Agenda 09/27/2011 Item #16A10
Agenda Changes
Board of County Commissioners Meeting
September 27,2011
Item 9B: Vacancy for District 2 Planning Commissioner to be re-advertised and continued to a
subsequent BCC Board Meeting. (Commissioner Hiller's request)
Add Item 9D: Recommendation to appoint 2 Commissioners as regular members, 3 Commissioners
as alternate members to the Value Adjustment Board. Per Ordinance Number 2011-17 a majority
vote of the Board is required to add this document to the agenda since it was submitted following the
publication of the printed agenda. (Requested by the Executive Manager of the BCe)
Item lOA: Add Commissioner Hiller's evaluation of the County Manager to this agenda item. Per
Ordinance Number 2011-17 a majority vote of the Board is required to add this document to the
agenda since it was submitted following the publication of the printed agenda.
Continue Item 10D to the October 11. 2011 BCC Meeting: Recommendation to approve and
ratify staffs unauthorized Zero Dollar Time Extension Change Order for Professional Engineering
Services with Atkins North America, Inc. (previously known as PBS&J) to Work Order No. 4500100227
in order to process final invoice for work completed for "Clam Pass/Bay Estuary," ratify staffs
unauthorized action of request for services, and then make a finding of quantum meruit based on the
value of the benefit received. (County Attorney's request)
Move Item 10L to 16A16: Recommendation to approve the Ribbon Cutting Ceremony for the
new Transit Route between Collier County and Lee County to be known as the "LinC" and to authorize
the Chairman to sign all applicable agreements associated with use of private property for the event
scheduled for October 6, 2011. (Commissioner Henning's request)
Item llA: Add Commissioner Hiller's evaluation of the County Attorney to this agenda item. Per
Ordinance Number 2011-17 a majority vote of the Board is required to add this document to the
agenda since it was submitted following the publication of the printed agenda.
Item 13Al: Add Commissioner Hiller's evaluation of the Airport Authority Executive Director to
this agenda item. Per Ordinance Number 2011-17 a majority vote of the Board is required to add this
document to the agenda since it was submitted following the publication of the printed agenda.
Withdraw Item 16AI0: Recommendation
to approve Request for Reimbursement as
an exception to the County Manager
Agency Organization Code ("CMA") #
5346, Reimbursement of Relocation
Expenses in the amount of $8,666.67, for
Anthony Khawaja, Engineer of Traffic
Operations for the Growth Management
Division. (Staff's request. Need for
additional review of back-up materials)
Move Item 16A15 to Item 10M: Recommendation to direct the County Manager or his designee to
amend the Collier County Land Development Code (LDC) and Right-of-Way Ordinance in regards to
storage containers, Planned Unit Development (PUD) Annual Monitoring Reports, specific standards
for the location of accessory buildings and structure provisions to include Personal Storage
Containers (PODS), number of dogs allowed in residential districts, and exceptions to a Right-of-Way
(ROW) permit meeting specific criteria. (Commissioner Hiller's request)
Move Item 16Bl to Item 13Bl: Recommendation that the Collier County Community Redevelopment
Agency (CRA) approves and executes an amendment to the employment agreement between the CRA
and David L. Jackson, the Bayshore Gateway Triangle CRA Executive Director, extending the term of
employment four years and modifying severance terms, and authorize the CRA Chairman to sign.
(Commissioner Hiller's request)
Move Item 16D9 to Item 10N: Recommendation to approve a budget amendment recognizing
$284,110.45 in revenue generated as program income when conveying property acquired through the
Neighborhood Stabilization Program. (Fiscal impact $284,110.45) (Commissioner Hiller's request)
Continue Item 16E2 to the October 11. 2011 BCC Meeting: Recommendation to approve a Revenue
Commitment Contract with Naples News Media Group to receive discounted pricing on advertising.
(Staffs request to clarify the language in the recommendation section of the executive summary.)
Continue Item 16F5 to the October 11. 2011 BCC Meeting: Recommendation to approve the Fiscal
Year 2012 Strategic Plan for the Naples Marco Island, Everglades Convention & Visitors Bureau (CVB).
(Staffs request)
Add Item 16H2: Proclamation recognizing the heroic actions ofChokoloskee resident Dwain Daniels
when he rescued ninety-year old Margaret Webb who was being attacked by an alligator. The
Proclamation designates September 24,2011 as "Dwain Daniels Day". Per Ordinance Number 2011-
17 a majority vote of the Board is required to add this document to the agenda since it was submitted
following the publication of the printed agenda. Sponsored by Commissioner Henning.
Time Certain Items:
Item 101 to be heard at 11:00 a.m.
N!lmi
Items 8B and 17 A requires that ex parte disclosure be provided by Commission members. Should a
hearing be held on this item, all participants are required to be sworn in.
Item 16B3 fiscal impact should read: Of the $400,00.00 $400,000.00 in the FY-2011 budget,
$384,965.94 has been awarded by the CRA Board and $15,034.06 remains. (Commissioner Fiala's
request)
Item 16C3: The work order made part of the agenda back-up is dated September 2, 2011. The County
Attorney's Office has requested that this date be changed to the BCC approval date, September 27,
2011, if this item is approved by the Board.
Item 16G2: The date referenced for the event is incorrect. The first event for the 38th Annual Sun-n-
Fly Event in Lakeland Florida is scheduled for March 27 through April 1, 2012.
9/27/2011 9:46 AM
9/27/2011 Item 16.A.10.
r"\
EXECUTIVE SU~Y
Recommendation to approve Request. for Reimbursement as an exception to the Couaty
Manager Agency Organization Code ("CMA") # 5346, Reimbursement of Relo~tion
Expenses in the amount of $8,666.67.
OBJECTIVE: To receive approval from the Board of County Commissioners for
reimbursement of relocation expenses for Anthony Khawaja, Engineer of Traffic Operations for
the Growth Management Division.
CONSIDERATIONS: Mr. Khawaja was issued a contingent offer of employment as a Traffic
Operations Engineer in the Growth Management Division of Collier County Government on
March 12, 201(r. The compensation package that was provided to him included relocation
expense assistance that was. not to exceed his monthly gross income. Along with the
employment offer Human Resources included County CMA # 5346, Relocation Expenses, which
has the following requirements:
r"'.,
A. Department Directors, Division Administrators or other hiring Supervisors may
not negotiate or approve relocation assistance with any applicant without
approval of the Human Resources Director.
B. Relocation expenses shall be paid only upon the recommendation of the
Department Director, Division Administrator, and Human Resources Director
and require the advance approval of the County Manager.
C. Approvals for reimbursement of relocation expenses must be obtained prior to
the move.
D. All recommendations for payment of relocation allowances must be made on
the Request for Authorization of Relocation Expenses foml.1 Commitments to
expend County nlflds for payment of relocation expenses shall not be made
without prior approval by the County Manager.
E. Any considel'ation of relocation assistance shall 110t exceed one month's gross
base sala1)' at time of hire.
F. Moving expenses eligible for relocation approval may include any combination
of the categories listed below or other expenses incurred, which are approved by
the Human Resources Director and County Manager. In no instance will the
total relocation allowance exceed the guidelines set forth in S 5346.
(1) One house-hunting trip for the employee and/or family.
(2) Movement of household goods.
(a) The employee must secure estimates from three reputable
movers or rental companies with national affiliations and submit
those estimates to the Human Resources Department. The Human
Resources .Departrnent reserves the right to choose the carrier if
there is greater than a ten-percent variance.
(b) Household goods will not include construction materials,
animals (except domestic pets), or sporting/recreational equipment
that cannot be carried in the moving van.
(3) Storage of household goods for one month.
(4) Transportation expenses incurred in movement of new employee and
dependents to Collier County.
r"\
Packet Page -1288-
9/27/2011 Item 16.A.10.
~
G. When appropriate, funds will be disbursed directly to service providers after
receipt of invoices or employees may be directly reimbursed. Reimbursements for
approved relocation expenses will be paid only after receipt by the Human
Resources Department of appropriate receipts/documentation.
On April 10, 2010, Mr. Khawaja signed and returned both the Request for Authorization of
Relocation Expenses and the signed Relocation Agreement form. Mr. Khawaja was unable to
provide the required three estimates at that time as he was unsure of the exact moving date of his
family. Mr. Khawaja began his employment with the County on April 19, 2010. Due to the
lapse of time from when he signed the Request for Authorization of Relocation Expenses form
and along with the urgency of selling the family home in Chicago and moving his family to
Naples, Mr. Khawaja inadvertently forgot to submit the three estimates to Human Resources
prior to scheduling the October 2010 moving date.
In January 2011, Mr. Khawaja provided itemized receipts for his relocation as well as the
required three quotes. The estimate that Mr. Khawaja chose to use to move his family was the
lowest moving estimate that he received of the three. The amount requested ($8,666.67) is the
most Mr. Khawaja is allowed to recover under CMA # 5346(E). The County Manager's Office
has reviewed and approves of this reimbursement request.
FISCAL IMP ACT: Funds are budgeted and available under the Transportation Services Fund
101 for reimbursement to Mr. Khawaja as a FY20 11 expense.
~
GROWTH MANAGEMENT IMP ACT: There is no growth management impact associated
with this Executive Summary.
LEGAL CONSIDERATIONS: This item has been reviewed and approved by the County
Attorney's Office, is legally sufficient for Board to take the action recommended by staff, and
only requires a majority vote for approvai-SR T.
RECOMMENDA nON: That the Board of County Commissioners approve a request for
reimbursement totaling $8.666.67 as an exception to C~,/1A # 5346's established policy due to a
failure to comply with the procedure by Anthony Khawaja. Traffic Operations Engineer for the
Growth Management Division.
PREPARED BY: Tara Castillo, Budget Analyst, Construction and Maintenance, Growth
Management Division
Attachments: CMA 5346Attachment I: 1, CMA 5346 Attachment 1 :2, Itemized receipts for
reim bursement
---...
Packet Page -1289-
9/27/2011 Item 16.A.10.
COLLIER COUNTY
...-..
Board of County Commissioners
Item Number: 16.A.10.
Item Summary: Recommendation to approve Request for Reimbursement as an
exception to the County Manager Agency Organization Code ("CMAIt) # 5346, Reimbursement
of Relocation Expenses in the amount of $8,666.67, for Anthony Khawaja, Engineer of Traffic
Operations for the Growth Management Division.
Meeting Date: 9/27/2011
Prepared By
Name: Tara Castillo
Title: Fiscal Technician,Transportation Engineering & Con
9/12/20] 1 6:33:55 PM
Submitted by
,,-.........
Title: Fiscal Technician,Transp011ation Engineering & Con
Name: Tara Castillo
9/12/201 I 6:33:56 PM
ApPl'Oved D:,
Name: BetancurN ataJi
Title: Executive Secretary,Transpol1ation Engineeriilg & C
Date: 9/13/201 I 2:55:25 PM
Name: AhmadJay
Title: Director - Transportation Engineering,Transportation Engineering & Construction Management
Date: 9/13/2011 3:0] :]2 PM
Name: TaylorLisa
Title: Management/Budget Analyst,Transportation Administr
Date: 9/13/201 I 3:15:33 PM
Name: LybergAmy
Title: Director - Human Resources,Human Resources
Date: 9/14/20] 12:05:19 PM
...-..
Packet Page -1290-
9/27/2011 Item 16.A.10.
~
Name: FederNorman
Title: Administrator - Growth Management Div,Transportati
Date: 9/14/2011 2:13:55 PM
Name: MarcellaJeanne
Title: Executive Secretary, Transportation Planning
Date: 9/15/2011 12:54:39 PM
Name: TeachScott
Title: Deputy County Attorney,County Attorney
Date: 9/16/201 1 9:06:53 AM
Name: IsacksonMark
Title: Director-Corp Financial and Mgmt Svs,CMO
Date: 9/19/2011 2:52:38 PM
Name: KlatzkowJeff
Title: County Attorney,
Date: 9/19/2011 3:24:03 PM
~
Name: OchsLeo
Title: County Manager
Date: 9/19/2011 9:23:39 PM
f'
PacketPage-1291-
~
OFFICE OF COUNTY MANAGER ADMINISTRATIVE 9/27/2011 Item 16.A.10.
COLLIER COUNTY
BOARD OF COUl\TY C01\'f\USSIONERS
Relocation Agreement
In accordancc with this signed agreemellt, I &ji!jLL~~fito
repay Colher County Board of County Commissioners for re~catjon reimbursements
or payment.,; received if T should discontinue my employment with Collier County
Board of County Commissioners for any reason within two years from date of hire.
This Agreement does not in any way constitute an employment contract between
myself and Collier County Board of County Commissioners.
f(/O/(O
d . IS. I (
]J;ltc
~ECE\VEO
FEB , 5 2011
"NANCE
./~
Packet Page -1292-
CMA 5346 Attachrncnt 1:2
~
~
{J'J - 15 ...
,.
RELOCATION EXPENSES
9/27/2011 Item 16.A.10.
('I\..fA 5346 Attachment 1
"..-...
REQUEST:
COLLIER COUNTY GO'VERN:\lENT
REQUEST FOR AUTHORIZATION OF REIJOCA TrON EXPENSES
Name:;{~~~~4WJ1tfale: ~ I {O ((0 .
Position: G,lr. ~ /YAfffc. Division: ~ r~::t.ovM. 611 'VI C
Date of Employment: r ( r't (I f) Department: f ya..,f{:/"L of<4',-a:fc 0 ~
Monthly Salary: ctr Br6r;, 1 Budget Code #:
~,
Relocation allowance for
i
Justification for relocation allowances:
Moved from City of: LinJerr h ()~te: ~ L- ..
Estimated Mileage to new residence: I tf () 0 ~ 1'( e.5
ttsf Employee and/or ~ Fa~~CEIVED
House hunting trip FEB 1 5 2011
Movement of household goods
Storage of household goods and personal effects for one month or le~' NANCE
Transportation expenses for movement of employee and dependents to
11e\N location.
Recommended mode oftram:portation ofho;sehold Qoods and personal effects: (three _ 1./ D
estimatcsrcquired) :z (.".)/11 rrt5~/?Le ta.-P-I/ vJhet1 ::r: ;-rOye ~e. l-~;lv
/
/
f
I
i'll'--" " ~ ,.....yl. ~~....,r' / ::'If,~t..,.-; ;..,.,.....~ ~ l"'-'~'\
L_." ,ammo,} ,-,~iTl'-" \ l,.~ llLa,,--"-, l.-(.;,t,
n R>"'11r'1 \r,~h;l'l~' (f'st;'''''at'''u'' r"'~f.\
L-J _Ie O-U ........'- 1'...... ..... ._,. ~.i"Lr.,"" ,,-\..}..'~)
f \
j,
if
:, \
) l
"'\
-f
." )
J ustl ficatlon for Recommended mode of transportation:
Department Direelor: ~. /'4,' -- -
DivIsion Administrator: .___:_ .if.?>_-- _ __
l
Date: _Lj_ll)J J ..
Date: w..>.. . 0~i!
----- --... ----- --- ---------------- - _.- ---- ----- - -------- _._- --... -- - ---- - - - --- ------- - ------ --- -- - --- -- ....----- ----- ----....
APPROV AL:
D The above request is not approved.
]gI The above request is approved for move by:
:ommoti Carrier
}rivate and/or Rental Vehicle
Estimated total Cost S
8, 75~.2.~
-----.-----..-.
t# th "
"..-...,
man Resources Director:
County Manager:
Date:
Date:
~/
Packet Page -1293-
CMA 5346 Attachment 1: 1
09 . 15 - 2007
"
9/27/2011 Item 16.A.10.
. . ".' C. \::y,~ ;
.~ \.-
.-...
.c'-,
_t \~~\ ,\...'.'
nt.c.:...'UI..ol .
N nV#'
\~\)\-.f\~' .
!
Chapter 5346
RELOCATION EXPENSES
~ 5~1. Purpose.
i 5346-2. Concept.
i 5~3. Currency.
i 5346-4. Reference.
Request for Authorization of
Relocation Expenses
{Effective Date: October 1, 1998 (Revised: October 1,2001; Revised: October 1, 2003;
Revised: April 1, 2006)J
~ 5346-1. Purpose.
The purpose of this Instruction is to provide for the implementation of a relocation expenses
procedure authorized by the County Manager.
~ 5346-2. Concept.
It is the policy of the County to recognize that allowances for relocation may be necessary to
recruit skilled professional, supervisory and technical staff. The County will provide direct
payment to contractors and/or reimburse eligible employees for legitimate expenses incurred
in relocation in the manner set forth in this procedure.
A. Department Directors, Division Administrators or other hiring Supervisors may not
negotiate or approve relocation assistance with any applicant without approval of the
Human Resources Director.
~
B. Relocation expenses shall be paid only upon the recommendation of the Depanment
Director, Di-vIsion -,A~dnlinistrator, and HU111a!1 P_CSOUfces Director (Lf1d requ~re. the. ad"'vc~rose
approval of the County Manager.
C. Approvals for rei..rnbursement of relocation expenses must be obtained prior to the move.
D. All recommendations for payment of relocation allowances must be made on the Request
for Authorization of Relocation Expenses form.) Commitments to expend County funds
for payment of relocation expenses s~al1 not be made without prior approval by the
County Manager.
E. Any consideration of relocation assistance shall not exceed one month's gross base salary
at time of hire.
F. Moving expenses eligible for relocation approval may include any combination of the
categories listed below or other expenses incurred, which are approved by the Hwnan
1. Editor's Note: The Request for Authorization of Reloc:ation ExpeJIses form is included at the end of this CMA.
~
5346:1
09 - IS - Z007
Packet Page -1294-
~
9/27/2011 Item 16.A.1 O.
~
S 5346-2
OFFICE OF COUNTY MANAGER ADMINISTRATIVE
PROCEDURE
9 5346-4
Resources Director and County Manager. In no instance will the total relocation
allowance exceed the guidelines set forth in S 5346-2D above.
(1)
(2)
One house-hunting trip for the employee and/or family.
~
Movement of household goods.
(a) The employee must secure estimates from three reputable movers or rental
companies with nationaJ affiliations and submit those estimates to the Human
Resources Department. The Human Resources Department reserves the right
to choose the carrier if there is greater than a ten-percent variance.
(b) Household goods will not include construction materials, animals (except
domestic pets). or sporting/recreational equipment that cannot be carried in
the moving van.
".-,.
(3) Storage of household goods for one month.
(4) Transportation expenses incurred in movement of new employee and dependents to
Collier County.
G. When appropriate, funds will be disbursed directly to service providers after receipt of
invoices or employees may be directly reimbursed. Reimbursements for approved
relocation expenses will be paid only after receipt by the Human Resources Department
of appropriate receipts/documentation.
H. Employees receiving relocation expenses will be required to sign an agreement stating
that he/she will repay the relocation expense should he/she separate from County
employment within two years from the date of hire.
S 5346-3. Currency_
The Human Resources Department IS responsible for maintaining the curren(~y 01 this
Instruction.
~ 5346-4. Reference.
Collier County Personnel Ordinance, Ordinance No. 2001-50: Relocation Expenses: It is the
policy of the County to recognize that allowances for relocation may be necessary to recruit
skilled professional, supervisory, and technical staff. The County will provide direct payment
to contractors and/or reimburse eligible employees for legitimate expenses incurred in
relocation in the manner set forth in the Human Resources Practices and Procedures Manual.
r-'
5346:2
09 - 15 - 2007
Packet Page -1295-
9/27/2011 Item 16.A.10. .
...-..
Moving ExpanSe5
Anthony Khawaja
Traveling Expaflses Anthony Khawaja
Item
~ Gas
Gas
Gas
@Gas
9 Food
Food
~FoOd
Food
CD Hotel
Anthony Khawaja
Anthony Khawaja
Anthony Khawaja
Anthony Khawaja
Anthony Ktlawaja
Anthony Khawaja
Anthony Khawaja
Anthony Khawaja
Anthony Khawaja
Amount Date
$38.26 lS-Apr
$15.12 lS-Apr
$32.74 16-Apr
$40.81 16-Apr
$5.46 15-Apr _I
$21.65 1S-Apr-N'\- \.~.iltt'1'<'"C{
$3.92 16-Apr
$18.92 16-Apr - t-Ill+ , Vn-\"T~~
$75.58 16-Apr-
Dorie & Sophie Traveling Expenses
jGas Dorie & Sophie $43.79 29-Sep
Gas Dorie & Sophie $24.59 I.Oct
-6 Gas Dorie & Sophie $36.71 I-Oct d
Gas Dorie & Sophie $25.84 I-Oct -No.... am. 7<(
,~: Dorie & Sophie $40.01 3-Oct -N1,q ((.PAlf' nohUfl#bUr.s.aAbI.~
Dorie & Sophie $31.05 4--Oct
Gas Dorie & Sophie $35.76 4--0ct
.Gas Dorle & Sophie $42.18 4-0ct
@Gas Dorie & Sophie $30.09 5-Oct
crGas Dorie & Sophie $28.55 5-0ct
Gas Dorie & Sophie .$41.66 6-0ct ~
Food Dorie & Sophie $19.15 30-Sep-l4o+ \~ntl"t.t!
Food Dorfe & Sophie $28.83 30-Sep- ~~ ~+!...nll"u.d
Food Dorie & Sophie $55.61 1-0ct-NDt It-( mt"Z.-~d
@ Food Doria & Sophie $3.10 1-0ct
Food Dorie & Sophie 529.34 2-0ct-I-Il>...... ::r.........,m Ie: (~
Food Dode & Sophie $11.91 3-0ct
Food Dorie & Sophie $21.91 4-0C1:
Food Dorie & Sophie $7.13 4.Oct
, Food Dorie & Sophie $8.28 4.0d:
~ oDd Dorie & Sophie $2,14 4-0ct
/q Food Dorie & Sophie $8.28 4.0ct
D Dorie & Sophie $2.11 5-0ct
t Food Dorie & Sophie $2.13 5-Oct
I Food Dorfe & Sophie $4.55 5-Oct - J
Food Dorie & Sophie $16.76 6-0ct -No-i-;r...kn-wr<t:.
@HDtel Dorie & Sophie $91.90 4-0ct
If'.'d",e r<ket Dorie $267.90 30-Aug House Hunting
irline Ticket Rami $173.90 30-Aug House Hunting
. Airline Ticket Jamie $227.90 5-Aug Houie Hunting
Airline Ticket Sophie $201.40 2S-0ct
~3 Moving-Motorcycle Anthony Khawaja $403.75 17-Apr
;;.?~ oving-Vehicle BMW 325 Anthony Khawaja $585.00 30-Sep
lng-Furniture Anthony Khawaja $5,091.39 14-Oct
Moving-Fumiture Rami Khawaja $173.00 25.Sep
Moving Vehide BMW 525 Anthony Khawaja $575.00 14.Dec
Airline Ticket Jamie Khawaja $93.20 13-Dec
~
Total
$8,738.26
The total cost of r~~~~?tion expenses.
Mr. Khawaja's :eligible a~lowable amount is
$8,666.67.
Packet Page -1296-
... , .
~j;/j: /;1ig-
&~j /C/ ~~ 90
r!aYIO;Y ~ 19 cJ
~tJ / /.3 C/o
1'f/J~ ~ 7. q ()
6f~()l f'6
12(i'J ~\1'<Zo
~,
.---..
~~/$
T2/U j'
DtJA"/c-
Mil1/ .
lam/IE
go. IE
Q~\~
9/27/2011 Item 16.A.10.
;11/ / a/rt~E" tOr/a R.
[ I - I r11Et6e5
. If/' I
I
ChJo,II h R:/J1cr^"s
I / tI/~ jIf:L ~ R /lkrr5
(!J;fJ f Pt
t1- r'I wcW fcee. - Pl-~
; -to(...,;.ul.
(Y'-O"'''' .,
-n't t.e.-t M ~ l..-,
~ 11; J 0t(...ttLe 7.
