Okaloosa County BOCC — March 18, 2014 — Airgas Invoice-Dec 2013

Okaloosa County Clerk of the Circuit Court »"*PLEASE RETURN YELLOW FORM Ni e mo WITH THE RESUBMITTED CONTRACT*** To: EMS From: Jodi K Gates, Financial Services Manager Date; 2/13/14 Re: —_ Return Payment Request Notification REFERENCE MATERIAL: ¢ The County’s Policy and Procedure Manual and forms are available online at http://www.co.okaloosa.fl.us/Purchasing Documents.html. « All contracts/leases can be viewed at http://www2.co.okaloosa.fl.us/contracts/defaultpage.aspx. THE FOLLOWING PA YMENT REQUEST IS BEING RETURN DUE TO ONE OR MORE OF THE FOLLOWING REASONS: C] Pricing/rates are not contracted values. Confirm. (1 Invoiced items not covered under contract. 1 Invoice removed from contract payment form for the following reason: Invoice #: Invoice Date: Invoice Amount Other After the fact purchase order-Requested dates are not p/o approval date weeNOTE: CORRECTIONS RESULTING IN ANY CHANGE MADE TO A CONTRACT PAYMENT FORM OR SUPPORTING DOCUMENTATION WILL NEED TO BE RESUBMITTED THROUGH THE NORMAL APPROVAL PROCESS**** Please review and make necessary corrections and resubmit for payment. If you have any questions, contact Olivia Tanner at x3414 or Jodi Gates at x3413. Thank you. Logged REV 1.4.13 = Airgas USA, LLC Airgas PO Box 9249 . Marietta, GA 30065-2249 ATTN ACCOUNTS PAYABLE OKALOOSA CO EMS i NICEVILLE FL 32578-1343 oone2e Airgas. www.airgas.com Airgas USN fhe Airgas. ce: ct Marietta, aN 30065-2249 AIRGAS USA, LLC 922 SKIPPER AVE FORT WALTON BEACH FL 32547-7315 850-862-5214 SOLD BY BiLTO }=9ATTN ACCOUNTS PAYABLE OKALOOSA CO EMS 90 COLLEGE BLVD E NICEVILLE FL 32578-1343 000628 TO ENSURE PROPER CREDIT, Peet Sern THE nea MT wi YOUR REMITTANCE. FOR SEES a YOUR ACCOUNT PLEASE oe 800-727-0693 CONSOLIDATED INVOICE _4\ FOR ADDRESS CORRECTIONS, PLEASE -FAX NOTICE TO: 770-590-6112 INVOICE DATE PAYER INVOICE NO. DUE DATE PAY THIS AMOUNT 01/06/2014, 1291991 ff 9500156047 ff 01/31/2014 J SEE SUMMARY PAGE PLEASE MARK YOUR METHOD OF PAYMENT CI Check LJ credit cara Please visit www.airgas.com/onlinebillpay or complete the information on the reverse side of this form. PLEASE MAKE CHECKS PAYABLE AND REMIT TO: Det Yeftee peat tee et elas tlive AIRGAS USA, LLC PO BOX 532609 ATLANTA GA 30353-2609 42919711950015604 70000381948 [SORDER DATE 120008 9022262855 00000000 NET 30 1202/2013 | i CRESTVIEW EMS 048 1020614299 03 OX USPDA $048 13 CL 13013 6.33 CL 82.29 N (Vol: 195 FT3) OXYGEN USP DA MED CGA 870 CRESTVIEW EMS $048 1020614299 03 OX USP125 8048 1 CL 1 1 14.04 CL 14.04 N (Vol: 127 FT3) OXYGEN USP 125 Sale subtotal: 96.33 Delivery Flat Fee 13.50 109,83 SHIP TO: 1288928 $ Airgas. www.airgas.com CHRISTOPHER D TANNER, MD Airgas USA, LLC 90 COLLEGE BLVD E PO Box 9249 Marietta, GA 30065-2249 REV 4.1.1 Set" 001000 NICEVILLE FL 32578-1343 FOR WIRE TRANSFER PAYMENTS AIRGAS USA, LLC Acct No. 8606074182 PNC Bank, ABA No 031000053 Page 1 of 42 CONSOLIDATED INVOICE § FOR ADDRESS CORRECTIONS, PLEASE FAX NOTICE TO: 770-590-6112 Airgas L USA, pie INVOICE DATE PAYER INVOICE NO, DUE DATE PAY THIS AMOUNT Alrgas | Fro Box 8249 as 0749 Ci ot/08/2014] 1201991 9500156047 | 01/31/2014 | SEE SUMMARY PAGE PLEASE MARK YOUR