington, DC 20036 Due Date 5/31/2016 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 5/31/2016 052616 $1,226.74 hereby certify that the attached invoice(s), or bill(s) is (are)true and orrect and I have audited same in accordance with IC 5-11-10-1.6 Date Officer Prescribed by State Board of Accounts City Form No.201 (Rev 1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice or bill to be properly itemized must show, kind of service, where performed, dates of service rendered, by whom, rates per day, number of units, price per unit, etc. Payee 357028 SIMON & COMPANY INC. Purchase Order No. 1660 L Street, N.W., Ste 501 Terms Washington, DC 20036 Due Date 5/31/2016 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 5/31/2016 052616 $1,226.74 hereby certify that the attached invoice(s), or bill(s) is (are) true and ;orrect and I have audited same in accordance with IC 5-11-10-1.6 Date Officer SIMON ANIS COMPANY INCORPORATED Intergovernmental Relations and Federal Affairs 1660 L Street N.W.•Suite 501 ^Washington,D.C.20036 (202)659-2229•Fax(202)659-5234•e-mail:len.simon@simoncompany.con? May 26, 2016 Mayor James Brainard One Civic Center Square Carmel, Indiana 46032 STATEMENT May 2016 Summary of Maior Activities Undertaken in the Last Month for Carmel Utilties Activi Date Description U.S. Conference of Mayors May 5, 12 Briefing with Mayor on activities in connection with the U.S. Conference of Mayors meeting in Indianapolis and Carmel; May 17 Worked with Mayor,USCM staff and Rep. Brooks staff in connection with Speaker Ryan video before the USCM Annual meeting; White House Inter- May 18 Meeting with White House governmental Intergovernmental Director for review of pending Administrationpriorities; TIGER Grant May 19 Provided an update to City staff regarding the legislative-status of the U.S. DOT TIGER program; Chinese Visa May 16,23 Assistance to the Mayor in connection with preparations for forthcoming Climate Summit in China; COPS Hiring Program April 25 Drafted and forwarded a memo on the Department of Justice (DOJ) Office of Community Oriented Policing Services (COPS) release of a notice inviting applications for the FY 2016 COPS Hiring Program(CHP); 1 Active Transportation April 27 Participated in a U.S. DOT webinar to Networks learn more about how programs such as TIFIA can be used to fmance the construction of active transportation networks, and prepared a summary; EDA Regional Innovation April 29 Drafted and forwarded a memo on the Strategies Program Department of Commerce (DOC) Economic Development Administration (EDA) release of a Federal Funding Opportunity (FFO) for the Fiscal Year (FY)2016 Regional Innovation Strategies (RIS)Program; Zika Virus Update May 5 Participated in a White House teleconference to learn more about federal efforts to combat the evolving threat of the mosquito-borne Zika Virus,and prepared a summary; Opioids Abuse Update May 12 Participated in a White House teleconference with the Office of National Drug Control Policy to learn more about comprehensive legislative action in Congress to combat the opioid epidemic, as well as the work of the President's Mental Health and Substance Use Disorder Parity Task Force, and prepared a summary; NEA Our Town Grant May 13 Drafted and forwarded a memo on the Program National Endowment for the Arts (NEA) release of Program Guidelines for the Fiscal Year (FY) 2017 Our Town Grant Program; DOL YouthBuild Grants May 18 Drafted and forwarded a memo on the Department of Labor(DOL)Employment and Training Administration (ETA) issuance of a Funding Opportunity Announcement (FOA) for Fiscal Year (FY) 2016 YouthBuild Grant Program; Airport Security May 23 Participated in a teleconference hosted by the Transportation Security Administration to learn more