/ ,1
DC""'f; L <; (CI,,;r0< .
J
r}~~
1\ (1//0
1\ \), v
, y \'
j\. '
/ e/l/
{!~V--
PacketPage-1297-
I
~
,
1
i Please note: AirTran Airways charges an additional fee for
I baggage.The fee is not included in your total trip cost.See
I details
!
Friday, May 28, 2010
AirTran Airways # 732
Fort Myers Southwest Florida Reg (RSW) to Milwaukee
General Mitchell (MKE) .
1 Departure (R5W): May 28. 12:35 PM EDT (afternoon)
I Arrival (MKE): May 28, 2:35 PM COT (afternoon)
!
I
9/27/2011 Item 16.A.10.
America, an Orb._ r -. - . -. .
Coverage is available for a
non-refundable airline
ticket up to $3,000.
Important limitations apply.
Buy Airline Ticket
Protector
I
~:
I ~irline tlc~~;n~~~er(~):ISSUe<l by ~~~irline
Class: Economy
IMKE
Tuesday, June 1,2010
AirTran Airways # 680
Milwaukee General Mitchell (MKE) to Fort Myers Southwest
Florida Reg (RSW)
Departure (MKE): June 1, 7:30 AM CDT (morning)
Arrival (R5W): June 1, 11 :22 AM EDT (morning)
~
Class: Economy
View the latest airport conditions at: MKE
Se Prepa.red
Orbitz Care
Find useful tips on topics such as packing carry-on bags,
checking in and traveling with e-tickets in the Travel tips
section. We also have answers to frequently asked
questions.
Booking C 'rmatiu~
Passe er: ANTHONY KHAW AJ ^ 2)
Airline .eket number(s): l.s.sttet'b;the airline
Ticket ty ~le.ct('mic-(Ei:ticket)
.-.....
Please note that
restrictions. Chan es to
2
Packet Page -1298-
AJ.rTran AIrways Keservanons
tJlll1e I or L
9/27/2011 Item 16.A.10.
,,-....
~
CairTran.com
receipt & itinerary
Thank you for choosing AirTran Airways.
We will send you an email message containing your itinerary. To ensure you receive the message, you may wish
to add confirmations@airtran.com to yGl.J address book.
confirmation nurn
Booking date: Sun, Au Status: Confirmed
Should our flight schedule change, we will notify you by email as early as possible.
Fligh!.Details
-
--
._--~-
:)
Departing: Monday, August 3D, 2010
Milwaukee, WI (MKE)
7:25 AM
to Fort Myers, FL (RSW)
11:18 AM
Flight 680
--
---..
Returning: Friday, September 03,2010
Fort Myers, FL (RSW) to Milwaukee, WI (MKE)
12:36 PM 2:37 PM
Flight 732
Coach
, Passengers and Seat AssJ.9.nmentct
----- -
Passenger A+ Number
Dorie A Khawaja Add A+ Number
OOB: added
M KE-RSW
RSW-MKE
~~iOrt
C Dorie Khawaja /'
-410 Brittany Lane-
lindenhurst, IL 60046
United States of America
dorie. k@comc3st.net
847-406-9216 (Tel)
847-265-0527 (Alt)
Pricing
Payments
Total for 1 passenger(full detail)
Fare price: $230.70
Taxes/fees: $37.20
Total price: $267.90
Payment via Credit Card
Form of payment:
Payment status:
Payment amoun .
'vi
Terms and Conditions
,..-..
Fare Restrictions
6Y
https://tickets.airtran.comlPrintItinerary.aspx
Packet Page -1299-
8/29/2010
9/27/2011 Item 16.A.10.
'~
C--airTran.com
receipt & itinerary
----..
Thank you for choosing AirTran Airways.
We will send you anemail message containing your itinerary. To ensure you receive the message, you may wish
to add confirmations@airtran.com to your address book.
confirmation number: OCM2UQ
Booking date: Thu, Jul15, 2010 Status: Closed
Should our flight schedule change, we will notify you by email as early as possible.
Flight Details
Departing: Thursday, August 05,2010
Milwaukee, WI (MKE) to Fort Myers, FL (RSW)
7:25 AM 11 :20 ,AJ\.~
Flight 680 '
Coach
Returning: Wednesday, August 18, 2010
Fort Myers, FL (RSW) to Milwaukee, WI (MKE)
12:36 PM 2:37 PM
Flight 732
Coach
Passenger
JAMIE KHAV
~~nformation
DORIE ./1. KH,l\.\^!.L\J/\
431 21ST STREET SVV
NAPLES, FL 34117
United States of Arllerica
,.-.....
A+ Number
MKE-RSW
22E
RSW-MKE
17E
DOR!:=K. KHAWAJP.@Gfvtll.!L.CQ1\!i
847 -406-9216 (Tel)
8473097500 (Alt)
Pricing
Payments
Service fees:
Total price:
Payment via Credit Card
Form of payment Visa
Payment status: Confirmed
Payment amount: $197.90
Payment via Credit Card
Form of oavrnent: Visa
~
Packet Page -1300-
~
AirTran Airways Reservations
9/27/2011 Item 16.A.10.
~.
~
CairTran.com
receipt & itinerary
Tnank you for choosing AirTran Airways.
We will send you an email message containing your itinerary. To ensure you receive the message, you may wish
to add confirmations@airtran.com to your address book.
confirmation number: M6BJ8S
Booking date: Fri, Oct 22, 2010 Status: Closed
Should our flight schedule change, we will notify you by email as early as possible.
Flight Details
Departing: Friday, October 29,2010
Fort Myers, FL (RSW)
5;37 PM
to Chicago, IL - Midway (MDW)
7.'J,7DU
, .WI . .r.
Flight 1204
Coach
Returning: Sunday, November 07, 2010
Chicago, IL -Midway (MOW) to SarasotalBradenton, FL (SRQ)
2:24 PM 5:54 PM
Flight 1217
Coach
~
Passengers and Seat Assignments
Passenger
sophia a khawaja
OOB: a
A+ Number
8590062204
RSW-MDW
260
MDW-SRQ
31C
Contact Information
sophia khawaja
431 21 st street SVV
Naples. FL 34 i"17
lJn1ted States of America
soph:a. k699@gnlaii.c8ili
8477759222 (Tel)
Pricing
Payments
httpS.lltl'Clr"'tCOQ;rfr"'n"o,...,!Printlt;npr"'nf,>conv
.l.1...L .11 ~,.........,....,u_" WI.A..... ~~.u..t. .......r. "'~I.""""'"J...~ LL
Totai for i pBssengenfull detail}
Fare prics:
Payment via Credit Card
$167.44
Form of payment: Visa
Taxes/fees:
Total price:
Payment status;
Payment amount:
Confirmed
$201.40
Terms and Conditions
/
~
Fare Restrictions
Packet Page -1301-
-.; - *'..
. ArrTqm Airways Reservations
" '
9/27/2011 Item 16.A.10.
- ~ ,
::>( -'; . : ..
Caiflran.com
....!,' ~
}.~.
receipt & itinerary
--
Thank you for choosing AirTran Airways.
We will send you an email message containing your itinerary. To ensure you receive the message, you may wish
LU ClUU l,;Ulllilllli::lLiulI::i@i.:Ii,LIi:lIl.I.;uJ11 LU YUUI. i::U.iult::;;;; uuur....
confirmation number: KDQ97K
tsoOKing ciaie; i=ri, uee u;j, ~uiu 5tatus; Confirmed
~hnl,lrf nllr f1inht ~hArllIIA r.h,::rnnA \AlA will nntifv vnll hv AmAill"ll: AArlv l"I!:: nn~l:ihIA
lJ _, ~~ J ".
Flight Details
Departing: Monday, December 13, 2010
Milwaukee, WI (MKE)
2:15 PM
to Fort Myers, Fl (RSW)
6:09 PM
Fliaht 217
Coach
Passengers and Seat Assignments
Passenger
JAM I!:. A K..HAVVAJA
A+ Number
Add A+ Number
MKE-RSW
,-.....,
f""\r\O. ....,.J,.J_A
--....... ....-...............
Contact Information
JAMI!:: KHAWAJA
A')~ ,}-l CT CTr:lC::::T CIM
danek. khawaJa@gmall.com
OA7 Ana orH A IT^"
..... I, ............ OJ_. . \ '-"""/
NAPLES, FL 34117
United States of America
847-406-9216 (Alt)
"",,".-.L_I _-=___
I V1.al 1'111\,..'0.
,...""... "'"
~""""..."
Payments
Pricing
Total for 1 passenger(full detail]
F are price: $78.14
Taxeslfees: $15.06
Terms and Conditions
~~o
~')l
~::"~ ~~~:=~~:":~
Coach
..; \/ :-u;-~ G:~~~
---
. Coach Class Fare
https://tickets.airtran.comIPrintItinerary.aspx
Packet Page -1302-
12/3/2010
AmericanAirlines'
9/27/2011 Item 16.A.1 O. I
~
Sta rt
Ticket Lookup Refund
Eligibility
Contact Review and
Information Submit
Request
Finish
Request A Refund
o -O.ll -0
-()
-0-0
Ildtet Data
CANCEL. .'.j
If you would like to request a refund on the displayed ticket, click "CONTINUE".
Ticket Number 0012198592235
...RefundStlltus..,':'::,,>;" .:' ..
No refund requests have been entered for this ticket.
; Ticket'1'
Ticket Type
Electronic
Flight Coupon
NO
. Passt:!ngerData:
Passenger Name
KHAWAJA, RAMI
issue Dale
Sale Date
Sale Amount
8130/2010
Sf30/2010
143.90 USD
..y
.", V ....J. /
. iJJ IV.' \
'1-.,/1 r'J. . r} . n.q
:;.v 0'-' . ".'. '- h .1' > \
, - .~...../\.,./ "'r'~
L.....:f~/ \
Sale Data
Credit Card
.... Jtinerary<.'.~
Coupo Fligh Departing Arriving , Refundabl
n t e?
001 500 MILWAUKEE CHICAGO/O'HA NO
3 8/3012010 RE
09:50:00
002 146 CHICAGO/O'HA FORT MYERS NO
5 RE
813012010
11 :45:00
Data;'" . .' ,~....,.,.'.".
Code Fee Statu Exchang
s es
NAOOERJ NON USE
1 E 0
NAOOERJ NON USE
1 E 0
Travel Agency Name MKE ATO
Travel Agency Number 5210110
Address MILWAUK Packet Page -1303-
9/27/2011 Item 16.A.1 O.
Cqp Take Control with Online Statements
Managing your account o~line is easy:
'"
. Check your balance and view recent activity
. View and print copies of past statements
. Pay your bill online
Sign up at www.capitalone.com
~
~
Visa Platinum
NEW BALANCE
$4,876.104
MINIMUM PAYMENT
$48.00
Previous Balance PaymelllS IIId Credits
[ $1,606.23 ) - [ $1.690.80 J
Pag 0 Z or 3 HlIlO-955.707D
www.capltalone.com
XXXJ(.XXXX.XXXX-l488
DUE DATE
Oct lI8, 2010
ADo. 12 - Sop. 11.2010 31 08)'$ i'I BIIing Cycle ).
CredIIl.imll:
Avalablo en.dlt
a.oh cndlt Limit:
Avail8tIIe credit for ClIsIr
11'll15actiuns
[ $4.96141
Fees and IlIleleSt Chi\l!lled
+ [ SO.OO )+
(TRANSACTIONS CONTINUED
tRANSACTIONS FOR ANTH01lY N KH4WAJA #1 UV ICONTINUED)
'4 1, AUG BLUE HERDNGENOADH
IS 1, AUG BItAVO SUPERMARmNW,Fl
16 16 AUG \'1M 5UPERCENlERANTlOCHIl
17 16 AUG ROlEN HONDAGURNHll
18 16AUG IHEllIDL,754248iiS08NAPlE5f!.
1! 16AUG Dnmni:l:sS1DrllOD1151IX5URNEEll
10 16 AUG BlffERA "'ARm ITDREUNOENHUP.5Tll
21 11 AUG I'ASI AliTOREPlINI;H #5400800-82.-71:711
11 IS AUG Wl.1 IUPERCEtlf,RNAPlISfl
13 If. AUE lllNGJOHN IllVEP.5NAPlElFl
14 15P.UG IHEllOLS74441100DIMILWl\l1l:EE.\~
25 Ie ~UG 1EXAce 003D39))NAPlESfl
H 18,61"5 AfRTRANAIR 3320og2f73~]j!\1LJd,:Ui.c'"')
TK#. 531 Q092173372
PSGP, KHI,W,liNAtITHDNY
DIllG: RSW. om: MKE
5/0: 0 CAMlEP.. R S\'C: "
ORl6: MY.<. DES!: I\lW
liD [) CARRiER; FL s'Ve: \
27 19 !lUG R mo D 31NUINtlENHURSTtl
28 20 !lUG W\.I SUPERCENfERllAPlESFl
)! 21 AUG VIM SUPEllCHlI!ltANTIOCHll
3D 21 WG K-5QUARENAi'LBFL
31 21 AlIG EXXONMOB~ 952&I77'GURNEEll
32 21 AUG WORlD MKl 000013Bl1GURNEEll
33 21 AUG WAlGREENS #690SllNDENHURSTIl
34 22 AUG SPRINT 'WIRE1.mBIIO-&3lI-;;1 t IVA
3S 22 AUG SPEEDWAY 07350 549GUftNEEn
36 22 AUG TACOS El NORTEGURNEIll
37 21 AUG GURNEE ONEMA5-Z300GURNEBl
38 21 AUG GROUPON INC.S77.7B87B5Bll
39 21 AlIG CmHARPolACY #0712 QDlNAPlESR.
4D 23 AUG WAlGRfENS #6!lD5l1NOfNHUR5T1l
41 14 illIG WI.l SUl'fRCEtITERANTIOCHll
42 2UUG A'GAO #1I9GURNEEll
43 24AUG WAX)( #0081GURNEEll
44 24 AUG ULTA #14DVERNON HIU5l
45 24 AUG ULTA 3 t67GUIINEBl
46 25 AUG MEWNS641-&62-1445~
47 25 AUG AlN'ORT HE5~API.ESR.
48 2,AUG SHEllOll57~D!UOll1.Al(El/IlI.AI.
49 28 AUG JEMI. #34DSGURHEEl
50 2B AUG TEXACO D0303!l71NAPLESR.
51 2' AlJG WI.l5UPERCENTEPJoIAPlESfI.
52 21 AUG WI.l SUPERCENTEAANllOCIl1l
53 2!AUG MURfH'r'1115ArwIll.lolRTANlIOOOl
54 25 AUG olIRlRANAIR 332l1Q9280Dll7JATLANfAGA
lKt: 3320092800872 PS6R: IiHAWAJM)ORIE.
I
lllilJeanpage3
Packet Page -1304-
$18.08
$10.58
m.07
m.13
S41.45
134.16
$32.BS
~C.I!{)
1'~.2E
~G,74
59)1
i2J2.9:1
13.01
115.16
m.41
538.9&
~3.9S
$1255
14.18
mU9
IlllDO
112.1!3
115.75
$12.00
$6.35
lB.71
$9.33
$13.96
$16.11
$54.)4
$50.00
$980.97
$44.73
1'337
$12.83
$,.92
141.77
5S3.43
145.70
1261.90
) =
115.000.00
$10.123.16
$5.DOO.oo
15.DOO.oo
New Balanl2
[ 54.876.84
)j
~ ~.3~,
TRANSAmON5 FOR ANTHONYN KHAWAlA #1<<8 (CONTINUED)
ORlG: MKE. OESl: RSW
!/C: 0 CAlIRlEt fllve: R
ORlIi RSW, DESt: NKE
!/C: 0 CARRIER: fl we: R
5S 3D AUG R5T"RESTAURANT.COM80D-!l7!lS985Il
So 3D AUG 'ANEJIlCAN AI 0012I98591Z35M~WAUK!EWI
11(#: 0011 ,gR5m]5
ORIG: MI<L om: ORO
SID: ): CARP JEll: AJ;. IYC: N
ORIG: ORO, 0ES1 RIll'
CARPJH AA I ve: N
57 30AlIG t..MEIKAN 1.1 OOlO&\34a7630M:LWAU~~W.
'Y.#.00105!340780
aRtG: XAJ.., D~T. xx>:
5/0.0 CI.flRfEt ;..J.. S\'~ i
ORIG: XX\ DE5~: >xY:
CAF.RIER: '('{'NC: Y
18 3D AUG \H~l'lS mAlJlOUIFNAPlElfl
\9 31 AUG GURNEE eTR CLUB-RNANCF8<\1-62'>-4J54L
60 31 AUG PU!llJX t33UNAl'lESR.
,1 01 IE!' (HE\~ON OOll477l1MMCOFl
62 OISEi' CHEVRON 0004172 I MARCOR.
63 02 IE!' SUNlHINE POSTA1DOIl/iD9&NAl'lB1'l
54 ()2 SE!' PUBUX D32NAl'LESiL
65 02 S E1' BRAVO SUPERM ARI:ElNAPlESFl
&6 02 sa> BRAVO IUPEJlI.tARKElNAPlESFl.
67 D3 IEP 0l1PDn.E 118&WAliKEG.\ll~
68 03 m WM .SlJPERCEtIltRANTIOCHIL
69 03 SEI' NENAADS 30B,GURNEEIl
70 OHEP 8URGEROlG COl0502003FTM'lERSfl
71 04 S<P RAND D 3 IIICUNIlENH~nt
72 D4 sa> MENAAllS30lfiGIJPNE8l
73 D4 SEP UNMR5Al.INSURAllCEClIICAGOIL
74 uS SEP TACOS El NDR1ElIBfRlWIUBl
75 05 IEi' IllTEIlA MAR~ STOREUNOENHUtlSlIl
75 os 5Ei' COl.lCAST CHlCAGOIIIlO-CllMCASIIl.
77 Dli SEP UNOENHURST !RUE YAlUEUNDENHUllSnL
78 Oli 5[p NENAADI3Il8SGURNEBl
7! D6 m THE HONE DEPOT 191JGlJRNElI.
80 07 IE, SHEll Ol57~154!1IHJWADSWORlHll
Bl 07 SEP TEXACO 003D3977W.PtBR.
81 DB 5EP 5HEllO~ 574441DIllOlYElNON HlUSI.
1!3 DB SEP FlAllANIlERS IIRE'MIK; COlJllCOlNSHlREI.
84 IJ9 SEP SPRlNT 'WIRIlE558lOo639-6l11VA
85 095EP GUftNff.BP141GURNEm
Ii 105EP SEND Gl.Ol!Al24S-36B330MI
87 105EJ> COuaE DF lAKE COUN1'r'GRA\'.iIA1<ElI.
~ T*,1lw8dI_THsl'eriad
f'
L ~&OO
> 143.90
>30.0[\
,~/
$SS.s.
~O.OO
19.00
540,01
13.11
$10.7D
$16.44
$9.!!3
$SJ6
$5.72
$38.06
$12.B2
17.71
$16.43
S61.o!B
$279.00
m.oD
$33.63
$1]11.75
$36.00
S32A3
$.45.09
114J7
$9JI
$44.&4
S41.D0
$135.55
S41.lB
$.25.00
$5S5.OO
$4,961..41
r'
9/27/2011 Item 16.A.10.
..
.
"
~
II
Comfort Inn (GA767)
333 Harold G. Clark. Pkwy
Forsyth, GA 31029
(478) 994-3400
gm.GA767@choicehotels.com
Account:
Date:
Room:
Arrival Date:
Departure Date:
Check In Time:
Check Out Time:
Frequent Traveler 10:
You were checked out by:
You were checked in by:
Total Balance Due:
150167006
4/16/10
228 BAR
4/15/10
4/16/10
4/16/101:52 AM
4/16/109:25 AM
IV tHOle! HOTEl.&
KHAWOJA, ANTHONY
410 BRITIANY LANE
Llndenhurst, IL 60046
spalme.ga767
rfinch.ga767
0.00
~.
4/15/10
4/15/10
4/15/10
4/16/10
Room Charge
State Tax
City I County Tax
Visa Payment
#228 KHAWOJA, ANTHONY
67.49
4.72
XXXXXXXXXXXX1488
Room Charge
State Tax
City / County Tax
Visa Payment
67.49
4.72
3.37
(75.58 )
This rate is eligible for partrlel" rewards. If this rate is changed. you
may no longer be entitled to partner rewards.
If payment by credit card, I agree to pay the above total charge amount
according to the card issuer agreement.
Balance Due:
0.00
x
Thank you ior Y'":lur busines.Sl Bool: your ne;,:~t fescp..'clion on v\J\vv!.c:hok:eho!ois.com foe the bes~ lntcrnet ralOS gUB18n!ee::J.
----'.-- .------------
~.
~-
/----
I ,.././
//
II
\
Thank You
I
, I
. '. . ...r-6~ t
AMOUNT ~', 1fJ-r>
d((. c;.e;- .II }(I ,
:t-\"-"/.
--~/
J
Packet Page -1305-
"
5? 542 :';49 I @9
S IH:L L
~? 1H? Sl: [)'l ~I
;..;E~;LE\' CH{Wt:::L
, L3354 J
: nl.roice
I' a i:e
J ill.e
.i.t.tth ..
B h2J 1. ~; ($
j,H/:l~i,,'.1B
.113: -Oaf'tit
H7 ltJ9Et
.; I :~ A A c (; t u
. . K){>( ><X}:X :,.C'<:,(X .14 U 8
, 1i':i~"AJA /AN 'i.G10N'l
t ".I.I'i1' C....lI on ,; f'r:i c '
it .1 .1 ::t . ~ 1 I{JJ :i 3: . It 8 )
i. "hoduDt,
Jl4L PIH,M
l:'trll) au n .
~$48 . a ,
:;;4 8 , a j
~. .) fa 1 S,:!. I c
(YJ
IYFI.COtjE
S fl
I {.:
,;. f"E r'
u 1 _
95
ORS
ES j\ECEIPT
8 47000B
AROLD G CLARI(
TH GA 31029
. ATE 04/15/10 9:35AM
'NVDICE# 331439
'UTH# 09354B
VISA
ACCOUNT NUMBER
,XXX XXXX XXXX 1488
. HAWAJA/ANTHONY'
uMP PRODUCT$/G
)3 VPOW $3.119
\LLONS FUEL TOTAL
10.498 $ 32.74
, ) U co ul d ' ve sa r n e d@.
1.64 with the Shell ~
MasterCard! Apply
today at j
1-888-935-4161'.
THANK YOU -
COME BACK SOON
, i
THA~ YOU FOii Db,
, .:0 RI\fRSlOf DRIVE
MACON. GA
31210
I I ! THANK YOU ! ! !
lR# 478 477 5580 Sturell 21030
~.oo
'10
~J .00
3.70
0.22
3.92
:1.92
0.00
52 i
u I'
II(
,CII lJ
z
0 (
>-
<
~
>
a
0
0
ct
..
0
52
j ~
z
0
~
lIoi
..
9/27/2011 Item 16.A.10.
~
239 SIND AVE
SELL.ERSBURG IN
FIVE STAR 981.7
239 S INDIANA AVE
SEL.LERSBURG
DL.rttt 98888891.298
IN I
.18:.18:37 :
ACCT~
1.488
j.. './ ~5/ .18
ViSA
**** **** ****
RCPTtt .14--4549
INVIt .181.834
REFit 6.1 36-8.18
AUTH8 88 APPR 81664B
PUMP" 12
REGULAR
PRICE/GAL.
FUEL. TOTAL
TOTAL.