METHOD OF PAYMENT soppy AIRGAS USA, LLC 1 check 922 SKIPPER AVE F] creait card FORT WALTON BEACH FL. 32547-7315 reat Gar 850-862-5214 Please visit www.airgas.com/onlinebillpay or complete the information on the reverse side of this form. PLEASE MAKE CHECKS PAYABLE AND REMIT TO: TAT ATES PLES PRLS TL Fe Per] | | PT euto ATTN ACCOUNTS PAYABLE PVA fy bel [tia Uc bi TU ro OKALOOSA CO EMS AIRGAS USA, LLC 90 COLLEGE BLVD E PO BOX 532609 é NICEVILLE FL 32578-1343 ATLANTA GA 30353-2609 000628 42919911550015604700003181944 TO a PROrER CREDIT, PLEASE RETURN THE UPPER CRN HE YOUR REMITTANCE. FOR QUESTIONS ON. yee ACCOUNT PLEASE CALL: 800-727-0693. = ESE RMS: RUBRDA TEE ecco 1201081 1288928 5022262066 | _NET 30 12/03/2013 ocean city f/d : $048 1020703422 02 OX USPDA S048 2 CL 2 2 6.33 CL 12.66 N (Vol: 30 FT3) OXYGEN USP DA MED CGA 870 Sale subtotal: 12.66 SHIP TO: 1288928 Airgas OKALOOSA COUNTY EMS www.airgas.com CHRISTOPHER D TANNER, MD 9 90 COLLEGE BLVD E AIRGAS USA, LLC Airgas USA, LLC Acct No. 8606074182 PO Box $249 NICEVILLE FL 32678-1343 PNC Bank, ABA No 031000053 Marietta, GA 30065-2249 REV 1.1.13 SFL-001000 Page 2 of 42 CONSOLIDATED INVOICE FOR ADDRESS CORRECTIONS, PLEASE FAX NOTICE TO: 770-590-6112 Alrgas | USM toad INVOICE DATE PAYER INVOICE NO, DUE DATE PAY THIS AMOUNT Airgas. : Mari Bae 30068-2249 Cipovvos2014§ 1291991} 9500156047 f 01/31/2014 I SEE SUMMARY PAGE . PLEASE MARK YOUR METHOD OF PAYMENT soLpBy AIRGAS USA, LLC [J check 922 SKIPPER AVE FORT WALTON BEACH FL 32547-7315 L] Credit Card 850-862-5214 Please visit www.airgas.com/onlinebillpay or complete the information on the reverse side of this form. PLEASE MAKE CHECKS PAYABLE AND REMIT TO: TeaDpafbaa] ped bon] ply Map pel fal fffan peed pe sto ATTN ACCOUNTS PAYABLE Theis Oa Li Cte Tha la EL OKALOOSA CO EMS AIRGAS USA, LLC 90 COLLEGE BLVD E PO BOX 532609 2 NICEVILLE FL 32578-1343 ATLANTA GA 30353-2609 000628 42945913450015604700003181948 ESSEX. ROAD S048 1020614471 03 OX USPDA S048 8 CL 8 8 6.33 CL 50.64 N (Vol: 120 FT3) OXYGEN USP DA MED CGA 870 ESSEX ROAD $048 1020614471 03 OX USP125 S048 2 CL 2 2 14.04 CL 28.08 N (Vol: 254 FT3) OXYGEN USP 125 Sale subtotal: 78.72 Delivery Flat Fee 13,50 SHIP TO: 1288928 a $ 92.22 Airgas OKALOOSA COUNTY EMS www.airgas.com CHRISTOPHER D TANNER, MD nega utc TOO ac pet No, S6807402 PO Box 9249 ° PNG Bank, ABA No 031000053 Marietta, GA 30065-2249 REV 1.1.13 SEL-001000 Page 3 of 42 CONSOLIDATED INVOICE FOR ADDRESS CORRECTIONS, PLEASE FAX NOTICE TO: 770-590-6112 . - ‘Airgas USN gic INVOICE DATE PAYER INVOICE NO. DUE DATE PAY THIS AMOUNT Airgas. eee 828° 0065-2249 C1M§01/06/2014F 1291991 §] 9500156047 9 01/31/2014 f SEE SUMMARY PAGE ff. PLEASE MARK YOUR METHOD OF PAYMENT soLpBpy AIRGAS USA, LLC 922 SKIPPER AVE e ae ard FORT WALTON BEACH FL 32547-7315 reat var 850-862-5214 Please visit www.airgas.com/onlinebillpay or complete the information on the reverse side of this form. PLEASE MAKE CHECKS PAYABLE AND REMIT TO: MoU faflon] poland Upete Ede eetPel [A cop TE pea pa pepeadf ppoayl BLLTO “ ATTN ACCOUNTS PAYABLE uo Ao eae ae bet Pe EET bo OKALOOSA CO EMS AIRGAS USA, LLC Fat 90 COLLEGE BLVD E ; PO BOX 532609 ; NICEVILLE FL 32578-1343 ATLANTA GA 30353-2609 000628 