about aviation security and steps being taken to reduce passenger wait times at airports,and prepared a summary; 2 Washington Friday Report April 29 Prepared and forwarded the Washington Friday Report to the Mayor,which covered the following subjects:2016 COPS Hiring Program Solicitation Opens, Senate's Water Resources Development Act of 2016,Two Years of My Brother's Keeper, House Committees Approve Opioid Bills, Department of Labor's ApprenticeshipUSA,Federal Financing for Active Transportation Networks, FCC Modernizes the Lifeline Program, Medicaid Access. for the Formerly- Incarcerated, Grants This Week, Moving to Work Advisory Committee,Nominate a Champion of Change for Climate Equity, and Mayors Survey on Infrastructure; May 6 Prepared and forwarded the Washington Friday Report to the Mayor,which covered the following subjects: HUD Disburses $174 Million from Housing Trust Fund, The President in Flint, Reducing Gun Violence,Update on Zika Virus,National Reentry Week,Every Place Counts Design Challenge, FTA Mobility on Demand Sandbox Program, FAA Policy on PFC Funding for Airport Rail Projects, Grants This Week, EPA Highlights the DERA Program, Champions of Change Fighting Opioid Abuse,Public Service Recognition Week,and In Memoriam-Senator Robert Bennett of Utah; May 13 Prepared and forwarded the Washington Friday Report to the Mayor,which covered the following subjects: House Passes Opioid Legislation,Bipartisan$1.1 Billion Proposal to Combat Zika, Transgender Student Access to School Facilities, A Great Mayor in the U.S. Senate - Senator Dianne Feinstein, Social Impact Partnerships and TANF Reform, Madison's Lead Pipe Solution,Examining Social Welfare Programs, Leveraging Science and Technology Enterprise,Trade Facilitation and Enforcement,Grants This 3 Washington Friday Report Week, Postal Service Reform, Secretary Foxx on "Every Place Counts," Transit Update, and Metro Year of'SafeTrack'; May 20 Prepared and forwarded the Washington Friday Report to the Mayor.,which covered the following subjects:The New Overtime Rule Finalized, FY17 House Transportation-HUD Appropriations, FY17 House Commerce-Justice-Science Appropriations, FY17 Senate Agriculture Appropriations, Congress Debates Anti- Zika Spending Level, Every Student Succeeds Act Implementation,Broadband in HUD Assisted Housing, Grants This Week, President Obama's Immigration Policies, Building Energy Efficiency, Transit Safety, Wetlands Assessment, Infrastructure and Neighborhood Parks, and Metro "SafeTrack" Plan Finalized. Professional Services for the Month of May 2016...................................$2,083.00 Expenses (see attached summary and receipts 71.4%)...................................$370.48 TOTALAMOUNT DUE.....................................................................................$2,453.48 LEONARD S. SIMON President 4 VOUCHER NO. WARRANT NO. Prescribed by state Board of Accounts City Form No.201(Rev.1995) SIMON AND COMPANY INC ALLOWED 20 ACCOUNTS PAYABLE VOUCHER 1660 L STREET NW, SUITE 501 IN SUM OF$ CITY OF CARMEL An invoice or bill to be properly itemized must show:kind of service,where performed,dates service WASHINGTON, DC 20036 rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc. $981.40 - Payee Purchase Order# ON ACCOUNT OF APPROPRIATION FOR Mayor's Office Terms Date Due PO# ACCT# DATE INVOICE# DESCRIPTION DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT 33441 STATEMENT 43-404.00 $981.40 1 hereby certify that the attached invoice(s),or 5/26/16 STATEMENT $981.40 1160 101 1160 101 bill(s)is.(are)true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except Wednesday,June 08,2016 I hereby certify that the attached invoice(s),or bill(s),is(are)true and correct and I have audited same in accordance with IC 5-11-10-1.6 ,20 Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer SIMON AND COMPANY INCORPORATED Intergovernmental Relations and Federal Affairs 1660 L Street N.W.