THANK YOU
SELF
13.477G
$2.839
$38.26
$38.26
i, 4
Apr.16'lO (FrO 10:02
G
/'
.) SIOC 1 KVS Or-der 38
JI~ ITEM TOTAL
I SAU EGG MCMUFFIN lolL 2.50
SHL COFFEE 1 _20
wta I
. -In T ota 1
6}
...
o
~
~
:5
::.-
!.~
o
o
q
iIt
,
I. NAPea EXPFiESS #3400
254 Long Hollow Pike
Goodlettsville TN ~
(615) 859-1005' -
J
hless
ng8
:' 1<# KB13491598001
1",110 rSSllER
'l;a ~;i\Lt ****
'. iHDR lZA HON CODE
. 'Lotllh#
;'1,*,1:*1488
~~ SEU# 4636
Date
Time
Senuo::':
0-1- / 15,' 1 U
U8 : 19 P!1
7914
i,',!ELCDHE:: TO !<.l~:C
:::TDF:t TD ,J5 /5-0!~A
~t 157
I $5 11EAL
35T CB
MP&G
BISCUIT
110 DRNK
I t'J
JJLirnp Gallons Price
05 5.54] $2.729
Product Amount
UNL $lS.12
Total Sale $1512
VJSA
XXXXXXXXXXXX1488
Auth #: 047888
Ref: 88838033
Ftesp Code: 000
Stan: 09571110415
.SITE ID: 8773590
Earn a 5% rebate
with the BP Visa
Take a.pp 1 ication
and Apply Today
j
(f2
......_-_.._-~._...
TXTl. .46
mTl 5 . 46
CASH 6.00
CHNG .54
- QUESTIONS OR COMMENTS? -
CAL.L
(615)859-2803
C:T~PHANl
...._.J..l ,'j:-1~~~ ~r:~' "~'"':'I".~: It!
,.' 1-' II". J
. !. ~tl.. ,
FINAL RECE [PT
[hanks f~- Shopping
~
.olJ'"....
//
PacketPage-1306-
9/27/2011 Item 16.A.10.
10/051'10 ,7:42AM
~. '~\1J?
~ ;:;::
-?;,~
LAQ1JINTA
INNS & SUITES
LA QUINT A INN & SUITES WARNER ROBINS
109 WILLIE LEE PKWY
WARNER ROBINS, GA 31088
(478)-333-3444
Khawaja, Dori
410 brittany lane
LINDENHURST, IL 60046
Company: COLLIER COUNTY
Folio#: 605452308
Room: 308
Arrival: 10/04/10
Departure: 10/05/10
Returns Club No :
Voucher/ShipIPO:
Trans #
183437
183438
183439
183466
Date
10/4/2010
] 0/4/2010
]0/4/2010
10/5/2010
Description
Rm: 30~ GEN]5 - Preferred Rate
TAX - OCCUPANCY - CITY
TAX - OCCUPANCY - STATE
CC PMT - VISA
Charges
$.79.90
$6.40
$5.60
$0.00
Payments
$0.00
$0.00
$0.00
$91.90
Balance:
Balance
$79.90
$86.30
$91.90
$0.00
$0.00
Method of Pay: Credit Card: VISA-... 1488
.-.
.::Inature:
THANK YOU
\V1: /Il'PRECIATE YOUR BUSINESS
,/'v. ) )
~
.-.
Packet Page -1307-
lf~J!~ lu?e-
!artland Automotive Svc II In
3':=i.:?, 1'.1t=11\!CI.!ES:iTU~ RD
f' '._()UIS, ~lC) 63122
~ 1.4) 8;~ 1-. 72 .~.~,
9/27/2011 Item 16.A.10.
10/03/10 12~51 PM
~
(Y INVOICE NO~:.~.~~;I;i.::;I;;;~,!r::!:1;'~";".~'F
j r0 TRANSACTION Nd:-L-~J'_'\'J L_L.,_,,-,b 1...'-....__'..1
~ ~:I~mb ~J.jG~J.~ 516~.!4
l) EMPLOYEES.' ...... r ., ....,.. .
").- ':.. .:f"=~ j':'.. . ..:, ". CUSTOMER INFORMATION
~j ,..
JAPLES, FL 34t12
(8I.j.7) t+I~:IG""Jc:J.6
FLEETS
I<.t1ST ~, ;:.. '.'_
.1 ,... ..... -.
;HAKl(3E,OILFTI~TEn :.' CHr-W.IGED
.(1J3FHCATE.. CHi=iSSI S ' SEf=tl.ED
~HECK TRANSMISSION/TRANSAXLEFULL
;HECH HEAR DIFFERENTIAL FL"UU,I/A
:HES:CW,BRm([{, Fl_U LiJU:':\IELFULL.
:HEQ< POWER STEERING FLUID FULL
:i-E:Tf< D(.;lrrEPv l,if-iTCH f=;U=:LED
',l.IECI{ i"J.O'.iD:3H :U::LD t,JA~3HEH i:LU InDDF~D
:I-1F::)( F!PDT {:nm,: U')[:RF~.CJl'i j':ULL
~!~-lE:(21< (~'~ I f~. ;::-.1 1... TT~ F~ f~,r<
-'t:' E; f~.[ t': Ttp:[~: i~ f'~~L., f~~ I'Jl E~I\!'T
\\1./
t~/ i~~ L. :~. i E~
l-iL'
:f.iEC:h ::;[~f~:PEi\!"T I i\IE ['.[L T
:!H.::CH: LIhHTU
HFJ~}" l'JJ. PE BU=WEG
HECI{ :fIlii::: PREsm.JFiE.
(.K;Uur.1 FUJOHE:;
Im3H EX TERIOH l'JINDm,J;~:;
Dl:
Cli{
f~EC; r\E~~)
I::']t} R3:5
CD!vIPL.ETED
CCWIPLETF:::D
.f .1.....1 \.
I J.. ...J .J . ~ ,
~:... .. ..'~ ..:J
_ ~.) 'j" ~J l....J
VEHICLE INFORMATION
Y R
MA~P L.OT
MOD~' 5L CCy].
ENGINE
LICENSE PLATE
, <ERNAT!; ib~;::~~ 838
( T 7""r:i/'" I I.. l' "J 1'- l -, r'." 'J c.J
., ... cJI"'. . I .H~ ILEAdE" >.:. .. \, ~, .J
SERVICES
0::.,-:....,- ./.,
",. u. ....J
i... .t.~' ...
:: I" t!llZ!
121. 1;;)0
~/
I / \c)\ I
11/ . \i\ O~
/f ~~,.\, .) I
I! G,'" ~ ,
j\ X
,---,.. ",,,,,~
--.---.--' "
~
(:} :\m:;~; ~)('~I.ES
.1\1 :::-.. :;. ,. .
;;::,X('~BLE
,'. -lI'~TI=1XFIB .E
SATE R I...,OCnl.:. T
T'JTRL,
.:. : C L i:r.~
..... r r-
.36.'3':)
~21. eJ0 .
~3 Jl J:jc~
VISA ************1408
~3e5:l B. lZi(~761ZIf:i
t.H?i . .G~11 .
. ;1.;.0 .'2' L
, \~~\':~,:\:i;~~~
rJ D. -. M.,.......~. C. .._....T."...~....-.
:, : . :', ., c"-", " .. ." :!:.."~:7.5',c, ';"'(. ".;' .:.~l:-';,~':':f'.~;~~:},- t".~
. .
,.... .'., "'-. . t J'~. ."""l .-
... .... .. do ....r.
',J/ ,,!{". T :..
. , ..... .....R'.....
E"Np '.IS FE:::E[)B~~U( f~T l.Jt<-Ji,.J..-P.J?FYOP 1. N ION. COfvl
r jr\ /)/() /".../ :\
/~ ~f-' !l :,:. )[ 1 J d;,;1? ~.:~l i~:::?()'
,I /', ,.{.J2..--"1/ J" / / f ( /, f /t.-/I" I /
'\ ....... l.f'", I,.. fl..,' .C. t...( ./1 & ./ Packet Page -1308- acknowledges receipt of goods and/orservices In the amounl of the total shown hareon
-. AUTHORIZED a: BE ' EIVE-l'1 BY ana agrees to perlorm the obligations set forth In the Cardholder's agreemenl wl\h the Issuer,
l!'!l Hff..,l..ha !",farnDti,.,rHlIl l~,.. I ..,-...... .-. ... .- - - .. -
.
.
~
~~
~
8215 SR 6
JI\SPER FL 32858
J AH~ J 183 . 81
~Wi SR 6
JA~I'ER. FL
32058
l-l ~~.n 34148, 88873414881
Ki :; TuiMaDli Trail
r!~.(1 r" FI
lU/85/2818 18:17:46 AN 155329695
l1/eC/2810 12:25:42 PH 3684
PUI~P. 1
REGULAR
PR I CElGAL
fua TOTAL
Hi:2 ~rSA
18 me lil:,'I;,M,jA/DORIE
. !N~OirE 122151
2.~99 ~1I1'~ B8-B6812S REf 65 75-837
$ 28.fi5 ,'UrlPHf1
) mULI:R
_ ------:: PRJCLfGAL
Subt.otal - $ 28.55 '!"'I. InrAL
fiK :: $ 8.~O Jt,..
fotal :: $ 28.55 l'ii t'.">lf wash
$ 28.5ti
11.me
$ 2.769
$32.66
~
!:REm
VJSA
lOiXXXXJOllO(J(){ 1488
4uth #: mm
((d: 38865823
Rtsp Cod.: 888
Stan: 26247336217
SITE rD: 5155122
Earn a ~~ reLate
wit.h the Sf ~isa
Take application
aod Apply Today
! $9. B8
--...-------
Total:: $4!.li&
$41.66
~:f!fi;l; tredit
@
{jJ
* f * * * * f * ; t * * * * *
Your car wash code is
233849
r::~, i" 1 ~" ;, ~j
~' '':
li.:.,':N/;;Oj ,i
I' .;... .....
--,,,
q.
o
~
" "'-,,\
-i..
(1'\0\0';
[."-.....-,0
DCf.) .
. -<::)
.::J ('..1('("\
....J .-;
C-. ~
,..- ::.:.. w
M (j
Lt.1
lr. r:.:: Lr.1
Olf\ -'
-.0" ....a::
c ......... '.n .:.;, (f).
M ;.t.~(.) Z "~.
::,)CW
W0.0....JU....J
;~~: 1T;:~
cr"j
-r
4'
,-,
(-1 -:I'
,....-... --r... ('"},_('I
G rl rt\O':O
r""f \[) ('J 0 l0,
;/,\00 .-<
:xcC'D "0(:'
;/, lC\ '.c- OJ CIJ
>< '.0 -a ,..-l
:x "0'. 00
:>< ~....... (j
~;:;-=..~C
:.I..I:>~ -+-' '!-< ill <1:l
~~ :; ,~ ~:. .2~ '~~ 1
(;1 J)("tiC
q ~ iJ)::):;:")
:.f:) ;~._......-f \"0
("':1 :::J>At-'"':J
..-:t' v I1J C
cC !....O-UI->
I..D ct.J~-
dP - >..
c; Lf\ ~ ~~
I1J -:-' <tl n.
-<(
w c.r:""
r- L-+-''::'<:u
_ ~.~roc::
'r1 '" to- <1:l
w
,-
a,!'\
'J~
dfi
~7;'
9/27/2011 Item 16.A.10.
~
:** REPRINT *** REPRINT *** REPRINT ***
IAlA FOOD , 00305848
i394 THOMASTON RD
IAeON, GA
/.)/04/2010 06:21 :01 PM 20706504
(~:XXXXXXXXXX1488 VISA
[NI/DICE E/4848381
~,UTH 075788
?UI,iP# 6
lIr;LEAD REG
f'fUl:E/GAL
FUEL TOTAL
16.2298
2.599
/
$ 42.18
Subtotal = $ 42.18
Tax = $ 0.00
*** REPRINT *** REPRINT *** REPRINT ***
. Ck CD IT
I
*** REPRINT *** REPRINT
2,28 c::pplication
~Gout how to E~RN
::"l'JLt:iDS with a
In and Texaco
lEd
Total = $ 42.18
$ 42. 1 B
*** REPRINT ***
GV
: Card!
.'.
::::l
:=>
~t3 :PRINT *** REPRINT *** REPRINT *~~
~z
~~~
l-<W
:>-
c( _
:r
r- ::;:: t.D \ @
-' t.D
cD D.... en ...:r-- r- =
.-< ...... co 0)- :;.,
r- C") co <..::lM I- =
'<t' .........:-- aLl'" Lrl c--
M 1-(") M <-.Q)Cl. ...... <::>
N ..... l'O.r:::: Cl. en <::>
= ......<"'co = N aJc.t:l<...j-I.---I :::>V'l
>- 04- -'EA- ......
~ 0- I- ",,"CTl WOo< lU",," =>
COX L"-' UJ >-::.<:
W _en Cl =......- :::> wro-. I
::E: WCTl = _LD -<T ::e:><:- LL. >c"O :::>-1-..... W
'-.('oJt.D :::::1::><:0::: '-' +-,t...-rt:S("'f":I :.<:"':
= We-') =0 UJ ~
W wC"> >- ..,,-U:>O = -l "0 "'"OCTl =c:a
'-<0 Cl.....J
"",co UJ = ...: -..cu 0 I ...:
-.. = '.= -~.....- 0= ='~L-+-'CO ::C'..l.J
LJ..J o.D :z::><.< c:::= V'l..." en
3 (/.l <: OW z::LI'" Q.....-j C) = 1->5:
......u <:::::;.~--, a.. :0 0
...L..iC'.J ::::<e: 00 -l U:3:.....
~O-luz: _=r.:..n~ -< <C U'l W
L.U~=-c.......;;><:=- ,., -l
<c..-.....: 0:: ..."
u:l l.L.JD>- ':;:~;;>~~~ Packet Page -1309-;~
..-l::C"o::::s:::
0"Ic..nt..-:(.,.'" ~-..~ ><"---
.: HANKS FO/'< fA TI NG
'-:TORE PHONE
,;'8-971-2540
:AY&PLAY FOR 1,000" f.--/
.!'I.'R YOUR CHANCE TOy ,I. \ ~ ~
;,N... CALL fi'"
:'888-731-9645
lJFTATI '\ ON BACK
, ,
i ;"",
354
UA TE :f f -04-10
Or ,( STORE 023171
TIME: 22: 14
sa
u
CASHIER: 5970 JASMINE R';I~! 'ii' =
1 B-CK z
:? S-CK 0
+ ~
FRSC .00 e
1 TOCKSR 2.19
1 BEAN .99 (;
+ 0
CI
FRSC .00 ct
.99 ~
] NACHOS ~
rei If, fOT AL
7 7A
. {.., 52
~'->
.. THRU Win ( 8.28;g
-UMOf1illn c, 'fll"G'r-.:---.--,..-..,--- / z:
__k_ "U..) ...;..~ J, t/ \...JL...j III .~ -"-__.._-. '0
5 ITEM(S) ~
o ORINK(S) ~ j!
~
rnN
Eg
OJ '"
::?~r-2-
~;.~ 8 f6
~o
;:::J .....r"l
= en
g:
:; -' '..
::-:. ..:3 ~
- - \.....
-" .v.~
OEm
OEO.)
<:JOCl
:::E:O,....-
>o~
:= ra
-< "-'
.:....:~
%0
S523
i.;:i
=
<C:
ai-
r-- =
~") :=>
r..o a....
".J
Si
u
ii
z
o
>-
;
~
>
(;
o
o
o
.:
-
-.
'-
:><:
z
~
::r:
u.
>
(;
o
o
ct
...
-
~.
** STARBUCKS COFFEE COMPANY **
1-24 SAM RIDLEY P ~08929
SMYRNA TN37167
1 VT ICD GRT SHK
1 GR CARM LT Ff<APP
SUBTOTAL
TAX 9.75
lOTIil
Vl:;f\
2.25
4.25
6.50
0.63
. 7.13
~
.........."........:.J...,..'N"'..
9/27/2011 Item 16.A.10.
,,-....,
./@.
~;
. \ ..
~
M,:DcniJld's CorJJrilt'jon
T'dlk Y(IU'lIr 8cl1:in3 :it ~l[DlJnaJd'::,
I~nd HIRIN:;
,J.,y(' ,la::.ll:~Dr[Ji a . :;Jnn429d
3"11:: INII TSDN 3L liD
'N: ',IE;;' ~'C6INS, :-;~ :l1093
nWIK Y:lJ
~ '!\ 1:1.
.; ::~ II
I! ,
~f'~[1 rEf\,
,-,I
:1 nr '.
',,\: :KJ IU1,:A;
E.# ('172)8/1'4;'7::,
[I::t CH '1,..: f.,lJI :j/~ :i:.
H~~'n ;L~E'I~:j2,58,-~~,U(Jl
C'";
to.......1
~.
CD
...,..
E ~
~: N
~* "'"
~: ~
g ~ ~~""J
~~~~
'-' , .
..,... -
<i:-
;... S ~
V5:::ii-::8
~U3~r~
en
-.<!:%::I:
~~~~
o::....J'>'---<
,,-....,
~. .1J:l
~~)
~
0 en '" ; crJ
en cn ~
("J ., en ~. ,
':::> .- c) ~ C"i
CJ .-" ~
~:.."'") ~ ~
::1J c..!:i
. -'. .~'~J
.--
."'l 1]) .n
'P i~g 0
....... ._<.r.
:;; '..... i--
~-
'- ~"")~
""' .::)
"'"
- --- 0:::: Cl..
- :,,) l...i....i
- a :2Z :;!:
0 ~
=
CD .:.,...J
.,.- (/)
-:;;. N ::::
~ U:J X
OJ :6 <(
.,... cc. )-
en G~ L.Ll .
~ ::;: )- :;: ~
CD <l: f- :::;
"";0-"1 ("'oj ~D ru v, =- ,:::r :::J
' . -,
!::::) '* -
.....J -1310- ....
~ ~ Packet Page ~ -a:;
= .:r
8 '-' - D? )-
Oi- a
--<. CD (./')
(, 14
0 c:>
.:::;, ,~
0 ~,
\ ~
,,-....,
Cl
u.J
,.....
W
9
W
~
~
z
~
u
::c
en
<r:
C,.)
,"
~
I)I~"I NO J.YMY3^IO OOO....S I
~)~
~~
00
01--
(.!:l
=
~ _U.J ::::.:::
I-- c..J LO (.)
<X: c::: :z: ....,. <I:
u.J = 0 <C co c:l
I.l.J .q u.. ::z: .....I OJ
a:: Z U"") c..J.....J I :z:
oO('o.J>- <C~O
u....:J:: I <C c::: (.) (")
a..~-'=> _en
V) r-Cl...0 .,.....1
.>o<::L.Uen~>- .CO......
=0:: I >- .CO<C
<coCO<CC:::Z:COI-
:::r::t-r-eno...... I uJ
f--cn-.q-= i..L..3:-.O
~
\~~~
1=:
II:::
Ca:-
~ ,::1 r
~--
10YS NO J.YMV3AI9 OOO'S,$ I
~[l .5
-,
%
ju
@
0::
U-.!
~UJ
-=:;.....1
<C
en
Cl~
u.J
=
UU
I-- '-
= Q)
~~ ~
r~
~.
_;0 0
<J") e::
'<t" <C
-.r c..:::
I-
l-t
=
l..U
e::
Ll
tJ
U?
:><:::.<:: :>-
u c,-, <C
! ,
en <0, +
0::
LW
~
Ci5
<C
U
9/27/2011 Item 16.A.10.
DlOYS NO AVMY3Al9 000'1-' 'en :OY: N; ~YMY~O OO;'BI.' I ..;~~~'
_ ~ ~ ~~ .Q-en om ~ ~::
~ ('o.J ~ ~ ~ r- ~.
(") c"" Z
N <C
o a::
u..J l..LJ
0:: L.U Z
0 :::E: ...... @
>- ~ :::E:
c.rJ I-- en
<C L.U
-:r -' ~
<C 0 >.
0:: (I") LLJ C1.
u.J a:: 0
0 00 uu
c::: _ 0::: -':T,.
0 en <c I-- '- 1-
InU = lU (::J
= ...... e ,.-
- I-- 0
I ...... ..... :=J
~ Cl 1Il CC: ,.-
0 u.J ;:, .....J ::c ,::.:::.
~ I 0::: U 0<( I-- L.W
U? J- U l- I ~'J:: u....
MU :U 0::: tJ en 0 W,..;. ~r::'i
Cl CI) en CI) 0 I-- :::.. ::Ie
0::: ..><:: :x: 0:::><::= c::: :::I: a::J >< I-I !- ""~
"'<t" :...J "_, U u.. U <C u.. U => <C c:.: :.% I
...... I , C3 u.J <C en I-- c~. ......u
L.U :~ :.;r:; c') ,.- -on + =
c:::r I-
L.U <C .:."! ... .:-~
c::: 0 .-'
-<j-
to
N...... co
::n C.f) C'.l L...(')
C'J lO ("".J
l"'"..J >- M
-:::I;:.l'tI'--.J...--
~......... I
...0..-' -0 ""'1-
C '"
!'C) 0 ("'-....1
.._ L 0
:::r cc c::
~ 0 ru c...-.::-;
l/1 -:.>
CJ l.CJ
Ct:: ...,..
~
c..
:L
<>: <C
---'
NO::
N -d:
.. =
......u
.....
co '-
ClI
:>
iii
S0
LrJO=Ol
=OO)Ln
.. ~ . .
~,,~c;;;~
~_M~~
i~~
>- >< ("'J
1'0 >< c=
_Oc.DCD
..::;
r."
OJ
cD
=
-
c.'J ~
OJ
::) =:;:-
+-' c=
-g~~~
U) f-- L:J. l--~
o:l
~
:>- <::: "
:::
l0
:)) .':2
::!.1='c.n
'" u..
~. --::::i C)
r.D en-.........
QJ ::> C (J)
CJ Q) --.J crl
"+- .co. en
'--~r-\2LLJ
U:ZC::.N
\
o
;:,;...~ _.'
..:;T c..:::;
:::D
-,
LnCl
f"-
.:;:;
N
..........LQ)..
V (1)-1--.--"'-"""'--
--....-o.n<c
DL!'CL1..J
..- 0 J-- U")
()40YS NO AYMY3AI9 ooo'J.$1
1)4:)YS NO A YM\f3^19 000'
~.-.: ,.
'-p-'
.~
;;~ ~~ ::.. .---.
:'" ~.r., ,~.
.- .~..)
c-.J
C"')
co
CD
-..r
-
X
X
X r.J':
X
X
X
X ro
-:<:~~
<CXl'-~
en X C"') r--
~>< C"') C:C}
>Xf:'")C
~
~
---I
<C
f-
o
l--
I--
e:::;
L.U
0::: uJ
UCI
Z
I- ~
=::3:
.......u
~
a..
>- .. Cl 1--.
I-- * ~ ='
l...Ll:
00= ::::
~ ~ S ID ~:
U (J 1-- -0 a..
r....:> 0
1-- I-- <:C '-' I--
l-"i 1----1 C1') ..-.t
= Cl := .J:: Cl
UJ u.J <c +-' u.J
0::: 0:: 0:: ~ 0:::
~Ut-~!...J
U 0::
u> en
-..,~
uu
=
I-- ,
0:::
:::l
CJ
en
u u.. CJ) CO
en<oCl~
""?i:I:;
u~ua..
CO <C U-J
==a..
<i:
~ =
Cl ......
I-- I
COX I--
=> <C <C
en I-- u.J
+
~ Packet Page -1311-
.. - SZECHWAN PALACE 1 ~#'
1144 MAIN STREET 6 \
ANTI OCH, IL 60002
D9j3Di2.Q10 14:] 1:54
t4erdlant rD: OOOD0000150~ I?
Terminal ID: O~Z~l6(]i;()
2674191]8883
CREDIT CARD
VISA SALE
CARD it xxxxm):XXXxh,~
JroJVOICE !lDU:J
Batch #: 00025~
Iwoval Code: 04563~
Entry Method: Swiped
Awroved; Online
PRE.TIP AMT ~16.15
TIP .3.{()
._-~-""'._"--"~ ..~
TOTALAMOOO J!l/!!
f\rA.~ 'r:>~ ~
/ ;1;.