2291595315950015604700003181948 ME / FD $048 1020747612 03 OX USPDA S048 4 CL 4 4 6.33 Ch 25.32 N (Vol; 60 FT3) OXYGEN USP DA MED CGA 870 Sale subtotal: 25.32 Delivery Flat Fee 13.50 38.82 SHIP TO: 1288928 $38.8 Airgas OKALOOSA COUNTY EMS . www.airgas.com CHRISTOPHER D TANNER, MD nas Ugh Ac Seat SE Ea fete are PO Box 9249 . PNC Bank, ABA No 031000053 Marietta, GA 30065-2249 REV 1.1.13 SEL- 901000 Page 4 of 42 Airgas Ue the Alrgas. (2%: Marietta, Sh 30065-2249 soipey AIRGAS USA, LLC 922 SKIPPER AVE FORT WALTON BEACH FL 32547-7315 850-862-5214 Biito ATTN ACCOUNTS PAYABLE _. OKALOOSA CO EMS se 90 COLLEGE BLVD E te NICEVILLE FL 32578-1343 000628 FD FOR ADDRESS CORRECTIONS, PLEASE FAX NOTICE TO: 770-590-6112 INVOIGE DATE PAYER INVOICE NO. DUE DATE PAY THIS AMOUNT 01/06/2014, 1291991 § 9500156047 ff 01/31/2014 J SEE SUMMARY PAGE CONSOLIDATED INVOICE PLEASE MARK YOUR METHOD OF PAYMENT O Check . C1 Credit Card Please visit www.airgas.com/ontinebillpay or complete the information on the reverse side of this form. PLEASE MAKE CHECKS PAYABLE AND REMIT TO: AIRGAS USA, LLC PO BOX 532609 ATLANTA GA 30353-2609 42919911950045604 700003181948 $048 1020614478 03 OX USPDA S048 2 CL 2 2 6.33 cL 12.66 N (Vol: 30 FT3) OXYGEN USP DA MED CGA 870 Sale subtotal: 12.66 Delivery Flat Fee 13.50 26.16 SHIP TO: 1288928 $ Airgas. OKALOOSA COUNTY EMS www.airgas.com CHRISTOPHER D TANNER, MD 90 COLLEGE BLVD E NICEVILLE FL 32578-1343 Airgas USA, LLC PO Box 9249 Marietta, GA 30065-2249 REV 1.1.19 SEE 001000 FOR WIRE TRANSFER PAYMENTS AIRGAS USA, LLC Acct No. 8606074182 PNC Bank, ABA No 031000053 Page 5 of 42 CONSOLIDATED INVOICE FOR ADDRESS CORRECTIONS, PLEASE FAX NOTICE TO: 770-590-6112 Airgas US fre INVOICE DATE PAYER INVOICE NO. DUE DATE PAY THIS AMOUNT Airgas. Marie, Ge 2 sooes-2049 C1 01/06/2014] 1291991 | 9500156047 | 01/31/2014 | SEE SUMMARY PAGE PLEASE MARK YOUR METHOD OF PAYMENT sotpsy AIRGAS USA, LLC : | Check 922 SKIPPER AVE FORT WALTON BEACH FL 32547-7315 [_] Credit cara 850-862-5214 Please visit www.airgas.com/onlinebillpay or complete the information on the reverse side of this form. PLEASE MAKE CHECKS PAYABLE AND REMIT TO: WalfaMeafpsMlead aly ale [Heft feag per pepe fppoagl BLLTO "ATTN ACCOUNTS PAYABLE TMs be Ee FT ce EYER vg MEAS HScAs Usa tc es PO BOX 532609 Ee NICEVILLE FL 32578-1343 ATLANTA GA 30353-2609 000628 1253591195001 5604 700003161948 To ae pone CREDIT, PLEASE RETURN THE UPPER EGCG wie YOUR REMITTANCE, FOR QUESTIONS ON YOUR ACCOUNT PLEASE eae ae 121 0693 fc ay g EERM 1201801 120028 fsozz337962 12042013 | 6 _| NICEVILLE EMS S048 1020614477 03 OX USPDA S048 9 CL 9 9 6.33 CL 56.97 N (Vol: 135 FT3) OXYGEN USP DA MED CGA 870 NICEVILLE EMS ‘ $048 1020614477 03 OX USP125 S048 1 CL 1 1 14.04 CL 14.04 N . (Vol; 127 FT3) OXYGEN USP 125 Sale subtotal: 71.01 Delivery Flat Fee : 13.50 SHIP TO: 1288928 Airgas. OKALOOSA COUNTY EMS www.airgas.com CHRISTOPHER D TANNER, MD Airgas USA, LLC 80 COLLEGE BLVD E Ast No, 8600074182 PO Box 9249 ICEVILLE PNC Bank, ABA No 031000053 Marietta, GA 30065-2249 REV 1.1.13 SE+-001000 Page 6 of 42 Aligas USM fhe 'O Box 924! Marietta, on 30065-2249 Airgas. ; ct INVOICE DATE 01/06/2014 FOR ADDRESS CORRECTIONS, PLEASE FAX NOTICE TO: 