•Suite 501 •Washington,D.C.20036 (202)659-2229•Fax(202)659-5234•e-mail:len.simon@simoncompany.com May 26, 2016 Mayor James Brainard Carmel City Hall One Civic Square Carmel, Indiana 46032 Purchase Order#32615 STATEMENT May 2016 Summary of Major Activities Undertaken in the Last Month for the City of Carmel Actbk Date Description U.S. Conference of Mayors May 5, 12 Briefing with Mayor on activities in connection with the U.S. Conference of Mayors meeting in Indianapolis and Carmel; May 17 Worked with Mayor, USCM staff and Rep. Brooks staff in connection with Speaker Ryan video before the USCM Annual meeting; White House Inter- May 18 Meeting with White House governmental Intergovernmental Director for review of pending Administration priorities; TIGER Grant May 19 Provided an update to City staff regarding the legislative status of the U.S. DOT TIGERprogram; Chinese Visa May 16,23 Assistance to the Mayor in connection with preparations for forthcoming Climate Summit in China; 1 COPS Hiring Program April 25 Drafted and forwarded a memo on the Department of Justice (DOJ) Office of Community Oriented Policing Services (COPS) release of a notice inviting applications for the FY 2016 COPS Hiring Program CHP); Active Transportation April 27 Participated in a U.S. DOT webinar to Networks learn more about how programs such as TIFIA can be used to finance the construction of active transportation networks, and prepared a summary; EDA Regional Innovation April 29 Drafted and forwarded a memo on the Strategies Program Department of Commerce (DOC) Economic Development Administration (EDA) release of a Federal Funding Opportunity (FFO) for the Fiscal Year (FY)2016 Regional Innovation Strategies (RIS)Program; Zika Virus Update May 5 Participated in a White House teleconference to learn more about federal efforts to combat the evolving threat of the mosquito-borne Zika Virus,and prepared a summary; Opioids Abuse Update May 12 Participated in a White House teleconference with the Office of National Drug Control Policy to learn more about comprehensive legislative action in Congress to combat the opioid epidemic, as well as the work of the President's Mental Health and Substance Use Disorder Parity Task Force, and prepared a summary; NEA Our Town Grant May 13 Drafted and forwarded a memo on the Program National Endowment for the Arts (NEA) release of Program Guidelines for the Fiscal Year (FY) 2017 Our Town Grant Program; DOL YouthBuild Grants May 18 Drafted and forwarded a memo on the Department of Labor(DOL)Employment and Training Administration (ETA) issuance of a Funding Opportunity Announcement (FOA) for Fiscal Year (FY)2016 YouthBuild Grant Program; 2 Airport Security May 23 Participated in a teleconference hosted by the Transportation Security Administration to learn more about aviation security and steps being taken to reduce passenger wait times at airports,and prepared a summary; Washington Friday Report April 29 Prepared and forwarded the Washington Friday Report to the Mayor,which covered the following subjects:2016 COPS Hiring Program Solicitation Opens, Senate's Water Resources Development Act of 2016,Two Years of My Brother's Keeper, House Committees Approve Opioid Bills, Department of Labor's ApprenticeshipUSA,Federal Financing for Active Transportation Networks, FCC Modernizes the Lifeline Program, Medicaid Access for the Formerly- Incarcerated, Grants This Week, Moving to Work Advisory Committee,Nominate a Champion of Change for Climate Equity, and Mayors Survey on Infrastructure; May 6 Prepared and forwarded the Washington Friday Report to the Mayor,which covered the