APPLY ON-LINE TODAY
Nww,mcillinois.com/4B05
MCDONALD'S OF LITCHFIELD
217-J24--61L4
2 OHRErJ DRIVE
LITCHFIELD, IL 62056
fRl~
~~'if
. ROSATI'S PIZZ:'J\ ~
616 BRIDGEPORT TERRACE
LIHDEHHURST~ IL 68046
847-356-0100
TERMINAL 10.:
~mHAHT H=
VISA
********mtI48B [xp:um
SALE
BmH: B9aB05 IHU: _ aOUWh
SHP 30~ lB 17:~,
RRH: OB05BB1Z AUTH: 081%lJ
lRACE N: 160m8~7B151JZ
IJAlIDATlDli CODE: 84PC
iWPROVED
SALE AMT
068980
8788850819ZZ1
SlilPE~
$23.83
TIP
L.........2..1!l
$_m~_g_K8
O.\- ; ,(-<,,!,J
.~
II
TOTAL
D0RIE KHAI.~JA
&&f(
) OHUi LDPV
9/27/2011 Item 16.A.10.
~,~
0004
Server: AM BAR A (#900)
10/01/10 12:30, Swiped
GURNEE
6593 Grand. Ave.
Gurnee. IL 60031
(847)856-0000
MERCHANT II:
Rec: 5
T: 997 Term: 2
CARD TYPE ACCOUNT NUMBER
VISA XXXX)(XXXXXXXl488
Name: DORIE KHAWAJA.
00 TRANSACTION APPROVED
AUTHORIZATION #: oo833B
Reference: 1001010000004
TRANS TYPE: Credit Card SALE
CHECK:
(p 4:Jl)
8 E2-lQJ
('^ot i{;d"~YC-
TIP:
TOTAL:
".,'
/'..
'","'"*Dup 1 ; cats
Copy**"'"
CArDHOLDER WILL PAY CARD ISSUER ABOVE ,,-.....
AMOUNT PURSUANT TO CARDHOLDER AGREEMENl
Please leave signed copy.
{2,/ /
Dup 1 i CEt t e Rece i p1:: ...--.- \iJ\.J~/
~ard Number ~y /\ AU:h~:'d~ /
~*********** 1468 ,. 0393f:JB
KHAWAJA/DORIE Visa
,D..mount 25 .34
TI-lANK YOU
LITCHFIELD MCDDNALOS TEL~ (217)324--6144
04 KS#01 Get .01' 10(Fri )20'')4
STORE~ 4805 .~
Order #104
1 MED CARAMEL FRAPPE
1 SML WATER'
SUB TOTAL
TAKE OUT lAX
CASH TENDERED
CHANGE
X
Cardmember agrees to pay total in
accordance with agreement governing
use of such card.
Total
TO GO
2.89
0.00
2.89
0.21
@
20,00
Tip
~/. 34
~O
f3R~
_"uk. , t
~"AQ rr\~
...l
Total
16.90
j
(iY
,;, if-,:::T COpy
Packet Page -1312-
~ . ef\
~NUY~ V .
0101a
SHINIQUE [ $vrCk: 14 11:55 10;05/10
TO GO
CASHIER RIGHT
~
GRILLED WRAP, no
l'Iustal-d
9/27/2011 Item 16.A.10.
n,'i O/v
rP
WEj_[~tJi~r~~
f]ljf;~ B.ft~~~:c"
99
lia'~~-"'"
;,.!\_,'.,;..,) ~
.~.~~;.;.:; ;I:-..;~
, 1IU!__;!...l! ~ !~
SuI: Total: 1.99
TAX: 0.12
1i)/05 1 \ .S5 TOTAL 2. 1 1
/rJ ;{~~" nt"F'~.~
8Ub./b;.:NDWl.CH
1
THANK YOU
~I EASE COME AGAIN
CASH
,5;10 1155
~
!Que E
T Di:,]l
i. r'~:~:'
'1.. ;.;. ~_l
liJX
d ;""H
4~55!
'or ~:.~' r ~:~f, ~_.
AMT-IEND
20.25
CHANGE
ilL 14
'rfillY
2.11
.~,
*'
li1C:Cl
:-........, ~'"i='-.i.._!
@
''-' 1 i
Hc'Ct/Car-c~ ~~ >~X.:(:~,XXX~K;(:(:(~..l4dH
Autn :~~ ~ G445CB
1':8t~ OB7b6026
F-:E!SP GC:Je: noo
@
l~ I
>- CD Ire: 'V
0:; ::::: r-... ! +-J ~
t..U +-' 4: N -- ia '-
~ ((leD 0__ ;~ UJ
<1; to - en Cl l7J ::J
co l..U r- ".0.. _-.:r (I') I ;0) (J) ~
a:lOeD><><CO :> ~i>o:n
oZl ..- I OClt..UX- LJ..l L:::) : i 0 .~
._NN X~ f""' ! ~..o ~
;- n:l_CO'::;:):Z:X~ w..: .c:Jl ~ ~-c
= <- - , ...- <:;:( :><: C') ..... .1 '-
<C t-~en~ UXM co c:: ~ lID <t:I
a::: ("":Jt-(CJ0--4XOXM ~ ' 'A1..cu ~
:::J r-- 0 a::: x 0 x 0 ,=> - ::0: ~+'
<C ID e-l ......u.Jxw---.-...,,----. ' >.
;- ~ l:C L..2- __ 0 ::E: 'X !..J-.x ~ ""'=t' \.CJ. r-- I !:;>, e
en o.~ OJ C! 4::>< <1; X U"J__Nl.&) ,__ltU ~
W = . C") I I Cl.. 0
a::: '" (/) N I +'
t- ID- \0 >-
en ID >- QJ l+' 0..... 0-
= = Cl.. Cl. OJ Q,) "'C I C C 0
I-< l:'"J td >. ..:;'::+-' 0 td I aJ.~ al U
~ C":l:% I- = td U '- +' al U -
c:: ~ 'n ,::::) -"" ro Q) 0 '- '- Q)
u.J tD ""0 ....., C ..c (..)~ > ..... td 0)0 Q) er,
a.. ...... '- U to Cl. .,..., aJ .a '- .D Cl. ...... ca u '- u.i
~ '" td U .... x ::3 ..c td w ::J 0 U 0) :::J
c::.U<1;l-LU<CUt-CfJ r:n l- I- ...... td td c.!:l
Packet Page -1313-
.'
~
.'.....,
WELCtntE "
SALES RECEIPT
S', 444 090609
SHELL
6050 GRAHD ~UE,HUE
GURHEE
IL 60631
;\ATE09/29/1D 6: 01PM
lr.-i11CEU 5-14703
flU I tl_ 582635
AHEX
ACCOUNT .....I"tBER
~XXX XX~X~~ X1002
KH"WAJMDORIE A
PUMP P!~ODUt;T $/G
05 uHLD $l.6i~
GALLONS -FUEL TOTAL
16.347 $ 43.79
,tlCl O.".,G UISC(i)
Th~HK 'IOU
lIAUE A ton Cf. D{W
COITI!:.' flgain~
...1136
..~r'DUT AHEli:K,INC
9852 S. HARLEM AVE
BRIDGEUIEII IL 60455
7eH19-4177
TERttIHAl I .D.:
D
I, 1 1\ i
\V\ V-
\~
&0197391
VISA
XsXXXXXXXXXXX1488 m: 1
ALE
B~TCH: 889196 I HV . 1
DATE: OCT &1, 18 'TIIE: 16:48:38
RUTH HO= 81218B
BASE $25.84
TIP
CAPTAIN TIP
__a;L?:~~t- t ~
. ~Q ~\1{
~ r)<. \
TOTAL
DDRI E KKAYlJA
x______________________
+**CUSTOMER COPV***
,
~
rphY USA 5889
~1 W. Ferndon st.
:chfield, IL 6285
-18-843-4298
'= . 5889
: ~ 18-81-18
._: ze:3~
iftACE~ 5679
Merch5429298813588~
Term 10: LP622375
SALE
lJisa
************1488
Ent.ry Method: S
Invoice*: ' 8724
Aut.h _*: 88585B
Batch: 28181881889
CARD AMT: $ 24.59
PUMP~
PROD:
PRICE/GAL:
NET/GAL:
QTY<GAL)
FUEL TOTAL:
NET TOTAL:
4
UNLEAO
$2.699
$2.699
9.112
$24.59
$24.59/.:'1)
M&M.s W
for $1
Regular Size
& Sr; ~kers 2
~
I
i
WELClJME
58845:~1
D'U GHT BP
1~ E HORTHBROOK DR
DWIGHT IL
TRAH It 1.811;12198
DATE 18/81./18 17-59
PUMP . 81. .
PI:Z:OOUCT: REGLR
GI=liLLONS: 1.3.386
PRICE/G: $ 2.759
FUEL SALE $ 36,.71.
U[SA
XXXXXXXXXXXX1488
Aut.h It: 825848
ReE: 4881.6915 ({i)
Resp Code: 888
Sir-an: 888296?~5 );.
SITE ID: 58845~1
E.~rn a 5:1. J~ebate
w.th t.he BP Visa
Take applicat.ion-
and Apply Toclay
THANK YOU
HAVE A NICE DAY
Packet Page -1314-
9/27/2011 Item 16.A.1 O.
--
i
pilot #482
4610 Bt'oadway
Nt. lJernon
Invoice 1
Date
tillie
Ruth 1t
11721
10/04/1
08 :5
07309
UI
Acctl
11111#1111111488
pump
04
Gallons pt'ic
11.546 $ 2.68
@
Product
unleaded
A 11I0 un
$ 31.0 'S"'
Total Sale
,.-
$ 31.0"
,......,
SALE - Cat'd S~liped
Redeem this Receip
fCI' a "Ioe;: Hot iea,
coffee ell' ::;Zippucci~
fOl" $1.50
anytime of the day
"Fresh Guan~nteed"
Limit 1 per visit.
E:<pit"es 91/'-l1/201-t
Ho Cash Ualue
Thank You For
ChDosing pilot
Please COllie Again
--
...-..
I
9/27/2011 Item 16.A.10.
ONE-WAY OUT OUSEHOLD
RENTAL GREEMENT
24919190
09125110 1 :23 AM
09/28110 1 ~23 AM
BlttTo
NO
~.
6010 -12FT SAG UGHT HICUBE
Unit #9904380 Plate # 1106735 St IN
Max. Payload 3,2441bs.
Days Allowed 3
Mileage Out 38527
Discounted Rates $164
LIMITED 9A M W LOW RMponalblllty
SUPPLEMENTAL LIABILITY .DECLlNED.
PERSONAL ACCIDENT INSURANCE *DECLINEO.
CARGO INSURANCE "OECLINED"
onvironmental fe.
Fuel Out FULL
Exp 01/31/11 Owner 0123.10
Height 9 ft. 6 'n.
T~IP
164 164.00
Unlimited Mi\e~,
-DECLINED.
. -
-T
._~:t..~~~': '._'-'__....
.... .~,--_...._-------_._--_.~~.--_.,--_.....-
._,----~--------_._-'--
1.0
TRIP
9.00 9.00
~
J P~se verlfy the above fuel level Is correct. Cuslomers who relurn \lehlcll!ls witl1 ,ass fuel than wnen rented will be charged $6_0QlglllI
y tne vehicle_ You may be subject to a charge for certain breakdOwns resulting from driver error or customer negligence_ X.
ST. LOUIS CAR MUSEUM (0720-42)
1575 WOODSON RD
OVERLAND, MO 63114 USA
Voice (314) 726.5785 FIx (314) 993.1540
Created b;' R.BRODERS
Completed by' R.BRODERS
Entered at 7672-34
Status COMPLETED
y slgnlng-1l61ow, Customer 89,ees that he/she rDce ved, ...ad, underst"nds and agr';';S-Wilii-QTi'---'
Ulrms. contlitlorll; entl obligations snown on the n:",t:tl 1(>108r and approprla+a Us..r'" GuiCle. Pen sku
makes no warranties. expre.., implied or r.llltutory. including but not IImltt:tltu.llw implirtd \IIIur.
rlllnties of nlerchontabillty and fltn_ for e particular purpose..In addition, if Customer IS ",merino i;,i,)'
this Agf'eBment In Ft., HI. MI or MN, Customer acknowledges that hel1lhe ha:; ..."d. undltr~t;;"c:lil and
agree.. with tilt' tennli uf the lItAte'" required InnguP9" ,,$ ...1 forth in Par"sr"-ph A. Sac-iioll." 1 . 4 of
lh... rental folder. Mh,imum driver's Igo 1518 years 01(\.
Customer agrees that truck 1$ clean. Additional fllllS may be charged it truck is llt.ot return~d clean.
Customer's Signature
L::.:" .-' .(;.,
Packet Page -1315-
If
,~
U~
il!;f.t:; J &. 3!i
4fJ3. 1b
~&. 0 to.l 4-
I
(j)~ CtVzD
<----- Packet Page -1316-
~
9/27/2011 Item 16.A.10.
,
j f
,-...IAnlhony N. Khawaja
From:
Sent:
To:
SUbject:
Attachments:
Motorcycle Moving [quote@motorcyclemovlng.net}
Friday; March 26, 2010 3:22 PM
a.khawaja@comcast.net
Motorcycle Moving Quote
orderform.pdf
/~~
-t- G1.,+-t:/ l ~ 0
'3l~CO
anthony khawaja;
Please find our fully insured door to door quote below:
Quote Number: moto.9512
Origin City: 60046
Destination City: naples; fl
Shipping Date:
We can ship yo r motorcycl in one of our enclosed trucks for a total cost of$475.00 These trucks are brand
new and have thcapabili of carrying six high end cars along with up to two motorcycles. Each of our
enclosed trucks is lzed to hold motorcycles, therefore we do not have to crate the bike or even drain any
fluids. Simply put, you will IT impressed with the shipment and how your bike ets ~d.
~ /' .
We can also ship ur motorcycle' one of our open trucks for a total cost of r$403.75 Our pen trucks are
a typical nine car c ier that yoy may see delivering new cars to your local car dealership. We/~ave a
customized spot rig behind We cab of our truck (therefore the bike is protecte by the trucleitselt) to insure the
, /
bike arrives damage free. rus method not only saves you money, but is also quic ~r.-tnose who need a
speedy delivery.
WE A.P,E LOCATED D'J Iv1A.t:l.CO ISLk.ND FLOFJ"DA (5 IvilNUTES FROM: NAPLES)!!!
We hope to earn your business with this shipment We take pride in every one of our 5,000 motorcycle
deliveries per year.
To book the shipment, please download our shipping order form (attached) and fax, mail, or email the
form back to us or call us toU free at (888) 222-2065
Thank you,
Bob Brotzman, Owner
Motorcyclemoving.net
F::i ~
610- 8GD -1/l1
~
1
Packet Page -1317-
9/27/2011 Item 16.A.10.
otorcycle Moving
o Bald Eagle Dr" Unit 1-8
arco Island, Florida 34145
5 oridaautotransport.com
,".' ".....
". . ." -'
....,(i::fj/fil'lJllf}YtJLEJJJIJJ'IArl;
TOLL FREE: 888-222.2065
LOCAL OFFICE: 239-393.2040-'
FAX: 610-860-9127
..,.'l"~" :":', ;:.~-,,:.~ >.
~.~ - -". .;!,
.,..::--..'..i.;
Shipping Order Form
1.
Vehicle Owner's Name:
Primary Contact Person:
Primary Contact Phone Number:
Cell:
Fax:
Email:
Estimated Pick up Date:
Estimated Delivery Dale:
2.
y: r'
Make:
Model:
Color:
VIN#:
License
Plate#:
Operable
/"""
Cpen
(mast ec 0 ,lical)
Closed
Ctieck here if mLJllrple vehicles are being trans:'~)r1ed ~. r}'!sase complele and attach the ~Ir!iti()ndl \fehi~!e2 Form) I
3. PICKUP LOCATION
.-
'I
Name:
Address:
Citv
State:
Phone 1:
Phone 2:
Cell phone:
Work phone:
Fax#:
4. DELIVERY LOCATION
Name: ~
Address:
City
Slale:
PhonE! 1:
Phone 2;
Cell phone:
------
Please print, complete, and FAX this form ta Motorcvcle Moving: (610) 860.9127
PacketPage-1318-
9/27/2011 Item 16.A.1 O.
,.
09/28/2010 09:09
8475239956
B&W WF
PAGE El2/El9
~
-:
From: "Stateway Auto Transport" .anike@s~atewayauto,coll'l>
Subject: Stateway Auto TransportOrder Confirmation with Terms and Conditions - #1 69290
Date: September 27,20102;:13:23 PM ODT
To; <:dorlek@horizonshades.com>
Order 10#
169290
l c.rr~;.;". ...]
e~1 ~."., ,-,,'
.,'1-'" j I'" IoJ~~. r ' .'~~~ '_I"~. .'. ..,."",
:::t.:' ,'., '
~,
..-.
CUSTOMER INFO
Contact Narn~: Dor1e Khawaja
Phone: 847-406-9315
Street:
City; Naples
State: FL
ZIp:
ORIGIN INFO DESTINATION INFO
Contact Name: Dorie Khawaja Contact Name: Tony Khawaja
phone: 847-406-9216 Phone: 239.259-6002
Street: 41 0 8ritany Lane Street: 2015 Bay Street
City: Undenhurst City; Naples
State: IL State: FL
Zip: ~6D0461'- Zip: 341 "12 f
VeHICLE IJ\lFORMATIOrJ Vehicle Ready Date: 913012010 I
.'--.--/ I
Last 6 Of VlN Year Make Model Color Amount
2003 Bmw 325i 585
VEHICLE RUNNING CONDITION: De pos it: (" 165-'
Vehicles Brakes: Working Balance due on ----
Vehic!e Rolls: Working delivery : 420 (Ii /) n ,~,
#- _.J~
J
pO qj~J J
Runnmg Condition. Operable
COMMENTS / NOTES: @ /
Balance due on delivery is to be paid to the carrier by means of cash or certified funds.
Thank you for choosing Stateway Auto Transport!
STATEWAY AUTO TRANSPORT INC.
@
~
Packet Page -1319-
Motorcycle Moving
870 Bald Eagle Dr., Unit 1-8
Marco Island, Florida 34145
swRorid aautotransport. com
9/27/2011 Item 16.A.1 O.
TOLL FREE: 888-222.2065
LOCAL OFFICE: 239-393-204(\~
FAX: 610-860-9127
I Work phone:
Fax #:
Quoted Amount:
De osit:
Balance:
The deposit or payment in full must be paid via credIt card, cashier's check, or money order. made payable
to MOTORCYCLE MOVING
Please check one
Payment in Full - Credit Card, Money Order ~
or Cashier's Check
Deposit Only - Charged to Credit Card C
Deposit Only - Money Order or Chashier's (......',
Check i._I
. .
CREDIT CARD INFORMATION
Name on Card:
Dilling Address:
City:
State:
I Zip:
Card Number:
Ex iralion Date:
3 Digit Security ~(ey: (on back of ynur credit card}
Card holder Signature
Visa
Mastercard
If paying in full there is a
3% charge on credit cards
~
I aoree and undarstand all Terms and Conditions as stated by Motorc cl Movin ~gardlng ttl. trallspOI't of mele/els). By
sUbmltting tbls completed lorm, I ilorel 10 pay lilt above quoted amount to half my vehicle(s) trlllSpol'ted. payment menlhorJ Is
by credit card, I agree to have the deposit or full amount deducted from my credit card Informlltlon provided abov,. Un/."
payment In full Is checked .bov., I understl1ld that .ny rsma/nlng C.O.D, charges or fellS wllJ bll paid upon delivery of the vehicle,
and that only cash or cashier's checb are accept&d. Cash I,,. check! must be mad, Ply.blt directly to your transport c.rrler,
Although our ind'pendlJnt c,rrl.rs carry Insur.nce, it is understood that Motoreve/ll Movlntl may act IS , broiler, and If SQ, w/IJ
not be held accountable for any dam e5 Of late fees incurred.
6J
:J /z81fo
Dale
~
For office use only
I Invoice Number Date
Please print, complete. and FAX this form to Motorcvcle Moving: (610) 860-9127
r;..:",--,
Packet Page -1320-
.'_. 1.).
ATLAS VAN LINES, INC.
1212 ST. GEORGE ROAD, P.O. BOX 509
EVANSVILLE, INDIANA 47703.05051
(800) 252 8885 I (812) 424 2222
IATLAS I 9/27/2011 Item 16.A.1 0'1
po:
Ace Relocation Systems, Ine.
2565 Technology Dr.
8gin, IL 60124
u.s. DOT No, 125550 . . (84 7) 836-5200 (547) 836-8740
Nicll Santucci
Customer Doria Khawala Consignee Dorie Khewaia
, Street Address 410 Brittany lane Street Address TBD
Clty/StatelZip UndenhursL IL 60046 Clly/StalelZlp NaDles. FL 34101
847-406-9216 .
Counly Lake Phone County Collier Phone
Tariff ATVL 1000. MOes Pricing Option Pack Dates 9/30/2010 to 913012010
Effective Date 9/13/2010 Minimum Weight 1.000 Discount Level 68%. Load Dates 9/30/2010 to 9/3012010
Estimate Date 9114/2010 Estimated. Weight 8.315 Storage- Discount 0% Del. Dates 10/412010 to 10/11/20-10
Packing Opllon: o None o Fun Pack r;a Custom Pack Unpacking Option: o None 0 Full Unpack o Custom Unpack
acking Detail Packing UnPacking
Pack Per Unit Total Unpack . Per Unit Total
Count Price Price Count Price Price
blBed . 2 514.09 528.17 2 $3.12 $6.25
IIQBed . 4 $22.79 $91.15 4 $5.12 520.49
Vrror 2 $28.61 $57.22 0 $6.01 $0.00
Total Estimated Packing Cha'll8S: . I $176.54 Total Estimated Unpacking Charges: $26.74
~ddltionallnfl?rmation: Weiaht Net Charoes
Packing Servtee: 8375 $176.54
Federal regulaUons require that we provide you with a reasonably Unpacking Service: 8375 $26.74
~ccurate estmalll of (:Osls. Since nlthher you nor we are aware of Transportation S&rvlces: TransportaUon. (Unehaul): 8375 $3,555.66
~1I possible condltfcms at destlnatfon. the$E! are the charges that wDl
be added- to lhe total charges should these services be reQuired. If Other:
'thelO. services must be provided' due 10 Impractfcable operations.
.denned In Atlas' tariff, charges lor lhese services (subjecllo Additional Services: Fuel Surcharge: 8375 $248.90
rtaln limits) will be due at delivery. See Nole below for more
flnfcrmatlon. Insurance Surcharge: 8375 $142.23
,,-.., Additional Services: WeiQht Net CharQe Origin Service Charge: 8375 $223.51
I Destination Service Charge: 8375 $87.10
i
i Accessorial Service: $0.00
I,
Tilt.1 Possible Ade/iuonal DesUnallon Service Total BindIng Charges: 8375 $4,46().68
dhiJrce~ ~
!NON-BINDING Vaiuation Charges: Full Value Protection: Lump Sum $ S:5\l.300.0Q or $ per pound Weicht Net Charoes i
iCHtIRGES Deductible [2] NoneO $250 o $500 8375 I $0.00 I
!
Additional days _ (days):
Cartage lo/from Warehouse:
Fuel Surcharge:
Insurance Surcharge:
Miscellaneous Charges:
Total Non-Slnding. Charges: 0
TotatCharges
eddy
~\
~
Atlas.