770-590-6112 PLEASE MARK YOUR METHOD OF PAYMENT CONSOLIDATED INVOICE PAYER INVOICE NO. DUE DATE PAY THIS AMOUNT 1291991 § 9500156047 § 01/31/2014 | SEE SUMMARY PAGE so.pBy AIRGAS USA, LLC 922 SKIPPER AVE H Cet ard FORT WALTON BEACH FL 32547-7315 real war 850-862-5214 Please visit www.airgas.com/onlinebillpay or complete the information on the reverse side of this form. PLEASE MAKE CHECKS PAYABLE AND REMIT TO: WU UfeP eo] geD Dae fy phy chap dad pel fag f [Jac apse] ppp euuto ATTN ACCOUNTS PAYABLE They Oo bid Cha TA TUE RR a 0b OKALOOSA CO EMS 90 COLLEGE BLVD E NICEVILLE FL 32578-1343 000628 AIRGAS USA, LLC PO BOX 532609 ATLANTA GA 30353-2609 12919941950015604 700003181948 ORDER-DATE 201001 ‘20029 3022304010 | 00000000 NET 30 12/05/2013 ro? DESTIN EMS $048 1020610327 03 OX USPDA $048 3 CL 3 3 6.33 CL 18.99 N (Vol: 45 FT3) OXYGEN USP DA MED CGA 870 DESTIN EMS S048 1020610327 03 OX USP125 S048 2 CL 2 2 14.04 Ch 28.08 N (Vol: 254 FT3) OXYGEN USP 125 Sale subtotal: 47,07 Delivery Flat Fee 13.50 60.57 SHIP TO: 1288928 = : 8 Ai OKALOOSA COUNTY EMS gas. www.airgas.com CHRISTOPHER D TANNER, MD 90 COLLEGE BLVD E Airgas US! LLC NICEVILLE FL 32578-1343 PO Box 9249 Marietta, GA 30065-2249 REV 1.1.13 S&L- 001000 Page 7 of 42 AIRGAS USA, LLC Acct No, 8606074182 PNC Bank, ABA No 031000053 CONSOLIDATED INVOICE FOR ADDRESS CORRECTIONS, PLEASE FAX NOTICE TO: 770-590-6112 Alrgas L USA fhe INVOICE DATE PAYER INVOICE NO. DUE DATE PAY THIS AMOUNT Airgas. : FiO BOK 9240 a 004g C1)01/06/2014] 1291991 || 9500156047 | 04/34/2014 ff SEE SUMMARY PAGE PLEASE MARK YOUR METHOD OF PAYMENT sotoBy AIRGAS USA, LLC 922 SKIPPER AVE H eee ard FORT WALTON BEACH FL 32547-7315 reat Var 850-862-5214 Please visit www.airgas.com/onlinebillpay or complete the information on the reverse side of this form. PLEASE MAKE CHECKS PAYABLE AND REMIT TO: Wel faflas[peVdoed glade [Hef lp foe pea a pegeall peng sito ATTN ACCOUNTS PAYABLE Ho fo Plan fge Mae get M fy te ead nara les OKALOOSA CO EMS ue AIRGAS USA, LLC ee 90 COLLEGE BLVD E PO BOX 532609 ie NICEVILLE FL 32578-1343 ATLANTA GA 30353-2609 000628 L25929941950015604700003181948 DESTIN FD $048 1020610326 03 OX USPDA . So48 1 CL 1 1 6.33 CL 6.33 N (Vol: 15 FT3) OXYGEN USP DA MED CGA 870 Sale subtotal: 6.33 Delivery Flat Fee 13.50 SHIP TO: 1288928 Airgas OKALOOSA COUNTY EMS . www.airgas.com CHRISTOPHER D TANNER, MD Airgas USA, LLC 90 Sea OE E 1343 nat Ne Be06074182 PO Box 9249 NICEVIL 7 PNC Bank, ABA No 031000053 Marietta, GA 30065-2249 REV 1.1.1 SEL- 901000 Page 8 of 42 FOR ADDRESS CORRECTIONS, PLEASE FAX-NOTICE TO: 770-590-6112 INVOICE DATE PAYER INVOICE NO, ‘DUE DATE PAY THIS AMOUNT 01/06/2014) 1291991 #§ 9500156047 ff 01/31/2014 | SEE SUMMARY PAGE Airgas US! USN fhe 10x 9) Marietta, oN 30065-2249 Airgas. C1 sotopy AIRGAS USA, LLC 922 SKIPPER AVE FORT WALTON BEACH FL 32547-7315 850-862-5214 BILLTO. }=©6 ATTN ACCOUNTS PAYABLE __.,. OKALOOSA CO EMS oe 90 COLLEGE BLVD E Ee @ NICEVILLE FL 32578-1343 000628 CONSOLIDATED INVOICE PLEASE MARK YOUR METHOD OF PAYMENT LI check AMOUNT ENCLOSED [J credit Card Please visit www.airgas.com/onlinebillpay or complete the information on the reverse side of this form. PLEASE MAKE CHECKS PAYABLE AND REMIT TO: Ut fe eee