following subjects: HUD Disburses $174 Million from Housing Trust Fund, The President in Flint, Reducing Gun Violence,Update on Zika Virus,National Reentry Week,Every Place Counts Design Challenge, FTA Mobility on Demand Sandbox Program, FAA Policy on PFC Funding for Airport Rail Projects, Grants This Week, EPA Highlights the DERA Program, Champions of Change Fighting Opioid Abuse,Public Service Recognition Week,and In Memoriam-Senator Robert Bennett of Utah; May 13 Prepared and forwarded the.Washington Friday Report to the Mayor,which covered the following subjects: House Passes Opioid Legislation,Bipartisan$1.1 Billion Proposal to Combat Zika, Transgender Student Access to School Facilities, A Great Mayor in the U.S. Senate- Senator 3 Washington Friday Report Dianne Feinstein, Social Impact Partnerships and TANF Reform, Madison's Lead Pipe Solution,Examining Social Welfare Programs, Leveraging Science and Technology Enterprise,Trade Facilitation and Enforcement,Grants This Week, Postal Service Reform, Secretary Foxx on "Every Place Counts," Transit Update, and Metro Year of'SafeTrack; May 20 Prepared and forwarded the Washington Friday Report to the Mayor,which covered the following subjects:The New Overtime Rule Finalized, FY17 House Transportation-HUD Appropriations, FY17 House Commerce-Justice-Science Appropriations, FY17 Senate Agriculture Appropriations, Congress Debates Anti- Zika Spending Level, Every Student Succeeds Act Implementation,Broadband in HUD Assisted Housing, Grants This Week, President Obama's Immigration Policies, Building Energy Efficiency, Transit Safety, Wetlands Assessment, Infrastructure and Neighborhood Parks, and Metro "SafeTrack" Plan Finalized. Professional Services for the Month of May 2016......................................$833.00 Expenses (see attached summary and receipts 28.6%)...................................$148.40 TOTAL AMOUNT DUE........................................................................................$981.40 LEONARD S. SIMON President 4 SIMON AND COMPANY,INC. Carmel Expenses Summary May 2016 EXPENSE DATE DESCRIPTION TOTAL Telephone& 04/21/16 (prorated) Telecommunications& $25.06 Internet Internet Postage 04/21/16-05/19/16 Postage Due $1.62 Photocopy 04/21/16-05/19/16 Photocopying Expenses $10.65 Registration 06/22-27/16 Registration for U.S. $200.00 (prorated) Conference of Mayors Annual Meeting, Indianapolis,June 22-27 Publication 05/16 Indystar.com $12.00 (prorated) 05/16 Wall Street Journal $1.62 05/10/16 The Washington Post $7.37 05/02/16-07/31/16 The New York Times $10.05 Monday-Friday Service 08/19/16-08/18/16 CQ.com $96.60 Subtotal: $127.64 Travel Expenses 05/16/16 Taxi to office from $6.24 Chinese Embassy Visa Office 05/23/16 Taxi to the office from $7.67 Chinese Embassy Visa NDYSTAR BRANDON KEY MAY 20.1.6 Share digital access j INDYSTAR Manage account � Newsletter settings Full access:Digital only Access eNevvspaper i Billing info j Monthly rate: $12.00 Need help?Call Customer Service at 1-888-357-7827 or email them at indianapolisstar@gannett.com ii II Interested in print delivery? � Upgrade today to enjoy the convenience of home delivery,with money- Call Customer Service at saving coupons,ad inserts and more. 1-888-357-7827 to add print delivery. S12 Monthly Subscription Charge for the Indianapolis Star Stephanie Carter From: Len Simon <len.simon@simoncompany.com> Sent: Monday, May 16, 2016 8:24 AM To: Stephanie McIntosh Subject: FW:Your receipt from Apple. From:Apple [mailto:no_reply@email.apple.com] Sent: Friday, May 13,2016 5:57 PM To: len.simon@simoncompany.com Subject:Your receipt from Apple. hmeceiv-,t APPLE ID fen.simon@simoncompany.com BILLED TO Visa ....2007 DATE LEONARD SIMON TOTAL May 13,2016 1660 L Street N.W. $24,31 Washington, DC 20036-5603 