ASSURED PRICE PROTECTION ESTIMATE
jf'lOTE: Under Ihe Assured Price Proteclion {APP) Program, Ih" APP lolal charg"s al.
l::ompared to Ih. ta,iff chill!leS lor aC1uol weigh I "nli semces and Ihe lower 01 the two
~ounts wm be the- U>tal charges due, This estimate is based on the a~jc!es anD' !e!'.~ces
iSle!!. The APP lotal charges .hown lor Ihis shipmenl will epply and w,U be binding on
I tlas unless Bddmanal enlel!l5 ~re added ar addllionel service. me requesled Dr prDvid~d.
so, sddillonal charges (baGed 00 the lBriR raleS in e!feci on, lh. dale cf this e.timale) will
e added 10 lIle APP lalBl. In Bddllion 10 ell other thallle. due al lime of delivery, all
herges for addifiOnal.ervx:es Ilollntludeo in this esllmale requested a~er the bnl of
&ding Is e~etuled win be due. as wiG chBfD8SIor addltional leNlc8$ required due 10
mpracUcsble operallons. os dafined In AUas' tariff (whii:l1 includo dosllnetion shuttle
elVite). subJett 10 a maximum Dl15'olo of all otherchBfDes due III dellvelY. YOlI will be
iliad_lor any balance I~ ucns olll1e \5'~ after dellvol)' and you are obligated to PDY ahe.
alance. ThIs esllmale is \IllIId lor 60 days from dale of customers signature. All charges
o be paid In U.S.lund. by cas.h; postal money order. ceshier 's or approved personal
heel< payable \0 Alia. Ven Unos; ""'erican Expre&s. Olscover. MaslerCard or VISe
harge card..
SIT Valuation: I
Advanced Charges:
Storage.ln.Translt Service:
1st Day Storage:
Jas Agenl
enl.RepresentaUvll
Agent Code No.
COde Nil.
RATlNG& DlSTRJ8UTION
SCAN AS ESTIMATE OFS DOC TYPE
CUSTOMER
lin\1 VrmiDn;' 6.20,5., .1l:mW.l0
~
o
$0.00
o
o
o
o
o
o
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
x
9/27/2011 Item 16.A.10.
Additional Services Price List
(Potential Additional Charges, If Needed Or Requested By Customer)
Atlas Van Lines - M.C.: 79658
P.O. Box ~09
Evansville, IN 47703p0509
BOD-638~9797
, I
.--...
Shipper Name: Dorle Khawala.
Origin Address: 410 Brittany Lane
Clty.Slate,Zlp: UndenhursllL, 60046
Order Number.
DesL Address: . TBD
Clty,Slale,Zip: Naples, FL. 34101
IMPORTANT NOTICE TO SHIPPER: Below is a list or en route and/or destination services and corresponding
rates/charges, which you or your designated representative may request or that may be necessary to deliver your
household goods shipment. We have reviewed these services with you and to the best of your knowledge no such
servIces are requi"red at this time. These potential services and their cost are based upon the tariff issued in
accordance with the regulations of the Surface Transportation Board of the Department or Transportation.
The rates/charges for lhese en route and/or destination services (should you request th.em or If they are necessary
to deliver your shipment) will be based on actual weight and/or per occurrence and are in addition to all other
charges on the estimate you received at origin.
The carrier will not deliver or relinquish possession of property transported by it until the charges on the estimate
given at origin i.e., (1) either the total binding. estimate (Oplion ''8" or Option "C") amount OR 110% of the
non.binding estimate (Option MAlt) amount; prus (2) any charges applicable for service(s) requested by the shipper
after the contract was executed that were not included in the estimate; plus (3) any charges for impracticable
operations (such as shuttle servIce), that do not exceed fifteen (15%) percentof the total charges due at delivery,
have been paid in cash, certified check, traveler's check. or bank check (one drawn by a bank on itself and signed
by an officer of the bank).
Additional Services Service Oescr:ptlon Rate Estimated Charge
)' ./)JIt
J {/ C-.
II f1 \~
,tY' / t' ~~ 1
~. '.(. I !
) \ l
n: ~ i /)/. .'
j IYt ;//1 ~!/( /
l{ /1 V f
!Vice Per CwO
ShuUie Service al Charge Weight-Based)
Extra Slaps (Per Slop)
Waiting Time (Per Hour. Per Vehicle) & (Per Hour. Per Man)
Extra Labor (per Hour' Per Man)
Overtime Unioading (Per C\\-i)
Advanced Charges (Pei Thtid Party Invoice)
1s1 Day Storage-In-Transit (Per eWT)
Each Additional Day Storage-in-Transit (Per ewr . Per Day)
Delivery Out of Storage-In-Transll (Flat Charge We1ght-based)
Self-Slorage/Mlni-Slorage Delivery (Flat Charge Weight-Based)
$12.29
$1.971.00
$129.45
$63.12
$63.12
$3.59
$0.00
$10.11
$0.39
$2,642.00
$343.00
~
$20.20
~230.21
so.oo
$465.69
$17.96
$1,453.10
$109.76
Must Be Signed & Dated @ Origin, Prior To Completion
Date:
Date:
~
J;~ -A/r-iItolVf
Packet Page -1322-
.~
AtIai.
.S.. DOT No. 125550
ORDER FOR SERVICE
ATLAS VAN LINES, INC.
1212 ST. GEORGE ROAD, P.O. BOX 509
EVANSVILLE, INDIANA 47703-0509
(BOO) 252-8885 I (812) 424-2222
ustomer Doria Khawara
treat. Address 410 Brittany Lane
ItY/State/Zlp Llndenhursl, IL 60046
ounty Lake Phone 847-406-9216
IATLAS REGISTF 9/27/2011 Item 16.~.1 O.
PO:
Ace Relocation Systems, Inc.
2585 Technology Dr.
Elgin, IL 60124
(847) 836-5200 (847) 836-8740
Nick Santucci
Consignee Dorie Khawafa
Street Address TBD
Clty/State/Zip Naples, FL 34101
County Collier Phone
Binding en Atlls. The charges shawn ere t~ cl1argellhat will be eSleaHlf. ror the aeMCD. Idenllfied In !he
Imela, Al time 01 delivery, you mey not be requlRld 10 pay mOllllhen the lotlll eatrmaled blndlllll ehlIrgl6ll1us:
10% orlhe .sumaled non-binding chllrOll$. wIIlch Include SIT. Valuallon and Advanced Chargas;
U charges tor addlllonal services not lndudecf In lI1is esllmate Ihal are requested after Ihe bBI or lading is lWlCUted; and
. harges lor additional services required due ID imprectlcsllle operation.. IS defined In Alles' terlffs (which lncIude
d lnallon shullle service), subject 10 a malClmum 0115% 01 all olher charges due el dellwlry,
Y u wMl be bnled lor any balance in llllcaSs or ellber the 110% or the 15% aller delivery and you lire obllgaled'to pay the
b~ 0~~~
BINDING ESTIMATE VALID ONLY FOR 60 DAYS FROM DATE OF CUSTOMER'S SlGNATURE
charges Bre 10 ba pefd In U.S. funds by cash; polla1 money DTCler; cashier's or approved personel check payabla 10
At s Varl Lines; American ElCpress,Carte Blanche; oiiun ClUb; Olscover; MaslarCard orV11B challle canis.
ACI<ING CHOICE: I2J CUSTOM 0 FULL 0 NONE UNPACKING CHOICE; 12J: CUSTOM 0 FULL 0 NONE
Packing containers and materials are your property, The unpacking service Indudes removal of then It&ms unlesa you direct otherwise. An acldllionaJ charge
wilt be assessee!, ror disposal of packing materials lrom Items unpacked by customer or camer on a date other than at delivery time.
CUSTOIo1lER'S DEClARAllON OF VALUE. THIS IS A TARIFF LEVEL OF CARRIER UABlUTY .IT IS NOT INSURANCe.
a1fel5 !WO lellel..oU.bllily lor 1055, damage or dutruclion 0' your ,hl"men~ Full Value PRII.c1lon IInd Minimal Prolecllon. The opYon thaI apPlliitatlbllhes Alias' maximum liebllfly loryaur gDOds,
su 'llCllo the rules contained In Alla$'leri~. If you do nol sal.et an opllon, by law, you will rec.lve Full Valul Protection undll' AIlaa' Ilrlff .. ap.clOed below, wllh no deduc:Pble. You wiD bl
c ed for Ihls covel1lll. a<<ordlAv to AU..' tariff.
Binding Estimate
Bln!!ln; Charges; $
NOIl.Blndlng Charges: $
Tolal EsUmatlld Charge&: $
Total EsUmatecl Cha~es
with possible E14t111lonll
desllnallon services: $
$4,460.68
$0.00
$4,460,67
SubJecl to minimum weight 01
1000 Ibs. Dr mInImum charge of; $
. Va Undar Full Value ProlectiOn. unlus you declare a higher Y11lue lor your .hlpment, your rhlpmenl ",10 bIlll1l""port.d based on I vllue of notla.. lhen $10,000 Dr $6.00 per
d mulliplied by the &dual welghl of the &IlIpm8ll~ WhIchever leglelller. SubJacllo the value established lor )'ClUr ,hlpment, 1/ eny anlcle Ia losl, desllO)'lld or damaged willie III A11as' cllllody, Alias wl1l Bither
pair the anlcle to the ex1en1 necessary 10 reslore 1110 the same condlllon as when it was received by AIIa$ or pay you th. co.t of sUCh A1palra; or 2) replace lhe article wllh en ar1lc1e clllke Jdnd and quellly
I' you for the cosl cf such a replacement. An addlUonal charg..llppll.. for this option. To IVllId'lhl. addlUonal charge.l'ou mtl6lulecl and .lsn.lor Opllon. 2, MInimal. Prolactlon.
II DU declare II value lor your .hlpmenilhelli; I.ss than lhe aclual replacemenl cost c' your enllre shipmenl, you waive Alias' fiBbOlly l!rlhe lull velua 01 ygur household. goods 10 the ""enllhellhe lotal
AI Iacemenll'Clst exceeds 111. YBlue thal ~o. decler..
selecl Full Vatue Prolectlon, complele Ihe follOwing:
inlllal) I selec/Full Value ProlecllDn and declare that (he value 01 my shipment" the amount apeeffied In Alias' lariff (8 mInimum of SIO,OOO or 56.00 per pound, whlchel/Br Is pr.aler).
l lIIal11.eleCl FulIV"lue ProlecPon, but declare that (he value or my shlpmenll. eillter; lump Sum $"6,'1 ~ or par pOUnd (must ba more than tha greater 01 $10,000 or.$6.oo
un
~ mu,j also select 0"" of lhe oil . dsducllble ameu"l. lhat will apply lor your shipment (II you do not make e oelecllon. no deductible will apolvl:
No Oeducllble [Inlllal) $250 Deduellble f l (inlllell $500 Deductible ( ) pnllial)
o ION 2' nlm I Pro o. ti c nt5 or P I d er Arti I . If any article islesl, deSlroyed or damageli while In Alia.' cuelody, Alia.'lIobl!ny I. IImiled to the eCl",,1 weighl o! the losl, destroyed or
:l aged anlcle mulUphed by 6D cenls per pound per an'cle Tho; I,ablln,. level is proVIded at no charge. Ills oCO'\$lderablv I... !hon the aver~Q. Ylllu.. of household Iloods,
B selecl,ng Il1ls opl,on, you are waiVing Alias' Ilabli'ly /0' the full villue 01 your IY.lucel1old DoDds If you do not selecl Minima' Prolecllon, you wI!. receive end will be charged lar cv'l V"loc PrNt~lIan. eo Duli",e<I
'0. pilon t.
T
Speciel ServlCell Ordered by CUslo er
cu. fL ElCpedited Service
cu. ft. HoIsting/Lowering
cluslve Use of Vehicle
ace Reservation
L or
T nslt Storage a Origin 8 Des~nalfon
T e of Shlpmenl Charge Creoll Card
MIles 0
o Prepaid 0 COD U Approved Check
Booking Agenl Ace RelocaUonSystems, Inc.
Ongln Agent Ace Relocalfon Systems. Inc.
Address 2585 TechnolorlV Dr.
Clly & Stale Elcrln , IL
estTnaucn. Agent
Address
, Clly & Stale
Code
Code
Phone
0064
0064
'847) 836.5200
Code
Phone
A reed PJU Dales:
A reed Det Oates:
N me or AUas' Estimator:
t .., by algnatu"'.balow, IS"'.. 10 provId.l.... a.....lcea 04JlIJnad.
AI s Agent
A nl RepresenlaUve
Aganl Cod.. No.
. Code No.
R. Ins V.,,,iom ~.2(j.fi. 4t'.:'7t:!OlD
RATING & OISTRIBIJ'nON
SCAN AS ESTIMATE OFS DOC TYPE
Packet Page -1323-
CUSTOMER
Ac:lolllonallnstrucllons/Ramilrks:
Customer'li Contact
Destinallon
Phone
Name
(Opllonal) 1 appoint
all my
Name Phone
agenl. in my name ami place, 10 give AUas mstrucUons and to perform all acts and
execute afl documents pertaining to lhls lransportation.
CUllomer reque81s notlflc1Itlon cr actual welgbtllnd charge. 0 No 0 Yes
CuslomerwalllGs a physical eurvey 0 No 0 Yes
Additional Services Price List
(Potential Additional Charges, If Needed Or Requested By Customer)
9/27/2011 Item 16.A.1 O.
Atlas Van Lines - M.C.: 79658
P.O. Box 509
. Evansville. IN 47703-0509
800-638-9797
.-......
ShIpper Name: Dorie Khawala
OrigIn Address: 410 Brittany Lane
Cily,Slale,Zlp: Undenhurst.IL,60046
Order Number:
Desl. Address: TBD
C1ty,Slale,Zlp: Naples, FL. 34101
Additional Services - Unpacking Per Container
Container Rate Estimated Charge Container Rate Estimated ChargE .
~
Dbl8ed
$9.76
$18.77
$3.12
$6.01
KlQ Bed
$16.01
$5.12
Mirror
Carrierls
Reore5sntaUvs:
Date: ')(.
Print Name:
Dat~:
~
Packetpage-1324-
:l
ATLAS VAN LlNES,INC.
1212 ST. GEORGE ROAD, P.O~ BOX 509
EVANSVILLE. INDtANA 47703-0509
(800) 252-8885 I (812) 424-2.222
9/27/2011 Item 16.A.10.
IATlAS RE .. -.. --. I
.S..OOT No, 125650
N TE: The charges shown below Bre Rolin addition to the Total Charye. This section Is a broken out descrlption of the Accessorial Service and
scellaneous Charges $hown on the first page.
Listed below are the Valuation Options that are offered and the talal price for the move wiSh each optfon.
Full Value Protection (FVP): $50,300.00
FVP
FVP
FVP
$.6Q
Charge Total
500.00
4'60.67
;0-".
~:
Packet Page -1325-
9/27/2011 Item 16.A.1 O.
Additional Services Price List
.~
The Additional Services Price List has been provided to inform you, our customer, of the costs of potential services
that may have to be performed enroute or at destination to complete your move. At this time, you may not think
these services will be requIred. however, we would like you to understand the nature of and the reasoning behind
the charges, should any of these services become necessary.
EXPLANATION OF TERMS
SHUTTLE SERVICE -In cases where It Is Impossible for the van operator to deliver your shipment direcUy from the over-the-road
vehicle (usually e long tractor-trailer), either because of the physical terrain characteristics (such as tight turns, overlJanglng branches,
etc.) or safety considerations, you may request, or the van operator may require. shuttle service. A shuUle service Includes placing your
household goods on a smaller vehicle and transporting them between the over~the.road vehicle and your residence. While the charge
shown on the Addlllonal Service Price List has been based On the estimated weight of your shipment, the actual charge wlll be based on
the actual weight of the shipment and the- location where the sefVice Is provided.
EXTRA STOP - The transportalion charge Includes loading from a single address and delivery to a single address. If you would Ilks us
Lo deliver a portion of your shipment to another location other than the destination, there Is a flaL charge for each extra delivery.
SELF-STORAGE I MINI-STORAGE DELIVERY - Because of the adclitlonal handling, stacking, and other labor required tn delivering a
shlpm&nt into a self~storage faourty, there is an extra cherge for this service basad on the aclual weight of the household goods delivered
Into' the self-storage and the location where the service is provided. Please be aware that if there Is not sufficient room for the van
operator to drive the over-the-road truck into the facil1ty for unloading, there may also be a shuttle charge Involved,
WAITING TIME . If the van operator arrives at destination, and you are unable, for whatever reason, to accept delivery, the van
operator wUl walt for up to two. hours at no charge. After two hours, WaIting: Time charges will apply for the truck and Extra Labor
charges wlll apply for the van operator and any helpers that have been hired. These charges apply in conjunction with. each other and
are charged on a per vehicle, per man, per hour basis (quarter hour Increments -15 minute minimum).
EXTRA LABOR - If lhe carrier Is requested to provide a service and the tariff does not indicate a charge for Ihe service, Extra Labor
charges apply. Examples of situations where Extra Labor applies are, but are not limited to, Waiting Time (as indicated above),
unpacking "packed by owner" cartons, placing items In atticsfcrawlspaces, and, removing/replacing doors and railings. Extra Labor
applies on a per man, per hour basis (quarter hour increments - 15 mInute minimum).
UNPACKING - Unpacking includes the removal of items from carrier packed cartons, placing those Ilems on the nearesl fiat surface,
and the disposal of any packing debris. It does nol include placing items in10 cabinets or closets. Most customers do not want the mover
to do any unpacking other than unpacking their mattresses and box springs so the van operator can set up their beds. If additional
I unpacking is desired, either as a full or partial unpack, the cost Is shown.
i
.' OVERTIME UNLOADING - If you demand that the van operator only unload after 5:00 PM (Monday through Friday) or anytime on a
'I' weekend ~r holiday, th~ van operator is entitled .to charge for Overtime UnloadinQ' If the delive:ry is performed. after 5:00 PM (fYiondal'
'through Fnday) or anytime on a weekend or holicay at the van operator's convenience, no additional chs.rge a;;piles. Overtime
I Unloading is applied on a per hundredweight basis, based on the actual weight of the shipment.
I.. STORAGE - tf you cannot accept delivery at destination and your shipme ni must be placed Into an agent's warehouse for storage, the
: following charges wUl be incurred:
i
[2] FIRST DAY STORAGE . This charge Is for the preparation of the storage vaults, receiving the shipment into storage, and
I. preparation of storage documentation. This Ch.arge is applied on a per hundredweight basis, based on the actual weight of Ihe
shipment.
[2] EACH ADDITIONA1. DAY STORAGE - The charge is for each edditional' day after the first day. The charge is appHed on a per
hundredweight basis, per day, based on the aclual weighL of the shipment. The storage period cannot exceed 180 days, after which
lime, the rules and rates of Lhe warehouse will apply.
DELIVERY OUT OF STORAGE-tN-TRANSIT (DRAYAGE) - This charge Is ford'eJiverlng your belongings from lhestorage
warehouse to your residence, This charge is based on the aClual weight of the shipment and the location where the service is
provided.
EXTENDED VALUATION - If you declared Full Value Protection on your Bill of Lading, this charge is equal to 1-0% of the Initial
valuation charge and it will be applied every 15 days, or increment thereof, that your shipment remains In Storage.
"........,
"........,
packetPage-1326-
. 'OS
ACE
9/27/2011 Item 16.A.1 O.
,-,...
'1e~tbM
S~, 1~.@
PLEASE READ CAREFULLY BEFORE SIGNING
(__ l ORIGIN RELEASE
I -".... - j /' . ... '"... (MlIST liE SIGN};}) AT ORIGI"!)
I ,AV'(tS"/(k''/(}(l./(ir q acknowledge that I am responsible for the final walk-
through at the origin of rt1'y relocation. I understand that it is my obligation to personally
check including but not limited to cabinets, closets, attics, outside storage sheds,
basements & garages to ensure that every item I want included in my shipment has, in
fact been placed on the truck. Additionally any floor protection which includes
masonite, carpet runners and or plastic masking has been removed, if floor protection is
not removed immediately upon completion of the move, shipper assumes all liability.
During the final walkthrough of the origin residence there was no evidence of property
damage including home, driveway, landscape, etc, except as noted below.
There is no evidence of any leaks or running water at my residence. Any damage claims
to soft flooring, plants/pots, assembled particle board items, unpacked lamps/pictures/
paintings/glass/marble tops/mirrors/unstable furniture or any non-third party serviced
item ,,:will not. b . .'~.. .'1:s responsibility.
Ix f)/ /} , )
If, . 1./
--...
/'
}.6-~?'?1<J
Reg.#
>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>><<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<
'f", 1/ DESTI!'\ATION RELEASE
J ' .... f 't
i )..! . - [//) r, (~IlSr BE SIGNED AT DISTl'lAT10f\)
L./()f/ (<,~';'~>-/{! (1(t,i( cr acknmv1edge that I am responsible for the final \valk-
through at the destination ofimy relocation. I am satisfied that all of my items have been
delivered and that none afmy items arc missing orren1ain on the truck. Any claim for
property damage home, driveway, landscape etc. must be noted at this time. Additionally
any floor protection which includes masonite, carpet runners and/or plastic masking has
been removed, if floor protection is not removed immediately upon completion of the
move, shipper assumes all liability.
During the final walkthrough of the destination residence there was no evidence of
property damage including home, driveway, landscape, etc. except as noted below.
There is no evidence of any leaks or running water at my residence. Any damage claims
to soft flooring, plants/pots, assembled particle board items, unpacked lamps/pictures!
paintings/glass/marbletops!mirrorslunstable furniture or any non-third party serviced
items, will not be Ace's respons,ipilitt..) \
/1-- . //}_. ;/ /1 .i Ii
--..,
San Diego · Long Beach,. San Jose · Seattle · Florida · Baltimore/D.C. · Austin · Illinois
T
1 prints Business Foons 760295-2614
PacketPage-1327-
Walkthrough Rev, 01108
(jyv:-2-
9/27/2011 Item 16.A.1 O.
.":;'ifl '~.
.y'~~~<:>~~:'~';-" ';'7,:: .:,) \,':r ,,' ,,{,',:'::....... :.:.,.." ': . ..-:./!~ /;
/;1'..' .i,.....r..)...... .......'....!. .....'. "'J..J .'" "./." .,',
.. "'1Vir<">'..l'"fq,,r-'J'r"'I',:"r .""'.....,..:,.i.J'..I\Ii!- "," .1 l
......",...." :1Jj'( ,;irUl' ,': ~'t....., '.......,. ...;:
r " "'''':tr'tf'1I1ru i
~
Order Nwn:
........- ........
~~~'t/-UJ.
Ship Via:
Vebic1e(I) Yes
-(PdJ2/J5(/()/JJ1J Id/1/;o
Shipper
L Name: Dorie Kbawaja
2, Company:
3. Phone 1: 847-406-9216
4. Email: doriek.kbawaia@.l!maiLcom
1. Origin: Lake Villa I IL
2. Destination: Naples I FL
1. Year: 2003
2. Make: BMW
3. Model: 525
4. Vebicle Type: Car
~. I J ,JJ of) YflllDPD
\juJiJ{fJ' p1
~
Vehicle 1 Information
s:;: Surge Protectl:lll f ~l J I
F 01 BUSiness (ntlmi (\r l' I rt/
u ~ \\})
~\~~~. ~~
W~l"V\~ .. EMEtON_
Network Power
L, ! consent to 2.l! the conditions cfth.i7: Drder :forn;.~ and give Bright Star
It ca.rd for auto transport s.ervice.
~ke YU~H" !'equ!red depn~!t :
Deposit Options
Opiion i $200.00
I*Last N
* Dilling
I*citv:
I*Sta~e:
I*:ip ~(
I*UOOlt
https:llmail.google.comlmaill?ui=2__ .
Packet Page -1328-
~
II
if56db2&a... 12/8/2010
. -....