Meet ate te leer! AIRGAS USA, LLC PO BOX 532609 ATLANTA GA 30353-2609 129149911950015604700003181944 93 a4 = 20 ERD g con 1288028 fanzzsee0t | 00000000 NT 30 42106/2013 | ESSEX ROAD S048 1020612063 03 OX USPDA 8048 10 CL lo 10 6.33 CL 63.30 N (Vol: 150 FT3) OXYGEN USP DA MED CGA 870 ESSEX ROAD So48 1020612063 03 OX USP125 048 4 Ch 4 4 14.04 CL 56.16 N (Vol: 508 FT3) OXYGEN USP 125 Sale subtotal: 119.46 Delivery Flat Fee 13,50 132.96 SHIP TO: 1288928 = OKALOOSA COUNTY EMS Airgas. Airgas USA, LLC PO Box 9249 Marietta, GA 30065-2249 90 COLLEGE BLVD E NICEVILLE FL 32578-1343 REV 1.4.13 SEL- e000 www.airgas.com CHRISTOPHER D TANNER, MD AIRGAS USA, LLC Acct No. 8606074182 PNC Bank, ABA No 031000053 Page 9 of 42 CONSOLIDATED INVOICE FOR ADDRESS CORRECTIONS, PLEASE FAX NOTICE TO: 770-590-6112 - Airgas USA, fic INVOICE DATE PAYER INVOICE NO, DUE DATE PAY THIS AMOUNT Airgas. Maree BS so08s-2040 Ci01/06/2014 1291991 J 9500156047 J 01/31/2014 | SEE SUMMARY PAGE PLEASE MARK YOUR METHOD OF PAYMENT sotpspy AIRGAS USA, LLC 922 SKIPPER AVE 4 Cork ard : FORT WALTON BEACH FL 32547-7315 reat Can 850-862-5214 Please visit www.airgas.com/onlinebillpay or complete the information on the reverse side of this form. PLEASE MAKE CHECKS PAYABLE AND REMIT TO: MabffUeafpatbendy pala ef pel fd [ Toop lp fponpapepeedfapeagl auto ATTN ACCOUNTS PAYABLE Tao oe ei co bc UU TU OKALOOSA CO EMS AIRGAS USA, LLC “wa: ~=90 COLLEGE BLVD E . PO BOX 532609 ly NICEVILLE FL 32578-1343 ATLANTA GA 30353-2609 000528 . 42591499114950015604700005161948 TO ENSURE ae CREDIT, ai cee THE UerER portion WITH YOUR REMITTANCE. FOR QUESTIONS ON) YOUR ACCOUNT PLEASE CALL: 800-727-0608 1291991 1288908 "2029384013. 00000000 ocean city f/d S048 1020849275 02 OX USPDA S048 1 cL 1 1 6.33 CL -6.33 N (Vol: 15 FT3) OXYGEN USP DA MED CGA 870 Sale subtotal: 6.33 $ 6.33 SHIP TO: 1288928 : Airgas. OKALOOSA COUNTY EMS www.airgas.com CHRISTOPHER D TANNER, MD Airgas USA, LLC 90 COLLEGE BLVD F3 3 Ante se0co74iee PO Box 9249 NICEVILLE FL 32578-134 PNC Bank, ABA No 031000053 Marietta, GA 30065-2249 . : REV 1.1.13 SEL- 001000 Page 10 of 42 CONSOLIDATED INVOICE FOR ADDRESS CORRECTIONS, PLEASE FAX NOTICE TO: 770-590-6112 ° Airgas USA, LEC INVOICE DATE PAYER INVOICE NO, DUE DATE PAY THIS AMOUNT Airgas. PO Box 2240 e5-2249 C1 01/06/2014] 1291991 J 9500156047 J 01/31/2014 | SEE SUMMARY PAGE PLEASE MARK YOUR METHOD OF PAYMENT sotpsy AIRGAS USA, LLC 922 SKIPPER AVE H cre , FORT WALTON BEACH FL 32547-7315 reat var 850-862-5214 Please visit www.airgas.com/onlinebillpay or complete the information on the reverse side of this form. PLEASE MAKE CHECKS PAYABLE AND REMIT TO: - MeEfofoadpolhoady Uy oLaf aD pal [eM Dora D[peyrayogeedf geet auto ATTNACCOUNTS PAYABLE afte Mead tye lL ate tae . OKALOOSA CO EMS AIRGAS USA, LLC 90 COLLEGE BLVD E PO BOX 532609 i NICEVILLE FL 32578-1343 ATLANTA GA 30353-2609 000628 129199115950015604700003181944 Ocean City FD S048 1020876364 02 OX USPDA S048 2 CL 2 2 6.33 CL 12.66 N (Vol: 30 FT3) OXYGEN USP DA MED CGA 870 Sale subtotal: 12.66 12.6 SHIP TO: 1288928 : ee § 6 Airgas. OKALOOSA COUNTY EMS FOR WIRE TRANSFER PAYMENTS . www.airgas.com CHRISTOPHER D TANNER, MD niga us Lic arr aee eto. 0742 PO Box 9249 