ORDER ID DOCUMENT NO. USA ML5S84VTV7 194126331448 App Store TYPE PURCHASED FROM PRICE The Wall Street Journal—Breaking news headlines,stock market updates&financial WSJcoverage, plus business analysis.,The Wall In-App YYStreet Journal (Automatic Renewal) Purchase $22'99 Monthly I Jun 9, 2016 Report a Problem Subtotal $22.99 Tax $1.32 TOTAL $24.31 Learn how to manage your password preferences for iTunes, iBooks, and App Store purchases at https://support.apple.com/HT204030. Apple ID Summary a Purchase History• Terms of Sale • Privacy Policy i lree�tr Porker INVOICE 90 Account Number 409408309 Billing Date 5/1/16 Due Date 5/22/16 Previous Balance $130.60 Service from 5/2/16 to 7/31/16 Payments-Thank You $130.60 CR Number of days in billing period 91 Payments received after 4/29/16 will not appear on this notice. Credits $0.00 Service adjustments occurring after 5/1/16 will appear on future notices. New Charges $130.60 Make checks payable to:The New York Times. 026050 000011090 Amount Due $130.60 409408309 050116 90 R112 MF 1 M For Customer Care,call 7 days a week: I�III��II��I�III�I'��'�Illltltlt�tltlttt�lltllrl��lilll�tllttlrlr 1-800-NYTIMES(1-800-698-4637) r NONE SIMON CO Email:customercare@nytimes.com 1660 L ST NW STE 501 Monday-Friday 5AM-12 Midnight ET 234 WASHINGTON DC 20036-5662 Saturday&Sunday 5AM-5PM ET or visit our Web site: http://homedelivery.nytimes.com (see reverse for more information) Previous Balance $130.60 Subscriber Name: SIMON CO Payment Received 3/09/16 Thank You $130.60 CR Monday-Friday Charges 5/02/16 - 7/31/16 $123.50 Tax-Newspaper $7.10 Amount Due $130.60 NJ 160501-26050-0000110 -_____________________________________________________b_— _______—__—_______—_—_. DETACH AND MAIL WITH YOUR PAYMENT.PLEASE MAKE SURE THE ADDRESS SHOWS THROUGH THE WINDOW. 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I have read and agreed to the terms on + �. the back of this notice.Please enclose a voided check for the bank Q71pe Xcw Mork &*M11W account you wish to use. PO BOX 371456 El CHANGE OF ADDRESS-Check here if you have a change to name, PITTSBURGI3 PA 15250-7456 address or phone number and complete the boxes on the back. Z 03 3201129 050116 218860 409408309 00130609 01V W454MAton Vogt ETZ CONTACT . - 1301 K Street, NW Washington DC 20071 For Billing Questions Contact: Subscriber Services Telephone: (202)33476100 MANE-mail: ciresales@washpost.com 3.1.569 AT 0.273 41953851.ps 007277408 1-1 1.2.3.4.6 R W I1�111111'1111'll"l�l�l�l'I..I..'�'I"��'I���I�'�lll�lllllll�l�lPay your bill and manage your subscription online! LEONARD S. SIMON Go green and sign up for paperless billing statements via email. 1660 L ST NW STE 501 washinotonpost.com/profile WASHINGTON DC 20036-5662 Statement Date: 04/10/2016 Account Number: 20965788 Subscription Type: Daily and Sunday Newspaper Delivery Address: 1660 L ST NVV STE 501 ACCOUNT 'CTIVITY PAYMENT You have currently paid for For Daily and Sunday Newspaper service until 08/02/2016(12 Weeks) $95.81 home delivery until: 05/10/2016 This includes the following activity on your account Note:Your renewal includes average transportation costs of$0.14 daily,$0.48 since your last statement: Sunday,applicable sales tax and any current balances. Please note,we will continue to deliver your newspaper until you Description Transaction Date Amount call and ask us not to. Payment 02/09/16 -$95.81(CR) Going away?Stop your print delivery at washingtonpost.com/subscribe or call 202-334-6100.While you are away,your print subscription will not be credited or extended as you will continue to have full access to all Washington Post All credits were used to extend your period of service. content through our web site and apps during your temporary stop. 5/16/2016 Uber Riders � ) Brandon FREE RIDES YOUR TRIP r 10:49 AM on May 16 2016 Brandon w Ind u�t Itemz� ret a p=are revielf:l R T Dt wend tact 't Your profile 33 - -�- — Add Credit Card FARE BREAKDOWN ilsg P Verify Mobile Verify Email F � ` m Base Fare 1.15 x Qq P1 My Trips e°� " 1p5`". Distance 2.67 SS[NY/ Profile Pz1„W- Time 2.42 c oSINW #.