'1:.1'-1, :
.J....: .'\:;,~::- .:"', .\1;.:,~!:~t.T.'.-:7. .f.~...:;.:..~., .. -, ';:0:',_ "-,r'!'}""~.1;r;.;f"",",":-"!:;"~~'!'~.'!1.~""
r""">>'J"""~'--''' .'t'~..~,.~.;,.<y..,'~-'\: ~'-~' ...~.."JJ,..,..~:."",.>,r""<'.~,..'. ~', "'7''' . .- ~F' "'.'.L'.~ J .:: '.-', ',.~~j!:- .-~.:,;,.... ." .,:;-....:, ":'"r(::,,: -':,''''}'';,:';;. . t ,: ".:-: "_.' .
" ~---L
. ..~ ' I j.O. Box 110610
. oung 5 VNaples, FL34108-0111
~ Phone (2~9) 514-3124
li s rt Fax (239) 514-8613
ran po INC. Motor Carrier # 330557
cftO)t)
JL/O
YEAR [) ()O~ MAKE f3 r(\ LA) MODEL'5 ~ s
YOUNG'S TRANSPORT INC. WILL NOT BE LIABLE FOR SMALL SCRATCHES, SCUFFS OR DINGS NOT DETECTED AT
INSPECTION. THIS INSPECTION REPRESENTS A GENERAL OVERALL CONDITION AND IS NOT ALL INCLUSIVE.
B
BS
BR
C
CR
o
.-- F
. FF
G
L
t.,.,
p
.--.
CUS~ER NAME
o ADDRESS
~
R
I
G
I
N
I e. L h t1 u.J (!.~ (A.
(1 .)eJ (y\ Iu {I (~., I) ( ;.pt.. Z a::;[3
~
9/27/2011 Item 16.A.1 O.
8ROKERN. II
J i.l ;0 0 I
VINII
CUSTOMER NAME
r-~' , G
l fYJl
;( j \1' . Yr ..s u..J
.p STATE
~'~L
llP
MILEAGE:
CHART OF
IDENTIFICATION
CODES
Open For Re lnspection Due To: 0 Rain/snow D Too Dark ~TOO Dirty
... '~"
eO "
lJ15' .1. Ill;
-, .;j I
.'uO .
.. I J'-'-
~'C(J
r''J /l S
n,,~ l V~
~~-:fJ;~_/_:~c~1{Q 5~? j
~~~--""7'7.r'"'-'---_:"_- tn. ') fhfy
stained Vehicle CDntiitiDn at ()(Jin --....-:::=;-- // ..'"....... ( ~~---- :~ ~tz::2
T Tom .//- r/ DRIVr:fi-- .. c.C\D.
;:/:. .
During Transport Vehicles and Vehicle Equipmentfvlay Cease to Operate Properly Througrl No Fault of the Transpolier.
The Transporter will be Responsible for Damage Directly Caused by the Oriver.
The Transporter WILL NOT Responsible tor Damage NOT Caused by the Driver.
I !lave Read and Understand the Terms and
Conditions on the Reve!?e'Side of This Form,
[ Agree to be? Ol nd.J?>Y. t.h8Sj3'/'1erms and Conditions.
/V ~.//
l v ./;;-;/
/..
/~~./'
/v."-;;," .
/~/ j /;'CU$TOMER'S SIGNATURE'~ .
/. ../ ' "
Is t}1lS' /:.e~SleJree of cOl}tents? E;l(Yes 0 No
C// t~~/(' . .//// .'
/ " //~.
f (' ,'/ . ~rCl:~._ ~: ..
s.,/- ~ CUSTO~ER'sj?IGNATURE . .... ;~,
j ., Packetpage-1329-
Tiansoorter Office. White (Justomer'{i;/8sllmn~nl .. YellOW
r
"'~
PC
Bent
- Buffer Burned
Broken
Cut
Cracked
Dented
Faded
Foreign Fluid
Gouged
Loose
Missing
Pitied
Painted Chi.:)
Rubbed
This space is for Destination Exceptions by Customer
'i&,:
~
R
R'.)
Rl!st
Sc,at:;!-ltJd
Soiled
.;.. It
(--.
,~l_
Su:f~K;e S,:.xa~ ::h
ORIGIN
I Agree with the Driver's Assessment of the Condition of
This Vehicle,
~.-'
, ' ..
9/27/2011 It I
em 16.A.10
\,........
\.
"
..-
c.J'....\ ./ ,\) "
" ,Qj) \\L;I(/ / ."
X . ~~~Vj
J . ~ i
~~
.... T:
~
~ \::;? ~
~.~?
~"cZ. 0
~~ <:
S ('(."" c::::>'~
(""
Packet Page -1330-
,.-.....
,.-......,
.-......
9/27/2011 Item 16.A.10.
~
Mayflower = $5091.39
(Lowest quote used)
~
~
Packet Page -1331-
, ): ........
. ; )!S-
ayflower .IIIIIIIIIIII~IIIIIIII
9/27/2011 Item 16.A.10.
..n Poinr
ON POINT PRICE CERTAINTY
ESTIMATE/ORDER FOR SERVICE
U.S. DOT No. 125563
Pd, i' (t~r1ain.I~'-
CUSTOMER: DORIE KHAWAJA
(COd$iGr~l)~~;
STREET ADDRESS: 410 BRITTANY LN
CllY, STATE, ZIP: LK VLA IL,50045
ORIGIN PHONE: 847-406-9216
CONTACT:
COMPANY(Aseoclated With) :
APT.:
PHONE:
~ C.O.D.
BILL TO:
STREET ADDRESS:
CITY, STATE, ZIP:
ATTN:
o NAT. ACCT.
II:
P.O. NO.:
GUARANTEED PICK-UP Bnd DELIVERY DATES. DAILY AllOWANCE
(If eppllcable, per terlff): &12500 Per Day
&;;.~. uv,"" . I;; nUIVlI;lC;;"
MOOa9g-4069216
ORD#
-..
o.
....
w
>
o
:Iii
CUSTOMER: DORIE KHAWAJA
iCONSIGNeEI
STREET ADDRESS:
CITY, STATE. ZIP: NAPlES
DESlINA liON PHONE:
CONTACT:
PHONE:
CASHIERS CHECK
APT.:
FL,34102
FORNI Of" PAn.1t:f\:1 S~L1:.cn:D ~on larrtt}
;..:
u..
t-
O..
:2::-'
. NOTIFY IN CASE OF: 0
CHARGES
NAME:
STREET ADDRESS:
CITY, STATE, ZIP:
PHONE:
E-MAIU FAX:
J
PACK
DATE
ACTUAL
WEIGHT
BINDING
DATE
09/1512010
VALID
THRU
TARIFF PRICE SECTION MILES
PROGRAM
MT01
W
3
.. VOLUME I WEIGHT CONVERSION '!' 7.00 LBS. PER CUBIC FOOT ..
CUSTOMER REQUESTS TO VIEW WElGHINGS: 0 YES [EI NO
VALUAnON OPTIONS
You must complete this section.
Our liability for loss or damage to your goods is limited under federal law. In this sectlon. you must choose how much liability we will have for loss or
dam a e to our oods. 1H!S I SU NeE. Your selection here will", lace and override an valuation selection that ou have reviousl made.
( UnI....s an Addendum or B New EstImale I Order for Service Is Executed
. This shipment is based on a Bound Estimate between the Carrier and the Customer. The On Point Price Certainty Totel amount includes e
T nBportation Services which Include loading saNioe. lnInsportation FROM the Cityl$tate/Zlp listed above TO the Clty/StateJZip isted above. and unioading se
( Cartons, Packing and/or Unpacking SIINices listed as included: (.) Other Additional Sarviceslisted as Included; fl.l.!S any non-bound clJaryes shown for Slo
C arges and Advance Charyes. The Carner must retinquish possession ofyourshipmenl upon payment of 100% of the On Point Price CertalntyT 'ce amount
",ices exceed Ihe amount of Ihe On Point Price Certainty Totel pnce.
WEIGHT ALLOWANCE CREDIT' If the shipment's Actual Weight is LESS than the Bound Weight. a weight allowance equel t $f.!i..oo
be paid to the Customer based on the DIFFERENCE belween the Bound Weighl ilDl1 either the shipmenfs Actual Weight or 2, 100
FULL VALUE PROTEC110N OPTION
'Full Value Protection" melll1. thBl ff any of YOll' goods are Ios~ destroyed or damBgad whla in our
CUSlOdy. then at our option and up to the maximum amounl Of our llablllly, we will aithar I) repair the
goods to IIIe extent necessary to reBtore them to same ccndltion as when they were "'_ by us,
or pay you for the coat of such repein;; or 2) replace the goods wnh goods 01 like kind and qUBHIy. or
pey you for the cost of such a replacement
By law, our maximum liability to you Is $6.0D times tlte welgltl Of your shipment; however, thlB
amount will never be lesB1han $15,000. You can increase the dollar amount of our maximlnlliablllty
ror Bn additional charge, by ronowing the directions below.
You should ask yourself .everal que.s1lons, Bnd provide answers below. when Bele n tha
Full Value Prolectlon Opllon:
1. Whal do I want your maximum Ilablllly, In dollars, 10 be 10 0 for loss or damage to my
goods? (;niti..I ONE) .. , _ _ --:-&{tf7J ~
1 accept your aut?matic maxfmum leval of ltabilrty ?f $6.00 95 the ei9.h. t ~hipmsn
'Initial) Based on ths estimated wtlJght of my shipment, tnls amOLJ~t $ 1'1
I want to increase the dollar value of your maximum~abll1~y to the amount I write here the
In/hall :;aniers maximum liabilHy for my shipmenl is: $ {'.)p.tiorJ.:: __ 100..e)
2. Do I want to reduce my charges by agreeing to i! deductible?
Claim payments will be made to you tor J05S O~ damage to your goOds ...",th:)u\ a deductible. HClv;ever.
in exc.nangs for lower Fuji Value Protection chargES you c~n aflree to a dCjLY.:llDIC. If you dsad';) to dD
mis, you ~ check your lielection, below:
U5c l)edudib.
"00 DeductbE
suo Oeauctible
VALUATION COST
$1
uSlorner hereby makes, constltules and appoints: (Namel
...:.:;':.,
J,., I MINIMUM. UABILITY OPTION
\ \ ( ~LEASED RATE LIABILITY
~rentli Per Pound Per Article)
'Minlmum liability" means that if any of your goods ere lost or damaged while
in our custody, our liability to you is limited to no more than 60 cents times the
~ ill ~ llim1 that is lost or damaged. even If the ac1lJal value of that lie
Is mucIJ higher.
This is the minimum amount or liability ror your goods that we are required 10
provide 10 you under federal law, and is provided at no charge. If you do not
complete this section, your shipment will be transported at the FULL
VALUE PROTECTION option and you will be charged the applicable Full
Value Protection charge.
Minimum Liability Option Is considerably less than the averacre value of
I:Lo.uJllill2l.Uo.Q!1~ We do not recommend thai you agree to tills Minimum
Liability Option unless you have adequate protection for your goods from
elsewhere.
1
... "I~
OR'
,;,;:.',-'
(ChOOse
one. Do
Ill!lfiD'
out bOth,
slde~':r
In order to choose the Minimum Liability Option. and waive the Full Vallie
Protection option, you !IlU~ mitial below and complete the follovvmg:
WAIVER:
Per Hundredweight (cwl) will
Inlmum weightl. whichever is greater.
. (Address)
. . ,
(Phona) as true and lawful agenl for customer 10 ael in customer's nama, place and stead, to give carrier.
n.!ructions. parform all acts end 10 llX!lCU18 81 documents pel1alning to the lrensportalJon and s8IVlces ortiered.
Order for Service Acknowledgement
X
Customer's'Sign8lUfB (Dale)
l'fQR: WI,," the Customer slgrl$ tllS Order for S......ice Aclmowledgamant on the YlI!lldate on
Which lhe Binding EsUmate la Initially presented to the Customar, as indicated by tha 08le Recelved in
the Estlmala AdmowladgemBnt box, this Binding E.bmate (or any .uIl.equant revlalon thereto) shall
be vaid..,d bi~ng lor a period 01 up 10 120 day. aftar1ha Date R""eived. Otherwise, the Binding
Esbmet (or a. .ubs~. .nntt rev rev.isian thereto) .haB be valid and binding for e pariod of up to 60 days
-(9-(D ~er D~R :-52A-L.:..o- q q-(fS-(D
(Agenl Code & Data) Cam Rapreoenlabve Signature (Agent Code & Date)
1 MAYFLOWER DRIVE FENTON, MO 63026 PAGE 01 OF 06 20111-0H309.3&
s algnatUre I. required hare. acknowledging the VaJulllion you seleClad (noIell'8bove) and
celpl Of the foIlowirv. 1) Eslima1a end lhe Additional 5entices Prica Ust 2) yOU( Righls &
esponslbilities When You Move brochure; 3) Ready to Move brochure; 4) Inventory of Ilems Valued in
cess Of $100 Per Pound Per Articla (High Value Inventory) form. As evidenced by the .;gnaws
elow, Custom..- and CllIrierfurther agree to a1ll8rms, ..~tten orprlnlad, stamped ortype<l on all page.
n! .nd back) Of 1I1il roan.
(Date Received)
e1'i
\.
\ m """ "","".""."."~' w,
Yelu .hould sign baIoW only W you w1at1 MAYFLOWER TRANSIT, tLC 10 perfonn all of the services
Indicated above. By .'gning. the Customer aloo acknowledge. receipt of the On:lerlor 5entice. .
~
PacketPage-1332-
.\~.~~~ IIIIUIIIftIIIIlIIIIIIlI
ON POINT PRICE CERTAINTY
ESTIMATE/ORDER FOR SERVICE
U.S. DOT No. 125563
9/27/2011 Item 16.A.10.
::-,',n Poinr
M00899-4069216
PI ;r(' (crlai:.Ii~'
800-241-1321
l
CUSTOMER: DORIE
KHA.WAJA ORD#
/
AGENT AGENJ'NBR
BOOKER MOB99
ORIGIN / MOB99
~iNJ(fioN
CI
ZC)
;;c:z
u;;C:
;~"" I I
III Z V0UJol <e
z:;:l
00 fl- r-
~Z \\-L~_
<to<!: . J.. ~l I
u V 6 i l!JJ1;j;Jt[
f I
P bLv<~[ f ~V--<V\'l1JS
(<'-~-=-~ \ r'>l- I
_-. -t )..7:)v.,-,'V - t:.t
.-,
NAME
OLSEN BROTHERS, INC.
OLSEN BROTHERS, INC.
ADDRESS
3650 INDUSTRIAL AVE., UNIT C
3650 INDUSTRIAL AVE.. UNIT C
CITY, STATE, ZIP
ROLLING MEADOWS IL 60008-1053
ROWNG MEADOWS IL 60008-1053
PHONE
847-394-1900
847-394-1900
PICK-UP I DELIVERY
ADDRESS
CITY, STATE, ZIP
CONTACT PHONE
DESCRIPTION
INCLUDED AT ORIGIN
INCl.UDED AT DESTINATION
DESCRIPTION
FULL PACK
FULL UNPACK
PARTIAL PACK and J or PARTIAL UNPACK
INCLUDED AT ORIGIN
INCLUDED AT DESTINATION
(see itemization below)
(see itemization below)
CARTON TYPE
NUMBER
INCLUDED (up to) QUANTITY
PACK UNPACK CARTONS
ONLY
l(
NUMBER
INCLUDED (up to) QUANTITY
PACK UNPACK CARTONS
ONLY
CARTON TYPE
l}
J
:.--
2-
t C
'-.
'"
5
<;u~ TV b>i
DESCRIPTION
DESTINATION SHUTTLE
INCLUDED AT ORIGIN
INCLUDED AT DES TINA TION
X
~. ~~iY"- (('0* feJ: 9
sl-€1' ~ hd
'/v
)(
PURPOSE:
,,/
/
Gi' ~'I "OS,MT.Re,'_2:1J_'J6_3C.;;d' - VO' 1 MAYFLOWER DRIVE FENTON, MO 63026 PAGE 02 OF 06
Packet Page -1333-
ayflo~er. (i.1I1111111111111U1111
800-241-1321
ON POINT PRICE CERTAINTY
ESTIMATE/ORDER FOR SERVICE
U.S. DOT No. 125563
9/27/2011 Item 16.A.1 O.
n Poinr
M00899-4069216
Prh.- C~;rl,dnl\
CUSTOMER:
CORlE KHAWAJA ORD#
DESCRIPTION
POINT OF SERVICE
CHARGE
'. MuST BE SUPP()flTEJ) BY INVOICE~':
TCJlf, [ 3rd PARlY & ADVANCE CHARGES
('JOI, BOUrWj
$1
SIT PICKUP
MILES
~
CI
.~. 1STDAV
2ND DAY
EXTENDED VALUATION
NO. DAYS
RATE CHARGE SIT SIT DELIVERY WEIGHT RATE CHARGE
.z : MILES
0
l-
e EXCESS WEIGHT >23,9GG
z
.... 1srDAV
cri
III 2ND DAY NO. DAVS
Cl
WEIGHT
TOTAL STORAGE jNON-BOUNDj
$1
BINDING
ON POINT PRICE CERTAINTY TOTAL:
l.~
. . ." .
L STE:D BELOW ARE THE VALUATION opnONS THAtARIEOP'FiEREI(ANDTHEToTAL, PRICE FOR THE MOVI! WIT'" EACH OPTION.
LUAllON OPTION: RELEASED VALUE .60 CENTS PER POUND PER ARTICLE
DEDUCTIBLE CHOICES
FVPwfth $0 DEDUCTIBLE
FVP with $250 DEDUCTIBLE
FVP wfth $500 DEDUCTIBLE
FVP with $750 DEDUCTIBLE
FVP with $1,000 DEDUCTIBLE
$ .60 PER POUND PER ARTICLE
r-
IMPORTANT INFOIQIIIATION AND TERMS - PLeASE READ BEFORE SIGNING ESTIM TE I ORDER FOR SERVICE
1} The Total Bound Charges amount is based on the estimated (Bound) weight and estimated (Bound) services listed up to the quantities shown on the
Estimate as included in this Bound amount, except as otherwise provided. The Total Bound Charges amount will be reduced by a Weight Allowance
Credit should your shipment's Actual Weight be LESS than the Bound Weight (See Weight Allowance Credit on Page 1 of this Estimate I Order For
Service). The Total Bound Charges amount does not include charges for any items added to the shipment as indicated in the Table of Measurements
(Cube Sheet) andfor additional services that are requested or are necess8IY to accomplish delivery. Storage in Transit ("SIT') charges will be based 011
the actllil! weight and the actual number of days in SiT. In the event sir services provided are in excess of the estimated amount, the cost of tbess
services will be in addition to the arnount stated. Pal addrtional Futi Vaiue Protection Dpt;on c.~arge wm apply on shipmentstllat require SiT and far i,A/hi:::t'l
the Full Value Protection Option was selecred.
2) COLLECT SHIPMENTS: Unless other payment arrangements are made with the Carrier in writing signed by the Carrier, this shipment is a collect
shipment. Forms of payment honored at deiivery on Collect shipments (as provided in Carrier's tariff) in U,S, funds are.Cash, Certified Check,
Travelllr's Check, Bank Check (drawn by a bank on itself), andlor specific Credit Card(s) that have been pre.authorized by Carrier. All drafts
must be payable to the Carrier. All charges subject to audit, and if necessary will be corrected by refund or additional billing.
3) ADDITIONAL SERVICES OR QUANTITIES: The charges for services or quantities that are in addition to those collected at delivery must be presented
to Customer within 15 days of the date of delivery (or If the Carrier lacks sufficient information to compute the charges they must be presented to the
Customer within 15 days of the date when sufficient information becomes available) and shall be due within 30 days following presentation of the freight
bill and invoice.
4) If Customer indicates any change in the agreed upon pickup or delivery period within 72 hours (excluding Saturday, Sunday or Holidays) prior to the first
day originally agreed for loading the shipment, the Carrier shall assess a charge for each change.
S) The Carrier must deliver and relinquish possession of property transported by It upon payment of 100% of the On Point Price Certainty T alaI. However,
jf only partial delivery of the shipment is made, the Carrier mey not charge more than a prorated percentage of the On Point Price Certainty Total. The
prorated amount must be based on the percentage of the weight of that portion of household goods delivered relative to the total weight of the
shipment.
PEaALINSTRUCTIONSICOMMENTSIREMARKS:
~
GP '; t: OS JH _Rev _2010_(\5.. 30vof - \/01 1 MAYFLOWER DRIVE FENTON, MO 63026 PAGE 03 OF 05
2010.011-13 011.35
PacketPage-1334-
~
S~Jl ~
\rv.t-l.
tWit
9/27/2011 Item 16.A.1 O.
.:0 Your firs 50 ons are available to you FREE OF CHARGE. The cartons that we
provide to u are usually brand new - or they could be once used cartons.
Olsen Brothers, Inc.
847-394-1900
FREE CARTON OFFER
.:. We have a good supply of medium (approx.. 20" x 20" x 20") sized boxes and small cartons (approx.
15" x 15" x 12").
.:. Packing paper is available for purchase for $15 for a 25-pound bundle. The paper that we supply is
un-printed, clean white newsprint.... the kind all moving companies use!
.:. Packing tape can be purchased for $1.00 per roll. Each.roll is 165 feet in length. One roll is usually
good for 15+ cartons.
.:. We can deliver all of your moving supplies (cartons/tape/paper) f~. ~ \ c..,
.:. Each carton that you need beyond the first 50 free boxes that you get can be purchased for $1.00 each
- regardless of the carton size.
.:. If you return your "gently" used cartons to our office, we will purchase them back from you for S.20
each.
.-.
NUMBER OF CARTONS WE THINK YOU WILL NEED
SMALL
MEDIUM
TAPE
.PACKING PAPER
Please bring this sheet with you when you pick up your supplies. Cartons are
located at the rear of the building, near the overhead garage door.
'#
.NAME D&V(~ K.ka,.J&Jc.-
Sales Rep Name: ~..{e4e- ): 64~l{~D
DATE: Q-,8 '-( {)
---.
www.olsenbrosinc.com
Packet Page -1335-
9/27/2011 Item 16.A.1 O.
National Van Unes, Inc. . DOT. 76628
2800 Roosevalt Rd.. Broadview, IL 60155 800-333-6851
EmMATED COST OF SERVICES - ORDER FOR seitvIcE
....
NATIONAL:.
v ^... L I NitS. I.... c.
.11111'
u.s. DDT No. TIS28
FMCSA Ne. MC42111a
Visual sunoay?' (joi' '(.. n No
Shippee Dorie Khawaja
Stleet: 410 ElMItB"" Lane
City, Stale, ZIp: UndenhulSl, IL 60046
County: Lake
Elevator SeMee:
Home Phone:
1111111111111111
n Nat11>J;;ct
n.. c.........,.".MIfY_in.....cwfNr'sfKIrJ, or, 011"""'_ .,,"'Ir.NnNtl. HPYof...,. ................lIfal'lllr'l
-..... cn.pu .,......InD Ih. UIfI..1I.
.
INTERLINE CARRIER
NAME & ADDRESS:
Slopotf Name:
St.eel:
City; Stale; Zip;
Cherges tD be paid by check (Cashiers, Certlfred , Bonk Officlal, Pre-Appmved and Travelars
only). or Cach, or US PosIaI Money Order, or Pre-Approl/Cld Cledlt card (VISa, Oi8cover,
Zip: MaaterCard and American ExpIMs only).