7 PNC Bank, ABA No 031000053 Marietta, GA 30065-2249 REV 1.1.19 SEL - 001000 Page 11 of 42 FO Airgas USM he 'O Box 924! Marietta, aN 30065-2249 Airgas. : AIRGAS USA, LLC 922 SKIPPER AVE FORT WALTON BEACH FL 32547-7315 850-862-5214. C1 SOLD BY BILL TO 000628 ATTN ACCOUNTS PAYABLE OKALOOSA CO EMS 90 COLLEGE BLVD E NICEVILLE FL 32578-1343 TO ENSURE PROPER GREDIT, PLEASE RETURN THE UPPER PORTION WITH YOUR f i TREGION INV. NO, EMITTANCE. FOR QUESTIONS ON ae ASCO NT PLEASE CALL sews 727° 0608. CONSOLIDATED INVOICE R ADDRESS CORRECTIONS, PLEASE FAX NOTICE TO: 770-590-6112 INVOICE DATE PAYER INVOICE NO. DUE DATE PAY THIS AMOUNT 01/06/2014, 1291991 § 9500156047 ff 01/31/2014 | SEE SUMMARY PAGE PLEASE MARK YOUR METHOD OF PAYMENT Cd check LJ Credit Card AMOUNT ENCLOSED. Please visit www.airgas.com/onlinebillpay or complete the information on the reverse side of this form. PLEASE MAKE CHECKS PAYABLE AND REMIT TO: eH fla efollett AIRGAS USA, LLC PO BOX 532609 ATLANTA GA 30353-2609 12519911950015604 700003181948 CRESTVIEW EMS $048 1020841880 03 OX USPDA $048 12 CL 12 12 6.33 CL 75.96 N (Vol: 180 FT3) OXYGEN USP DA MED CGA 870 CRESTVIEW EMS S048 1020841880 03 OX USP125 S048 3 CL 3 3 14.04 CL 42.12 N (Vol: 381 FT3) OXYGEN USP 125 Sale subtotal: 118.08 Delivery Flat Fee 13.50 : / 131.58 SHIP TO: 1288928 § OKALOOSA COUNTY EMS Airgas. Airgas USA, LLC PO Box 9249 Marietta, GA 30065-2249 90 COLLEGE BLVD E NICEVILLE FL 32578-1343 REV 1.1.13 SEL - 201000 Page www.airgas.com CHRISTOPHER D TANNER, MD AIRGAS USA, LLC Acct No. 8606074182 PNC Bank, ABA No 031000053 12 of 42 CONSOLIDATED INVOICE FOR ADDRESS CORRECTIONS, PLEASE FAX NOTICE TO: 770-590-6112 INVOICE DATE PAYER, INVOICE NO. DUE DATE PAY THIS AMOUNT 01/06/2014 1291991 9} 9800156047 9] 01/31/2014 | SEE SUMMARY PAGE PLEASE MARK YOUR METHOD OF PAYMENT | LI check (J credit Cara Please visit www.airgas.com/onlinebillpay or complete the information on the reverse side of this form. pitgas | US fhe Airgas. °° Marietta, oe 30065-2249 c soLpey AIRGAS USA, LLC 922 SKIPPER AVE FORT WALTON BEACH FL 32547-7315 850-862-5214 PLEASE MAKE CHECKS PAYABLE AND REMIT'T0: Mabfaflan Dydd petal Hal alfa EEYoag pcg racpead fa peay sito. ATTN ACCOUNTS PAYABLE Uap epee fpf pele tL eee tet OKALOOSA CO EMS AIRGAS USA, LLC Feat 90 COLLEGE BLVD E PO BOX 532609 é NICEVILLE FL 32578-1343 ATLANTA GA 30353-2609 000628 429499320550015604700005181948 ESSEX ROAD S048 1020836077 03 OX USPDA S048 7 CL 7 7 6.33 CL 44.31 N (Vol: 105 FT3) OXYGEN USP DA MED CGA 870 ESSEX ROAD S048 1020836077 03 OX USP125 8048 1 CL 1 1 14.04 CL 14.04 N (Vol: 127 FT3) OXYGEN USP 125 Sale subtotal: 58.35 Delivery Flat Fee 13,50 71.85 SHIP TO: 1288928 - $ Airgas OKALOOSA COUNTY EMS FOR WIRE TRANSFER. PAYMENTS . wwwairgas.com CHRISTOPHER D TANNER, MD AIRGAS USA, LLC 90 COLLEGE BLVD E Airgas USA, LLC Acct No. 8606074182 PO Box 9249 NICEVILLE FL 32578-1343 PNC Bank, ABA No 031000053 Marietta, GA 30065-2249 REV 1.1.19 SE - 001000 Page 13 of 42 CONSOLIDATED INVOICE FOR ADDRESS CORRECTIONS, PLEASE FAX NOTICE TO: 770-590-6112 pirgas USA, LLC INVOICE DATE PAYER INVOICE NO. DUE DATE PAY THIS AMOUNT Airgas. Monee Sado 30065-2249 C1fR 01/06/2014 1291991 § 9500156047 | 01/31/2014 [| SEE SUMMARY PAGE PLEASE MARK YOUR METHOD OF PAYMENT sotpBy AIRGAS USA, LLC Oo Check . 