__. '. =M1ISINV t 4fV I,,, a f{ Subtotal $6.24 Payment - 5 v - - 1St IlY! °f Booking 1.35 Free Rides NEW! � �, qA H Fee (?) ^?' ..Map data%MlOGoogk Log Out 10:49 AM DC Taxicab 2209 Wisconsin Ave NW,Washington, DC Commission 0.08 Lost Fee (?) n something? 11:10 AM Check out 1660 L St NW,Washington,DC CHARGED $7.67 uber.com/lost Business •... 5370 CAR MILES TRIP TIME UBERX 2.62 00:14:15 You rode with RATE YOUR _$ JULIO EDUARDO RIDE https://riders.uber.com/trips/95203300-b8bb-4658-b3g-oaefa975ec10 1/2 THE UNITED STATES CONFERENU OF OR x2016 Annual Meeting' FJune 24 27, 2016 � '- f Your Confirmation Number: 16Annua19504 Len Simon Simon and Company, Inc 1660 L Street, NW Suite 501 Washington, DC 20036 202-659-2229 len.simon@simoncompany.com ILR-egistr lion Informa#ion�Y _ �. 4� r `' Registration Date/Time: 5/13/2016 2:41:06 PM Registration Type: WashingtonRep Badge Name: Len Special Needs?: No Payment Amount: $800 Payment Method: CreditCard Paid?: Yes The JW Marriott Indianapolis 10 S. West Street, Indianapolis, IN 46204 855-973-6587 Room: Single/Double ($189 per night) Arrival Date: 6/22/2016 Departure Date: 6/28/2016 Card Type: Visa Expiration Date: 08/18 King Bed: Yes Lnr Ad`dihonal Yaiformaton . . Ccpmcast. Account Number 09529 439216.01.3 Billing Date 04/21/16 Total Amount Due $651.62 Payment Due by 05/12/16 Page 1 of 3 Contact us: www.business.comeast.com 800.391..3000 F SIMON COMPANY F:revious B9l6nee. 1356 51 For service at: Payment 04/1;9/16=thank you -1356 59 1660 L ST NW STE 501 WASHINGTON DC 20036-5662 New Charges=see below 651.62 I Total Amount'Due $651,62 j News from Comcast ;6Payment aue by _ �_.: _ r_` _ 05i,12rs:� For quick and convenient ways to manage your account,view and pay your bill, please visit www.business.comcast.com/myaccount. .Comcast:Cable Television 189:50 @3 . Comcast Business Online Account:Service at your fingertips. Corn Comcast High;Speed Internet 109:90 Use your online account to manage services, pay your bill, m and shop for business-grade apps.Simply go to Comcast'Digital Voice®;: 264:45 business.comcast.com/mvaccount to register. Other Charges& Credits 47:81 Taxes, Surcharges &Fees 39:96 IN ew Charges $651 62 ISI lu :l! m F DATE 5/17/2016 LL NAME ID 3897 CALL INVOICE 77 K Street NE•7th Floor PO Washington, DC 20002 INVOICE 371996 4 www.cgrolicall.com TAX ID 13-3723190 800 432 2250•202 650 6613 Fax:202 650 6760• E-mail:contracts@cgrollcall.com DUNS# 780247644 QRTR 4049231 B S I STEPHANIE CARTER H STEPHANIE CARTER L SIMON&COMPANY INC I SIMON&COMPANY INC STE 501 1660 L ST NW P 1 16 0 L ST NW T WASHINGTON DC 20036 T WASHINGTON, DC 20036 O O Periodical :Start, Expire Copies Subscription Date Date PYIC@ Prevlous.payments,.(mc tax): 8/19/20'15 '8/18/2016 -4i0,046.25;' $7;534 68;. Budget Tracker Taxes (if app. cable);-- � UP�IV ®����® * Balance Due $2;511 57. Payment Enclosed in U.S.dollars made payable to CQ-Roll Call PLEASE PAY or ❑Mastercard ❑Visa ❑American Express (required information) Card Number (please list all digits) Expiration Date Signature If your payment has been sent,thank you and Daytime Phone Number please disregard this notice Please return this top portion with payment, ,, jl Customer.Record Tear Here' CCl ROLL CALL 77 K Street NE 7th'Floor. Washington, DC 200o2 www.cgrollcall.com 800-432-2250 1 202,650,6613 Subscription Title BGTR Amount.Paid Fax:202 650 6760 Name ID 3897 Method of Payment E-mail:contracts@cgrollcall.com Invoice' 371996 Date Keep this bottom portion for your records