CUSTOM PACKING
RATES
$13.67
$13.92
$22.51
S28.2e
$125.00
CUltom _ng Subtotal
Est Welghl: 9,000
I
I $38e.56 THIS REPR;"SENTS TrlE Oi^RGES FOR ONLY TH8S;" ITEMS L1STE~ ON THE TABLE OF
~ MEAS,JREMEN1SANIJ n-OSE SERVICES 1~'JI;::::ATBJON TI-.j:= ESTIMA""'-E --;HIS NON B "'~DlNG
( ESTIMATE IS NOT A GUARANTE::E -..tAl n-E A::-UAl CHARGES WLl NC'lT EXCEEIJ ....H~ N.lOUr" T :ir;;
.-----1 11 THE ES~IMATE COMMON CARRIERSNIE REQUIRED BY '.",N TO COLLECT TRANSPORTA,IOt<J N;;J
~ \ I, CI~tfl~E~r's~~ri"r';.~TtF~O~:,jlZ~&~~sT6~ g~so~ ~~;r17.4EA~~tf,,~~'1V{~~~ 0,E~~'ER (r<
// \ r-\ "- . \e.~I1S A(;Ef.ITS EXAC:T CHARGES FOR lOA~ING TRI\NSPOr~lING AND U!\LOAD,N(, ,ARE D.6.SED l,Poq
,/ _____ \ / ~ r-lEVvEI3,..n O~ rHE GOODS TRN'JS~O;:FED M"D ~ M.'\Y tv]~ BE P:)SSIB~[ TO DrTL"RMI!'J:::; S I:''''
// - ~ 'r n' (. ;jJ I:~::;~T~~::;'~: :=:::::~I:~E::~:~'L:~DA:~I;:CEE EXCEED THE ESTIMATE
~ BY MORE THAN TEN PERCE~T, THEN UPON YOUR REQUES1 THE CARRIER MJST RELINqUISH
, PQSSESSION OFYOUR SHIPMENT UPON PAYMENT OF Non"ORE lHi>N 110 PERCENT OF mE
ESTIMATEDOiAROES YOU ARE STill OBLIGATED TO PAY TrlE BALANCE OF TrlE TOTAL CHARGES
( L6 1 1fr~. \ liJ - \'IITHIN 30 DAYS AFER RECEIPT OF THE FREiGHT SILL CCW<GES FOR ADDITIONAL SER'.1C[S AT
-' ORIGIN OR DESTINATION THAT YOU REQUEST AFTER EXECUnON oF THE CONTRACT W1Ll BE
ADDED TO THIS TOTAL ANDW1LL BE DUE ATDElJVERY.
~ ~\b 8'f
/1 .....,
171 COD
nasA
I I Ves I I No
847-40&9216 Work Phone:
Emall: dorle.ktmcomcaet.net
Ao_d Load Dus: 11131l12ll10
~.cktn9 OBte Preferl'8d:
Driver to Pack:
National Aooount Name:
Natl. Acct. CradJl Clearance #
SSN (GSA) GBlJ(GSA)
Booking Agent Name:Shur-Way Moiling & Cartllge Co.
O.gin Agent Name: Sh.Jr.Way MOIling & Cartap" Co.
Stopo" Name:
St",et:
City;
Stopa" Name:
Street:
City;
ESTIMATED COST ON PACKING & UNPACKING
L/:leding oli of NTS or Permanent Slg: I I
Code: 1943
Code: 1943
Stale:
ZIP;
State:
~.p~~
NwBER
2
-4
3
TWIN MAT
DBL MAT
K/Q MAT
tAIRROR
TV CTN (nat .Ubject to discounll
~=-='::'~:~~':.=:r=:=~L:..,,=::m~-,
Tariff: NVL100 Secilon: 3 Mile.: 1,28.9
4
1
Peak; N
DESCRIPTION I RATE
Transportation C/'igs 9000 lbe I
TransportsUon Charge. include tha follOWing .ervices performed during the
interstate transport of your move: linehaul services, origin and destinatron
oharges, insurance re~ted surcharge, fuel6l.Jrcharge, and as. aRJlicable, items
classified as bullcy artides, p1Gkup aOO delivOfy ..rvice .131'0 party and
..If~.lorage warehouses, and extra stop offs (exdudln. diversions) All othar
servioes perrorrred will be charged at preval1Jrg tariff rates.
Full Value Prctec:ion $5(1,000.00
Cusiom Pack (see llst)
CHARGES
$4,351 90
S270.00
IBILII 16ll5645S6
I POll
IOIF 8/Ul
Phone 847-406-\1219
~
n Nat'l AodJCOO n SoIf Haul
Conslgne.: Dort. Khawaja
Street:
City, StBle, Zip: Naples, FL 34101
County: Collier
Conlll.OI for NoIIfioation d arMlIllllcharges:
Contact Name:
Street:
Cilv:
AlIreed Deli..ry_:
Destlne.on Agent:
Addres8:
Note:Pumantlo!he pr0lli6ions of am NVL,uu, carner w~1 be responSIble rordelay.relaled
.xpa...... such 8& .easonable oomrnerol.llodging, 51J'l\ of r.....enable food and other oti-d poc\cet
axpenses for shlpmenta weighing more 1han 3000 pound\l When a claim" filed w~hin 30 days after
delillery and receipta ore prO\llded. In tieu of receipts, 8550 par diem wll/ be honored
IA Vet I I N~
Coda:
CUSTOM UNPACKING
RATES
$3.02
$3.08
15.06
15.93
$20.00
Cuatom Unpacking Subtotal
SPECIAL SERVICES ORDERED BV SHIPPER
R Space ReseM!lion 0 Expedttad Servioa (DaIi.ar On of B.Io..
Exclusive Use of Vehicle CUbic Feet
REPLACEMENT VALUE PROTECTION (armunt S50.000.00 ) OR BASIC COVERAGE
~ ~ ReplaeemenlVaiue Protection. No deductible. D U 600 Per Lb. Per Article
B Replacement Value Protection, $250 deduclJble
C Replac.mert Vaiue Protection, $500 ded~tlble
TOTAl.
$27.84
$55.66
S67 .52
5113.04
5125.00
$399.66
NUlABER
o
o
o
o
o
TOTAL
$0.00
$0.00
$0.00
$000
$0.00
~
NON.BINDlNG ESTIMATE (Table 0' Mea:;>urI:;r.-,ents Required).
Uniquel)' Assigned Shipper#
$4,740..36 I acknow~BOge prior (809lpt of release inlttal each)'
o ~;r::==~"":::....~~C:""~tll~~~a;~-;'-;:":.:'':':-:::'''~.''II.
$0.00 0 ;::'=::"~::'=--':"-S:-':':~::':'=b -- jf"'wNdelU~tomvltllptNrltl.,",,*"
o 1......."'1...llItalr......pII,..l......,.d~fOOCIsprilnnM.
Sub ToIal of Valuation, SIT Veluat,on & 3m P.tty Chgs. Flat An >Un! -'21(1.00 I horebyreq_ .h............mBd comer""'""""". "llSIJor\lI1IM _....nd ..Nlooo d..cr1bBd In thI. crrI..-. ....hject
Total ,r-- $5,010.37 ."l....connell""".."d COtldIlIcnso1.....n1... h..Jlehdo ......hil.fl.ding. whoch hll oflodlng.. be...... ot 1m.
Tnls estimate is limited to tho",e ertlcles listed on the att&cned Ta~. ~f Meii&Un I118nts. Bindir'tQ and customer ~::s ~co of I1l!1 ShIpment. and S.lbjecl fJ the IIrtffs or1le cemer In BIfId on the OliM1f"Ins!:)ortaU lefVk::es
benefit estimates Ire crOl8cted for 60 dlilY5. TranSDOf1a,1too mu&t DOnmenoe in 60 davs trMuhe below .
fAulhorlzOtg Older For S.rvice'
Shipper Signature; X.- Shipper Signature: X
((7J/4-!iO~
IGC Software; Repor1$ Version 6.4.236; ~39891; Rallng Version 6.~~1 0
-- ----
{!{tv Cod COi/h(J~/1/1/~1/'0
~~u. ___ __ . Packet Page ~1336-
Sub Total Transportation and Accessoriala
Sub T etal of storage in Transit
Sslesman Signature: X
#
(Acce;tl.~ Esllmate)
J
Dale
---..
CUSTOMER COPY
-
Cevc
~.
Additional Services Price List
(Potential Additional Charges, If Needed Or Requested By Customer)
National Van Lines, Inc. . DOT. 76628
2800 Roosevelt Rd.
Broadview, IL 60155
800-333-6851
Shipper Name: Dorie Khawaja
Origin Address: 410 Brittany Lane
City,State,Zip: Lindenhurst, IL, 60046
Order Number: 169564566
Dest Address:
City,state,Zip: Naples, FL, 34101
9/27/2011 Item 16.A.10.
IMPORTANT NOTICE TO SHIPPER: Below is a list of en route and/or destination services and corresponding
rates/charges, which you or your designated representative may request or that may be necessary to deliver your
household goods shipment. We have reviewed these services with you and to the best of your knowledge no such
services are required at this time. These potential services and their cost are based upon the tariff issued in
accordance with the regulations of the Surface Transportation Board of the Department of Transportation,
The rates/charges for these en route and/or destination services (should you request them or if they are necessary
to deliver your shipment) will be based on actual weight and/or per occurrence and are in addition to all other
charges on the estimate you received at origin.
The carrier will not deliver or relinquish possession of property transported by it until the charges on the estimate
given at ori(Jin i.e., (1) either the total binding estimate (Option liB" or Option "C'') amount OR 110% of the
non-binding estimate (Option "A") amount; plus (2) any charges applicable for service(s) requested by the shipper
after the contract was executed that were not included in the estimate; plus (3) any charges for impracticable
operations (such as shuttle service), that do not exceed fifteen (15%) percent of the total charges due at delivery,
have been paid in cash, certified check., traveler's check, or bank check. (one drawn by a bank on itself and signed
by an officer of the bank).
~
Additional Services Service DeScrlptloll Rate Estimated Ch"rge
$11.43
$1,917.00
$120.35
$58.68
$58.68
5>799
Unpacking (Full Service Per cwt)
Shuttle Service (Flat Charga Weight-Sased)
Extra Stops (Per Stop)
Waiting Time (Per Hour' Per Vehicle) & (Per Hour' Per Man)
Extra Labor (Per Hour' Per Man)
Overtime Unloading (Per Cv/t)
Advanced Charges (F'ar Third Party Invoice)
sooo
.. 1~t Dey Stora2e-~ln-Trans!t (Per C.\:\fT}
$5.64
. Ea~h Additional Day Storage-in-Transit (Per CWT' Pel Dayj
. Delivery Out of Storage-in-Transit (Flat Charge Weight-based)
$0.22
$1,58160
$33400
Self~Storagefry1ini-Stoiage DeliVery (Flat Charge \t'\feight-Based)
Additional Valuation Options
Maximum Value Protection - $0 Deductible
Maximum Value Protection - $250 Deductible
Maximum Value Protection - $500 Deductible
Amount
$50,000.00
$50,000.00
$50,000.00
. The destination SIT charges shown above have been discounted at 40%
$349.76
$651.78
$40.92
$19.95
$19.95
$24449
SO.OO
$507.60
:;'199B
51,581.60
$113.56
Cost
$487.00
$339.00
$270.00
Must Be Signed & Dated @ Origin, Prior To Completion Of Loading
Carrier's
Representative:
Shipper's or Shipper's
Representative Signature:
Print Name:
Print Name:
,-"
Date:
Date:
IGC Software; Reports VerBion 6.4,236: Job 10 39891; Rating Version 6.20.8, 5f121201 0
CUSTOMER COpy
Packet Page -1337-
9/27/2011 Item 16.A.10.
Additional Services Price List
(Potential Additional Charges, If Needed Or Requested By Customer)
National Van Lines, Inc. . DOT. 76628
2800 Roosevelt Rd.
Broadview, IL 60155
800-333-6851
---.
Shipper Name: Dorie Khawaja
Origin Address: 410 Brittany lane
City,State,Zip: Lindenhurst Il, 60046
Order Number. 169564566
Dest Address:
CIty,State,Zip: Naples, FL, 34101
.
IMPORTANT NOTICE TO SHIPPER: Below is a list of en route and/or destination services and corresponding
rates/charges, which you or your designated representative may request or that may be necessary to deliver your
household goods shipment We have reviewed these services with you and to the best of your knowledge no such
services are required at this time. These potential services and their cost are based upon the tariff issued in
accordance with the regulations of the Surface Transportation Board of the Department of Transportation.
The rates/charges for these en route and/or destination services (should you request them or if they are necessary
to deliver your shipment) will be based on actual weight and/or per occurrence and are in addition to aU other
charges on the estimate you received at origin. .
.
The carrier will not deliver or relinquish possession of property transported by It until the charges on the estimate
given at origin i.e., (1) either the total binding estimate (Option "B" or Option "C") amount OR 110% of the
non-binding estimate (Option "A") amount; plus (2) any charges applicable for service(s) requested by the shipper
after the contract was executed that were not included in the estimate; plus (3) any charges for impracticable
operations (such as shuttle service), that do not exceed fifteen (15%) percent of the total charges due at delivery,
have been paid in cash, certified check. traveler's check, or bank check (one drawn by a bank on itself and signed
by an officer of the bank).
Additional Services - Unpacking Per Container
ContalON Rate EstImated Charge Contalller Rate Estimated Charge
~
DblBed
$9.07
$17.45
$8.89
$3.08
$5.93
$3.02
KlQ Bed
1V Carton
$14.88
$20.00
$5.06
$6.80
Mirror
Twin Bed
I
I
I Carrle~'s
I ~ . ,
l ~es:~r.ra\i\!e
Must Be Signed 8. Dated @ Origin, Prior To Completion Of Loading
Shippei's or Shipper's
ReDre~entativf-; Siant31UrC
Print Name:
Prmt Name:
I Date:
Date:
~
IGC Software; Reports Velllion 6.4.236; Job lD 39891; Rating Version 6.20.8, 51121201 0
CUSTOMER COpy
Packet Page -1338-
9/27/2011 Item 16.A.10.
"-".
Allied = $5642.54
.---.
.---.
Packet Page -1339-
9/27/2011 Item 16.A.1 O.
ShlppM
Done Khawaja
410- Brittany Ln
AURORA, CO 80046
h:847-26S-QS27
ConsIg-
ClIrrier
1
----.
ORDER FOR SERVICE GUARANTEED AND BINDING PRICE PLEDGE
NAPLES, FL 34112
Orig Agent
PBd Delivery Estimate
lD8d C D tt'ri f)/lfRdc S/rJnIge
This GLIA AND BINDING PR1CE PiBJGE Is bIIsed on mtfdes 1100 SIlTllices I/sI11d. In tile t!l'eIIt unknown MJdItit:JMJ SIlfYIaJs _ ~ to effect ddIrHy, thes& t:Dsts wII be In
addition to tile IIfIlOUnt ~ below iIIId wifI be billed to the sir~ 30 up MIrIr dsIivery. Sudl $t!I'V/t:fI$ /lnd IIpp/lcllbJtJ t:hNges wIIJ be bilS<<! upon tile tllrIIf ,.16 In ttffed on tile uts of
this estImi1m. 7h1s esl:lmi1m Is ViIIId for _ dIIys from dilm of s/(JIIIIlUre.
/Msed on T/lrIIr ~ Effective 9115110 02/15110 SH Vet. 5.0.124
TRANSPORTATION (B,922Ib,1911 miles)
CUSTOMER'S DECLARATION of VALUE
Basic Coverage (60 cents per pound per article) ________$
Full Value (minimum value 60,000) 1. $ 0 Deductible 560.00
2. $ 250 Deductible 424.00
3. $ 500 Deductible 355.00
lliet:8rs this shipment to be re/silSfId iIt /I Niue not exceeding 60 amts per potJIId per IIItIde. I '-11II ~ this option from those shown .bole.
--------$
5377.09
0.00
CUst:oIner Date
V8liJ6t/on Is not Ins~ It 15 /I limit 011 tile ClIrrters IIiIb/IiIJI for /tJss of or ""f11iI9fllD yrmr flOOds wille tiley /lte In Its twlrJdy MId COfIbT1I. In onJe ID Wlildllre )lOur
selection, you must sign /lbole or the shipment will be Jeleased lit /I I11iIXimum IiIIbI/ity of 6.00 times the iIdlMI-'9ht '" pounds of tile shipment.
CARTONS, PACKING 8:. UNPACKING
Containers Packing unpacking
Qty Rate Total Qty Rate Total Qty Rate
Mirror O1rton 5 10.50 52.50 5 20.80 104.00 0 5.90
Mattress Single 2 6.80 13.60 2 6.35 12.70 2 0.00 ----.
Mattress Double 4 8.35 33.40 4 6.35 25.40 4 0.00
Mattress Qn/King 1 13 .80 13.80 1 10.05 10.05 1 0.00
Gusmnteed Rate Re..-1uctiom If iIIctu.iif weight jg less tt.i!1r1 estimiEtad weight of 8,flZ2 Jf1:;., th~
per CH't {w tire difference between actual ami estimated weighi1>. Actuill packing ch~tVes tv based tlpa uarl'intee.d
container and packing rates subject to a maximum pacr.ing charge of:$ 265.45 f:Jr the number a of boxes outlined sbof'"c.
If more packing is required ill change order will be created and executed to properly prep8l'e your items fur transit:.
re=m
METHOD OF PAYMENT: COD _ PPD _ NAT'L ACcr _ CREDIT CARD
AU COO charges are to be piIid '" ash, c:ertlTted check,. travelel's check or b8nJ: dtecJ: (per liIIiff).
I have received a copy uf t) EstinH1tslJlld t1Ie Additional SeJ1I/ce$ Prir:e JJst, 2) Your Rights and ResponsibllltJef Whet! You Move Brochure, 3) Inventory of Items Valued In Excess uf $1()()
Per Pound Per Article (High VaNe InI'elltoJy) form , 4) Here's wiIlIt you JMed to know about p/lIdng /I IMJue on yt)Ur shipment befom)IDIJ move brochure.
customer X
Date
Agent X
Date
I ilClrnowledge receipt of a copy of this Order for 5'eMi't!. I request tlte IIbtwe 11IIm<<1 CIIfI'ier to fum/$l/ the -wces desrtibed In this on/er, sub~ ID the tenns IJI1d t:OIIdXIons
of the ClInieIs househokl goods b81 of lading Jssued ilt the time ClImer 11IJ:es possession uf tits $b/pment .
Customer X
Date
~J .-~
CS/ r{f)trT~ /
~/
~
Packet Page -1340-
9/27/2011 Item 16.A.10.
Ordr No.
9/15/10
..-.
S/tipf>>r Dorie Khawaja C/JnsigJIH CIIfrltr AWED VAN LlNES, INC.
410- Bdttany Ln P.O. Box 9as
AURORA, co 80046 NAPLES, R. 34112 Fort Wayne, IN 46B01-D9S8
h:847-26S-DS27 MC-1S735 DOT -076235
(630) 570-3000
0rfI AgtInt Berger Transfer 80. Sbol1lge
1515 West Fullerton Ave.
Addison, Il60101
(630\ 620-1311 (630) -620-7514
p.df q/~o LolPrD ~ Estimate
I.DMI lJnp<<k ~
. ~
Road fl3 QTY ARTICLE fl3 QTY ARTICLE fl3
1 Chair,OvrstufI'ed 25.0 1 Rug or Pld,lIIrge 10.0
1 Sofa 40,0 1 Table, Coffee 9.0 2 Table, End 5.0
1 Carton, 1.5 P80 2.0 1 Cartxln, 3.0 P80 3.0 1 Mirror an. P80 2.0
103 tt:i 659.2/b 9
KItchen
1 bend1 ~,O 6 Chair B.O
1 Table, Dining 30.0 3 MiITor ClIrton 2.0 12 ClIrton, 1.5 PBO 2.0
11 Carton, 3.0 PBO 3.0 1 Cartxln, 4.5 PBO 4,0 1 Carton, 6.0 PBO 6.D
3 Dishpaclc PBO 10.0
185 tt:i 1184/b 39
HIlIIwa,
1 Bed, King 70.0 2 Bookcase 2'1.0
1 Rug or PlId,Smafl 3.0 1 Mirror Cartx:ln 2.0 4 Carton, 1.5 PBO 2.0
7 Carton,3.0 PBO 3.0 3 Carton, 4.5 PBO ~.O 1 Mirror ctn. PBO 2..Q
6 WlII'drobe P80 10.0
226 tt:i 1446.4/b 26
2nd Bedroom
1 Bed Frame 3.0 1 Bed, King 70.0
1 Desk, small 26.0 2 Carton, 4.5 PBO 4.11 1 Dishpack PBO 10.0
2 Mattress Single 0.0 1 Mattress Qn/Klng 0.0
117 tt:i 748.8 /b 9
..-. 3rd Bedroom
1 stool 2.0 1 Bed, Double 50.0
2 Bookcase 20.0 5 Carton, 3.0 PBO 3.0 7 Carton, 4.5 P80 4.0
2 Mattress Double 0.0
145ft] 9281b 18
Laundry Room
1 totes 3.0 Chair, Boudoir 10.0
1 Sewing Machine 5.0 1 Shelving B.O Mirror Ct:rton 2.0
15 Carton,3.0 PBO 00 1 Carton, 4.5 PSO 4.0
77ft] ~~.81!z~___~_~_____. --~--------~--~- ....,-.----~.._------,_._... . 21
BiIliemenf;
1 hamper 3.D 1 cooler 3.D
4 tote ~.O 2 basket ~.O 1 Desk Chair 5.0
1 Rug or Pad,Large 10.0 1 Sofa ~D.O 1 Table, End 5.0
1 German Schral'lk 3 24.0 1 TV Console 15.0 1 TV Big Screen 50.0
17 Carton, 1.5 PBO 2.0 2 Carton, 3.0 POO 3.0 3 Carton, 4.5 PBO 4.0
1 Mirror Ctn. PBO 2.0
229 ft3 1455.61b 38
GlIl1IGe
3 planter 3.0 1 sno board 3.0
2 toolbox 4.0 1 x tree 3.0 3 Sicycle 5.0
1 Bookcase 20.0 1 Desk Chair 5.0 3 Ladder 4.0
1 Lawn mower 5.0 6 Cartx:ln, 3.0 P80 3.0 4 Carton, 4.5 PBO 4.0
114 tt:i 729.6/b 26
Gue. Room/HOUle
2 tote 4.0 3 tote 2.0
1 Bed Frame 3.0 1 Bed, Double 60.0 1 Chair, Folding 1.0
1 Desk Clair 5.0 1 1V Console 15.0 llV 20.0
10 Carton,3.0 PBO 3.0 3 Carton, 4.5 PBO 4.0 2 Mirror 00. PBO 2.0
2 Matlres$ Double 0.0
I 164 tt:i 1049.6Ib 28
Porch
4 peG 2.0 4 Chair, Metal 5.0
1 Table, End 6.0
34 ft3 217.6/b 9
Road SUbtomls 1394 ft3 892t.6/b item CDUfIt....~ 22J
~ CONTAINER SUMMARY
5 Minor OJrton 2 Mattress Single 4 M8ttress!:JclJbll! 1 Mattress Qn/Kmg 12
Packet Page -1341-
9/27/2011 Item 16.A.1 O.
34 QrtrJn, IS P80 S7 Qrtrm, 3.0 P80
6 Wardrobe PSO
24 Carton, 4.S P80
1 Qrtrm, 6.0 PBO
4 DShp8ck PSO
S MhTor Ctn. P80
131 ---.
1394 ft3
TOTAL ESTIMA TED WEIGHT. . . . . . 8922111
7DTA1ITEMCOUNT...... 223
Uvtng Room
H11llwey
Ba_t
G.rage
PordJ
*** ITEMS NOT GOING ***
1 TV
1 Dresser, Double
1 sofa
3 German Schrank 3
1 Batbt1cue
1 EnbutaInmntCntrll.8mp, Floor
1-'
CUslDmer X
Date
Agent X
Date
~
~
Packet Page -1342-
9/27/2011 Item 16.A.1 O.
".-...,
Atlas = $5290.83
~
~
Packet Page -1343-
~
AtlaS.