922 SKIPPER AVE : FORT WALTON BEACH FL 32547-7315 L] Credit Card 850-862-5214 Please visit www.airgas.com/onlinebillpay or complete the information on the reverse side of this form. PLEASE MAKE CHECKS PAYABLE AND REMIT TO: . Ua fof] pula py lp oTefQUstp Uf ff [poop] Tpepapepee tl prong euito ATTNACCOUNTS PAYABLE hectare ET gb OV VE OKALOOSA CO EMS AIRGAS USA, LLC is uals 90 COLLEGE BLVD E PO BOX 532609 NICEVILLE FL 32578-1343 ATLANTA GA 30353-2609 * pone28 429199115950015604700003181948 TO ENSURE PROPER CREDIT, PLEASE RETURN THE EER aP RNG PORTION wil YOUR REMITTANCE. FOR QUESTIONS ON YOUR ACCOUNT, PLEASE CALL: 800-727-0693 NICEVILLE EMS S048 1020839826 03 OX USPDA 8048 9 CL 9 9 6.33 CL 56,97 N (Vol: 135 FT3) OXYGEN USP DA MED CGA 870 NICEVILLE EMS S048 1020839826 03 OX USP125 S048 3 CL 3 3 14.04 CL 42,12 N {Vol: 381 FT3} OXYGEN USP 125 Sale subtotal: 99.09 Delivery Flat Fee : 13.50 112.59 SHIP TO: 1288928 § Airgas OKALOOSA COUNTY EMS . www.airgas.com CHRISTOPHER D TANNER, MD Airgas USA, LLC SO COLLEGE BLVD E Ant No, 8606074182 PO Box 9249 - PNC Bank, ABA No 031000053 Marietta, GA 30065-2249 REV 1.1.13 S8+-001000 , Page 14 of 42 Airgas USN fhe Air as. PO Box 924 Marietta, aN 30065-2249 sotpBy AIRGAS USA, LLC 922 SKIPPER AVE FORT WALTON BEACH FL 32547-7315 850-862-5214 BILLTO =ATTN ACCOUNTS PAYABLE OKALOOSA CO EMS 90 COLLEGE BLVD E Ee NICEVILLE FL. 32578-1343 000828 CONSOLIDATED INVOICE FOR ADDRESS CORRECTIONS, PLEASE FAX NOTICE.TO: 770-590-6112 INVOICE DATE PAYER: INVOICE NO. DUE DATE PAY THIS AMOUNT 01/06/2014 1291991 [| 9500156047 | 01/31/2014 | SEE SUMMARY PAGE PLEASE MARK YOUR METHOD OF PAYMENT _ Ol Check C1 credit Cara Please visit www.airgas.com/onlinebillpay or complete the information on the reverse side of this form. PLEASE MAKE CHECKS PAYABLE AND REMIT TO: Eee fe fle eye Moe eyelet! AIRGAS USA, LLC PO BOX 532609 ATLANTA GA 30353-2609 425919911550015b047000031815948 FD North Bay $048 1020839828 03 OX USPDA S048 3 CL 3 3 6.33 CL 18.99 N (Vol; 45 FT3) OXYGEN USP DA MED CGA 870 Sale subtotal: 18.99 Delivery Flat Fee 13.50 32,49 SHIP TO: 1288928 § Airgas OKALOOSA COUNTY EMS . www.airgas.com CHRISTOPHER D TANNER, MD nips Sino ACEH te tons sectors PO Box 9249 - Marietta, GA 30065-2249 REV 4.1.13 SEL- 201000 PNC Bank, ABA No 031000053 Page 15 of 42 CONSOLIDATED INVOICE FOR ADDRESS CORRECTIONS, PLEASE FAX NOTICE TO: 770-590-6112 Airgas USA, LLCO INVOICE DATE PAYER INVOICE NO. DUE DATE PAY THIS AMOUNT Airgas. Po Box 8249 30065-2249 C19 01/06/2014, 1291991 | 9600156047 § 01/31/2014 | SEE SUMMARY PAGE . PLEASE MARK YOUR METHOD OF PAYMENT sotppy AIRGAS USA, LLC : Oo Check 922 SKIPPER AVE : FORT WALTON BEACH FL 32547-7315 L] Credit Cara 850-862-5214 Please visit www.airgas.com/onlinebillpay or complete the information on the reverse side of this form. PLEASE MAKE CHECKS PAYABLE AND REMIT TO: HaMpafesfpetbead gly deltte HLT Pog peg peaee peat aLLTo ATTN ACCOUNTS PAYABLE Matty yd ht ETL Ch oe TT Re ef FT . OKALOOSA CO EMS AIRGAS USA, LLC xi 90 COLLEGE BLVD E PO BOX 532609 NICEVILLE FL 32578-1343 ATLANTA GA 30353-2609 000628 1294599414950015604700003181948 DESTIN EMS