9/27/2011 Item 16.A.1 O.
IATLAS REGISTRATION NO.-- I
po:
Ace Relocation Systems, Inc.
2585 Technology Dr.
Elgin,lL 60124
(847) 836-5200 {847} 836-8740
Nick Santucci
ASSURED PRICE PROTECTION ESTIMATE
U.S. DOT No. 125550
ATLAS VAN LINES, INC.
1212 ST, GEORGE ROAD, P.O. BOX 509
EVANSVilLE, INDIANA 47703-0509
(800) 252-8865 / (812) 424-2222
Customer Dorie Khawaia
street Address 410 Brittany Lane
City/State/Zip Lindenhurst, IL 60046
County Lake Phone 847-406-9216
Tariff ATVL1000 Miles
Effective Date 9/13/2010 Minimum Weight
Estimate Date 9/14/2010 Estimated Weight
Consignee Dorie Khawaia
Street Address TSD
City/StatelZip Naples. Fl 34101
County Collier Phone
Pricing Option
Discount level
Storage Discount
68%
0%
Pack Dates
Load Dates
Del. Dates
9/30/2010 to 9/30/2010
9/3012010 to 913012010
10/412010 to 10/1112010
1,000
8,375
Packing Option: 0 None
Packing Detail
o Full Pack I2J Custom Pack
.~
Unpacking Option: 0 None 0 Full Unpack I2l Custom Unpack
Packing
Pack Per Unit
Count Price
Total
Price
Obi Bed
KlQ Bed
Mirror
2 $14.09 $28.17
4 $22.79 $91.15
5 $28.61 $143.06
Total Estlmated Unpacking Charges:
Total Estimated Packing Charges:
Additional Information:
I
$262.38
Federal regulations requi~ that we provide you with a reallOnably
accurate estimate ofcollfs. Since ne~heryou norws are aware of
all possible conditions at destination, Itlese are the charges that will
be added to the lolal charges should these services be required. If
these. services must be provided due to impracticable operations,
8$ defined In Alias' tariff. charges for these services (subject to
certain limits) wiD be due al delivery. See Nole below for more
Information.
Packing Service:
Unpacking Service:
Transportation (Line haul):
Other.
Fuel Surcharge:
Transportation Services:
Additional Services:
Additional Services:
Net Charoe
insurance Surcharge:
Origin Service Charge:
Destination Service Charge:
Accessorial Service (see attached):
Weia hi
Total Posslb e AOOl11Onal Destination Service
C:--a.......e:;
t~ON-8INDING Valuation Charges:
CHARGES
t"uil Value Protection:
>----.
NOTE: Unoer Uie ;-\S$'Jrec Pri::e Protecti,n [.i\PP) ]-)rogram, the A:"P i~ldll;harU8E ri,P
compared to tho tariff charges for a:;tua! wei~~t and services and tile lower of ir.e t",'O
amour,ts will be tre total Charges dUe. I ms el;iUma1e IS based on tne artlc!es and services
listed. The APP total c-harge& shawn for this shipment wil! appjy and wfll be binding on
Atlas un~ess additional artlcleB ere added or additional eervice5 are reQue51ed or proviaed.
If 60, additional charges (based on the talin rates In e1'fed on the date of this estimate) wiH
be added to the APP total. In addition to aU other Charges due at tJme of c1ehvery, all
Charges for floditional &ervice5 not Included in thl6 esbmate reque&ted after the bifl of
lading is execut~d will be due, a6 wilt charges for additional services required due to
impraoticable aperationB, as deHned in Atlas' tariff (Which include destlnation shuttle
s~rvice), subject to a maximum of 15'.4 of all ather charge.. dUIIl at dehvery. You wiH.be
bllied fm any balanoe in 4!)(CEBf:l of the 15%. after delivery and you are oblrgatea to pay the
balance. ThIS estimate is Ylllid for 60 days from date of customer'. signature All charges
to be paid In u.s. runds by cash; postal money order; C8$hier 's or approved personal
cheok pilya~ to Atl~ Van Unes; American Expre&5, Discover, MasterCard or Vise
cnarge cards.
X
Atlas Agent
Agent Representative
Agent Code No.
Code No.
RATING & DISTRIBUTION
CUSTOMER
i~~tJl"'!) V<:r~,ior; G,:::Ij.~. ,~,'27;2CJ~O
SCAN AS ESTIMATE OFS DOC TYPE
Packet Page -1344-
'---"'"
UnPacking
Unpack I Per Unit
Count Price
Weinht
8375
8375
8375
8375
8375
8375
8375
Total
Price
2
4
o
$3.12 $6.25
$5.12 $20.49
$6.01 $0.00
$26.74
Net Chames
$262.38
$26.74
$3,555,66
Total Binding Charges: 8375
Lump Sum $ $50.300.00 or !ii per pcund WeilJht
Deduc'Jble [2J NoneD $250 0 $500 8375 I
SlT Valuation:! 0 I
Advanced Charges:! 1
Storzge.!n-Transit Service:1 0 ! $0.00 'f,
1st Day Storage 0 $0.00 It.J
Additional days _ (days):1 0 I $0.00 I\Y\~ t
Cartage to/frcm Warehouse: 0 $0.00 /) ~'1
Fuel Surcharge: 0 $0.00 ~
Insurance Surcharge' 0 $0.00 i Q~~
Miscellaneous Charges: ~o:ns.... . \"" t:J~
Total Non-Binding Charges: 0 I' $0.00 ""~
Total Cha!ges $5,290.83 .
I acknowledge recBlpt of thiS estimate and the Ready tl Move brochura. . ~ 'l)(f..
Customer SIgnature " \:)- \
""~ vb J)
~,- ~~:
cJfj \
$248.90
$142.23
$223.51
$ill 0
/ $744.32 ')
~ .-/
$5,290.84
Net Chames
$0.00
SO.OO
~
9/201201 0
.-...
~
~
,-..
9/27/2011 Item 16.A.10.
~
Atlas.
IATLAS REGISTRATION NO.
U.S. DOT No. 125550
ATLAS VAN LINES,INC.
1212 ST. GEORGE ROAD, P.O. BOX 509
EVANSVILLE, INDIANA 47703-0509
(800) 252-8885 I (812) 424-2222
NOTE: The charges shown below are not in addition to the Total Charge. This section is a broken out description of the Accessorial Service and
Mh.celianeous Charges shown on the first page,
Accessorial Detail
Item
Charge
$744.32
Org, Shuttle
Listed below are the Valuation Options that are offered and the total price for the move with each option.
Full Value Protection (FVP): $50,300.00
Deductible
FVP
FVP
FVP
$.60
Charge Total
500.00
Packet Page -1345-
9/27/2011 Item 16.A.10.
ORDER. FOR. SERVICE GUARANTEED AND SINDING PRICE PLEDGE
9/151JO Order;
pagel
.-...
Sl1fJper Done I<hawaja ConsJpfltll1 CIn1u.,!~ED;.;Y.MI:UN5;&lN~'
41 D- Brittany Ln ~.\i~'~ "P".o:1iCiX 988
AURORA, CO 80040 NAPLES, FL 34112 Fort Wayne, IN '16801-0968
h:847-265'{)527 MC-15735 DOT -076235
(630) 570-3000
Offg Agent Berger Transfer & Storage
1515 west Fullerton Ave.
Addison, IL 60101
(630) 620-1311 (630) -620-751
P<<k l>I1IIvery EstImate
lDlJd lJf/PiIck ~
7lrii GtlARANTEED AND BINDING PII1CE PlEDGE is bMsd ()fI BIticMs 1m! S6MCtor/istsd.In 1Irl1111<1111t lJnltnown.rddIliDnaJ SllNJcu Ire rtJIllJired iI> effect delivery, these costs wID be In
.ddllJon iI> IfuJ IJf110lJIft sIiII/ed below and wUf be bfIfed iI> /he shipper 30 ri8}IS lifter delivery. SudI RIl'Ibls and 6Pf)l/albIe r:h1119fJS wID be hlSl!d l/PfJI1/iM tariff mIl1s In effect on /he dale of
t1Jis estimate. This estimate /$ WJIid for _ dll~ from date of s/gn8turs.
Bi1seti on Tllrtff m:;. ~ 9/15/10 02/15/10 SM Ye. S.O,l2f
TRANSPORTATION (8,922Ib, 1911 miles)
CUSTOMER'S DECLARATION orVALUE
Basic Coverage (60 cent~ per pound per article) ________$
Full Value (minimum value 60,000) 1. $ 0 Deductible 560.00
2. $ 250 Deductible 424.00
3. $ 500 Deductible 355.00
I tIediue t1Jis shipment trJ be reie8;ed At 11 vaJul! Mt exceeding 60 Cl!Jlf$ ~r pound per I1ftk:le. 1lrBve sl!Jecteil tIJJs option from thqse shown IlboV<!.
--------$
53'77.09
0.00
CustrJmer Date
VIlIuiKIon " Rot Insunnce. It Is 11 limit on 11m r:lrrier's !li1tJ/ffty for loss of or dIm/Ige 10 your goods wilKe ti1ey ~ in Its cllStcdy i1m1 amtTol. In CJrritJr /rl1ltJiU1o! /'Pur
seJection, you Inust sJpn IbovI1 or 1M shJpmant wID be I81t>>SfId at I muimlJm 116b8Jty of 6.00 times the Ictwtl weight In pounds of thl! shipment.
CARTONS, PACKING 1ft UNPACKING
Containers
Rate Total
10.50 52.50
6.80 13.60
8.35 33.40
13.80 13.80
Mirror Clirton
Mattress Single
Mattress Double
Mattress Qll/King
Qty
5
2
4
1
Qty
'5
2
4
1
Packing
Rate
20.80
6.35
6.35
10.05
Total
104.00
12.70
25.40
10.05
Qty
o
2
4
1
Unpacking
Rate Total
5.90 0.00
0.00 0.00
0.00 0.00
0.00 0.00
--------$
~
265.45
MISCELLANEOUS SERVICES
Add'] Services Orig
....-------.$
125.00
IOIlJ....GUARANTr::ED PI'!.ICE .. $ 5 767 !;4
Charg"" followed by an ,,*. dn! no, bound.
Guaranteed RJ[e Reduction; If act:;af weight is less: than estimated weight of 8, ~22Ibs., me GPP pdce wi/! be reduced br ~:::rf'.O'7
per cwt for the difference bef:rlJfeen actuaf ana' estimated weights. Actual pecking charges to be besed upon gUi!ri/:7teed
container i!1!1d packing rates subject to a maximum packing charge of $ 265.45 for the number af1d type of iwxm; outlined above.
If more pacldng ;5 required iJ change order will be created and executed to properly prepare your items for transit.
IR_we
METHOD OF PAYMENT: COD PPD NAT'L ACCT CREDIT CARD
AU coo charges are to be paid In cash, certtrJed~1(, travelers check or l/6nk check (per mrtff).
1 have received il copy of 1) Eslimi1t8l1nd the Addltionlll SeJlIkes Price lJIt, :I) Your Rights and Re;fJMsiblllties WIlen You Move BrochuM, J) lhventory of Items Valued In E.xce$S of $100
Per Pound Per Artkle (High l-lthA9 I11Vt!f1iI>ry) farm . 4) Here ~ wIr;1t Yl'/I nef!d /rl know aDaut pklcing ;1 value on Yl'/Ir shiPment /Jefc>M YOII moVl!! brochure.
Customer X
Date
Agent X
Ddte
I ilCknowle:dge rerept of;1 ropy of this Orrier for SM'ft:e. I request the a!Jwe Ili1med Cilrrler to flJmlsh tile serrIaJS desc1fber! In this Qrrier, SIIbject /rl the telTT1S and t:OI7d/tfom;
of tile alrtiers IIot=hold gocds bJII of 1aO"'!l issued It lire time cllrrler /:likes possess.ltJn of this shipment.
Customer X
Date
~
Packet Page -1346-
,-.....
~
~
l
UUH.U LL,ulll;; L-UlllUlUIUli<1UOnS Lenter
l"'L~_~__ 1 rn
9/27/2011 Item 16.A.1 O.
SmartZone Communications Center
dorie.k@comcast.ne'
1: Font size:
~.- ".... --. ._~._._- "'M_ _. H~_ ,. _.. __""__'n_. n. ......... - .--.. _.n ~_. .._. ...._..__...._ "'. ~_.. _......., ~. _n, _...n.._.... _~ n... "~' _ ."_ ~H __.__ ........._.._..__... ._~ ~._ ,..._._,. ____.._~...._,._.._,._._.__.. H..._.._.._....H_
Auto Shipping Quote #416S0S"QY
.-...---.-...-. ...........-.. ."., --.- - '--'--'-'. - ...--..-. Y---...-. "- _... .... _~ ~_._ ... ......_ .. __. _.. ,.n '_'"n" _'_"_'._... _.....K... __... .__ _",_____.
From: Ryan <ryan@aacrossusa.com>
Subject: Auto Shipping Quote #4i6505-QY
Sun Sep 12 20104:13:52 PM
To : dcrie k: <dorie.k@c:cmcast.net>
Refer to Quote # 416S05-QY
01V
o
Across USA Auto Transport
Family Owned and Operated Since 1991
BBB ACCP.EDITED BUSINESS
A+ Rated
Ii.. : t ''V;'-w-vv. iicksunville.bbb.or 'COrnmoiire -rt.html?com-fd=1216S
www.aacrossusa.com
Vehiclei I
Year ake Model
i:~~~..::, IL .'''.Oe!;.., to, ".'5~'l3 ,.,
(Open Carrier Price: $500
/
-,,-, - -. n, ,- u....., ". ,. ,. -.. - - ,..- -1--' - - '-/' ["" I - "I ,. j'lL _I." ..' '1 ',- I _.",.", v-" If' I' '0 r 1 I 'C;,-",~, , I ,. " "., I.
I U"~KUII U!l~ ~CLlIl::: III or, lU pWU::: 0" U uel ~l~",;.rh r,,_,.U}~"'\\--,'lU"II.rl,li~"'.OjU"'Z"':'_'i::.~!:U1~':I"'i2
~::,::m' eo" coodi"" oce ",'nw) /
~~:~~:u for YO~~:i~I:~~ i;h:{~~~~ioT;::~i~~i;r~o:n~~~n~.i~~~:~:Y ~:~; :;:~!~o%~~~~:~~~~~~i11
uffer low fates. HowtlveT,'lfyou are Inter..stea In prompt, reliable SC:iYice wltl1 quality traniiputLers I can cettainly
help. I quote rates that I know from my experience can move you vehicle without delay. Any additional money that I
charge goes to the carrier.(not to our company.) That is how we can pay for quality carriers and keep our excellent
ratin"s with Better Business Bureau (A+). We give the best service in the business and our customers are happy! If
you have any questions please call 1-800-243-0066. Just Bsk forRvsn. You can also email me at
!'V!!n@a8c!"OsS!!S!!!.oom Our rate to ship your 2003 BMW 3251 in a!! Open car carrier is $600. This price includes door
to door service and full insurance with zero deductible. (Hawaii shipping information can be found below). We are a
film it,. owned and operabeid trahsport brokeiiiige. Simply put, Wtl find a fellahi.;, tnmapot-er thai: win RiOV';' your
vehicle In an efficient manner. We are in our 19th year in business and have continued to grow each year. A large part
of OUt business is from referrals and repeat customers. We must be doing something right! Before you decide on
which transporter to U5e, please read the folloWing:
Old you know that over 14,000 vehicles l!!!'e past the!r scheduled pick update risht !'!ow? The reason is tbat the rates
are not high enough to attract Dny carrier to move them. Don't be fooled by false claims, misleading gas card
rewards, or ex1:remely low rates. You wiii be waiting your time! Many brokei'$ move Ie_ than 50% ofthl!lir oi'dei'5.
We move over 95% of our orders. There ate a lot of aood auto transport companies, but there are also a lot of bad
ones. Make sure you select a good one. We are members of the Better Business Bureau. Please check with them
http://sz0117.ev.mail,comcast.netlzimbrat1i1printmessage? ld=257221 &xim=l
9/12/2010
Packet Page -1347-
SmarlZunt: Communi<.;ali~ns Ct:nlt:r
9/27/2011 Item 16.A.1 O.
>Cuswmer '-lame:
~
>
>Pic:k Up Car From:
>Name:
>Address:
>City, State, Zip: c.IJesney Shores, I!. 6!J046
>Home Phone:
>Business Phone:
>Ce/I Phune:
>Deliver Car To:
>Nllme:
>Addrt1S.S:
>City, State, Zip: Nap/f:s, FL 34.101
.>Ho."11e Phone:
~
>Business Phone:
>Cell Phone:
;>C;)r Des'C:i'iptl:Jni
>Hegistered O'.;/'ner:
>Car Make/Modef/Yeer:
Year Make Model
2003 BMW 3251
>Lic Plate Number/State:
> V.I.N.(requ;red for Hawaii transport):
>Color:
Cond.lt!!Jn of vehicle:
Operates on it's own power_
Does not operate on it's own power(must roll, brake and steerJ_
>C,'iaz-ges:
> Total Due $600
Less Deposit $175
~
http://szOI17.ev.mail.comcast.netlzimbra/h/prilltmessage? id=257221 &xim=1
9/12/2010
Packet Page -1348-
.'
n;.rA~+ P'V"""'Qrl.~~ ^ n+.n 'T'r...n.u....n"...... (').....n+A Q'I'I...............t')",
.............. ......""'" .&.,.;'~....,tJ.L.........hJ ... )..............r L.Lw..&..L""'j;""'.a"1. "'( WV"'_ 1ljWLJ..u.:L.........]
9/27/2011 Item 16.A.10.
~
Abcul Direct Expreos Auto Transport
Vehlolm; lor Auto Transport
About Car Shippl~ InduatIy
AUlll Traniporl Vehicle inde.
ALtomcbUe ManJ8Ctur.",
.~ ..... ;;','
.' ",..:. .~",~,,:<;, .~~~~~'~"
Home
Abottt In
C~tthi
S~
T el'TM
f'AQ
Slog'
Testimonials
NewaVtdllO
Quote Summary
Snipping Frain:
Shipping To:
T~'pE' of Vehicle;
Operating Condition:
Type of Trailer:
Click
I.oke Villa. Illinois
Naples, Florida
BMYV a 525
Door 10 Door Service.
AIlO'N tyPically one to several day's to pick up your Ijeh;c1e Your vehicle is fully insured while on the tfar.sport car!ier. 'lIVe require a deposit of S150 and lhe
btllance cjue to tne- drMer upon delivery,
~
Have questions?
1-800-600-3750
rat_Ed
r!8H RMI.O~ ....
~!oRep
Goog!e Site StatG - ~
/','-"7,_,~ O.~.
'/ C)O .\ C/UL~
[; X eEN--'
(u/ -" ~
~DJ
Copy,igh,C 2010, Aut<>Tran.portDirectcom
.--....
Ucanse # Me 479342
Auto Transporl CCfl'pan~i :nslilnt A1.:to Transpo,t Q:Jole Auto Transport.& Auto Shlpp:ng Ser',icos
~\lItC Tl"a'l~pnr: COf)tiH;t Us Teans ";11(,; Fi\(J Vehicle FAO Orolln0 Partner!'; Site rJj::lt'l pr,VQCv "J~ttco
Vehicles Auto ':rans~Cirt Car Shippi'lg ALoIo Shipper Vehiclo Manllfar.tu~~r '
https:l/\\n,,\"".autotransportdirect.co:rrJquotel, ~("'t"\
Packet Page -1349-
12/2/2010
pmail - Price to ship your 525 to Naples
9/27/2011 Item 16.A.1 O.
.,
G~ ...il
,,-..,
n_...:_ V'I._.._:_ ......_..:_1. t,L...............:...i'Ja\___11 ___.....
..,...,. IV r'.JRWT....JQ -"'VI'IIiiiiiPn..nIIU"'A.Ja~"'G"".V""""'"
I:? <. ;" I~ \,~;:k'
Price to shio YOUr 525 to Naoles
, . rill .
1 message
Rite Way Auto Transport LLC - Leron Gibbs c::Leron@ritewayautotransport.com;>
Tu: "uuriek.khCIWaja@gmaii.curnu <dUfiek.khawaja@grYlaii.cori'l>
FrI, Dee 3,2010 at
10:39 AM
..0;.;.<>::::,,;.1.;
..,...-.;':d~." .;.,;;,<..~~....c..f./.h .""J .
r "-~)i7
TIi./J.NS}.F._t~'!!;~t~
..;{,.t:; V J c:. l~V-;:::;
vV /O~
1~So-t:~t )( 0 u
'c)'X 00
~
Dear Dorie Khawaja,
Th~nL...- \.Jf""\.! I fr..r "^. fr"' inf~:;~r""'\("Io.f. ;n ~;"';r"\~;1"".1"V \t.........~ rt'"' \r~>hi.-.~c. ~..l~fl"'\. Qrr-c \fV'::.i\! t\ U'l"fl Tr:::<rl'~r"~r\nl"
IIIUII', J"-'U ,""'"( JVYI 1!'t.\"Jtv-vL IJ.I VII_l-'t-"ill:1 YVfo...tl V.......,IIVI_ V\'ILJI ~';.~..._ V ...........y,rf" ..... f L...; '-"t~)Vi
LLC {if rf nn:;:d ic~ './n! Jr r,:~mnLoi'A c:.~f~~f~rHr"1n
. - -.. .;;;--..- J --.. --"','--- ---.-.---.-...
The price.,{rfih1p~~~it:~'~-~fJiW 525 on Open carrier from Lake Villa, IL to
Naples1(FL is $-845. -l )
Your qUO~beristlOO~ZR. Foryour convenience, you can piace your
_~.J_~ __1:__ . ._:__ "L._ A:_II_...:__ ___. .~_ 1:_1,.
VIU~1 VIIIIlI~ U~III~ 1I1~ IUlluvv"r~ ;::,c....urc 11111\..
https:/Iwww.itracker.com/view quote.php?qid=cmIOZXdheTE4MDA10FpS
We are here to answer your questions from 9:30am to 7:00pm. We look forward
to hearing from you.
". - - - . - I
'::>HI<.;~r~IY,
{ffr~?
-
Leron Gibbs
Rite Wav Auto Transoort lLC
, ,
.-....
https://mai!. google. comlmail/?ui=2&ik=826~Q 17 (,,7 p.~vlPw=ntksearch=inbox&th= 12cadl... 12/6/2010
Packet Page -1350-
9/27/2011 Item 16.A.1 O.
~
c:::;'c;tff:-y C:A::n...I.'M.-ty
- ......-
"
March 12, 2010
Mr. Tony Khawaja
410 Brittany Lane
Lindenhurst, illinois 60046
VIA E-mail
Dear Mr. Khawaja:
~
Collier County Government is pleased to confirm our cOntingent offer of employment as
Engineer of Traffic Operations in the Transportation Division of Collier County Government.
This offer is contingent upon the successful completion of the background checks and drug
screemng.
Your compensation package will include an annual salary of $1 04,000.00; the use of a county
vehicle, relocation expense assistance equal to one month's salary, and the standard fringe
benefit plan for regular full time employees.
As previously discussed, you will have twenty-four (24) months to obtain your Florida PE. and
will be reimbursed for the cost of the classes associated with obtaining such. Failure to obtain
the Florida P.E. within the allotted time period could result in termination of employment.
If you decide to accept our offer, please send a written letter of acceptance including an
anticipated commencement date no later than March 15,2010,
I have enclosed a copy of our relocation assistance policy for your review and a "Request for
Authorization of Relocation Expenses" form that needs to be completed by you and sent back to
me as soon as possible.
I look forward to hearing from you soon. If you have any questions, please call me at (239) 252-
8768.
Dianne Janson-Moore
Human Resources Generalist
.---...
C: Norman Feder, Transportation Division Administrator
Jay Ahmad, Director, TEeM
Packet Page -1351-