S048 1020842518 03 OX USPDA S048 3 CL 3 3 6.33 CL 18.99 N (Vol: 45 FT3) OXYGEN USP DA MED CGA 870 Sale subtotal: 18.99 Delivery Flat Fee 13.50 SHIP TO: 1288928 Airgas OKALOOSA COUNTY EMS www.airgas.com CHRISTOPHER D TANNER, MD Airgas USA, LLC 90 COLLEGE BLVD E Acct No, 8606074182 PO Box 9249 NICEVILLE FL 32578-1343 . PNC Bank, ABA No 034000083 Marietta, GA 30065-2249 REV 1.1.13 SEL-201000 Page 16 of 42 CONSOLIDATED INVOICE FOR ADDRESS CORRECTIONS, PLEASE FAX NOTICE TO: 770-590-6112 Airgas USA, LLC INVOICE DATE PAYER INVOICE NO. DUE DATE PAY THIS AMOUNT Airgas. Marat, oN 30065-2249 C19 01/06/2014, 1291991 § 9500156047 Ff 01/31/2014 | SEE SUMMARY PAGE : PLEASE MARK YOUR METHOD OF PAYMENT so.psy AIRGAS USA, LLC [1 check : 922 SKIPPER AVE Fe] credit card FORT WALTON BEACH FL 32547-7315 Fealt Var 850-862-5214 Please visit www.airgas.com/onlinebillpay or complete the information on the reverse side of this form. PLEASE MAKE CHECKS PAYABLE AND REMIT TO: MAY ofa ofpeTLaaf pty ote Maf slfo PRL eag Dfaeayapeyee lf peegl sitTo ATTN ACCOUNTS PAYABLE eA ofh ef goELeg fg pote fA eto Lg Leaner diet ag, OKALOOSA CO EMS AIRGAS USA, LLC Fest 90 COLLEGE BLVD E : PO BOX 532609 i NICEVILLE FL 32578-1343 ATLANTA GA 30353-2609 000628 129495911950015604 700009181948 DESTIN FD So48 1020842517 03 OX USPDA S048 1 CL 1 1 6.33 CL 6.33 N (Vol: 15 FT3) OXYGEN USP DA MED CGA 870 Sale subtotal: 6,33 Delivery Flat Fee 13.50 ig. SHIP TO: 1288928 = § 19.83 Airgas OKALOOSA COUNTY EMS . www.airgas.com CHRISTOPHER D TANNER, MD nige ust ic Rice rE fee re PO Box 9249 ~ PNC Bank, ABA No 031000053 Marietta, GA 30065-2249 REV 1.1.19 SE- 001900 Page 17 of 42 CONSOLIDATED INVOICE FOR ADDRESS CORRECTIONS, PLEASE FAX NOTICE TO: 770-590-6112 Airgas USA fre INVOICE DATE “PAYER INVOICE NO. DUE DATE PAY THIS AMOUNT - Airgas. FiO BOK 8200 a5 0049 C1M§01/06/2014] 1291991] 9500156047 J 01/31/2014 | SEE SUMMARY PAGE PLEASE MARK YOUR METHOD OF PAYMENT soLpBy AIRGAS USA, LLC oO Check 922 SKIPPER AVE F] creat card FORT WALTON BEACH FL 32547-7315 ret Van 850-862-5214 Please visit www.airgas.com/oniinebillpay or complete the information on the reverse side of this form. PLEASE MAKE CHECKS PAYABLE AND REMIT TO: TATA Len PRL RPL Led AL | ert Peel] Pee suLto ATTN ACCOUNTS PAYABLE Ube af epee Maoh yet TTL eee thet _. OKALOOSA CO EMS AIRGAS USA, LLC ne 90 COLLEGE BLVD E PO BOX 532609 NICEVILLE FL 32578-1343 ATLANTA GA 30353-2609 000628 1291993155001 5604 7000031615948 TO.ENSURE PROPER GREDIL, PLEAS PLEASE R BTU THE UPPER PORTION WITH YOUR REMITTANCE, FOR QUESTIONS ¢ ON Lous ACCOUNT PLEASE G, el 800-727-0693 201004 [soe i “Ner 30 1213/2013 a ESSEX ROAD S048 1020837936 03 OX USPDA 8048 6 CL 6 6 6,33 CL 37.98 N (Vol: 90 FT3) OXYGEN USP DA MED CCA 870 ESSEX ROAD S048 1020837936 03 OX USP125 8048 3 CL 3 3 14.04 cL 42.12 N (Vol: 381 FT3) OXYGEN USP 125 Sale subtotal: 80.10 Delivery Flat Fee 13.50 SHIP TO: 1288928 Airgas. OKALOOSA COUNTY EMS www.airgas.com SARIS TORTER D TANNER, MD AigesUSA,LC «SO COLLEGE BLVD E Act No, 6606074162 PO Box 9249 NICEVILLE FL 32578-1343 PNC Bank, ABA No 031000053 Marietta, GA 30065-2249 REV 1.4.19 SEL-901000 Page 18 of 42 CONSOLIDATED INVOICE FOR ADDRESS CORRECTIONS, PLEASE FAX NOTICE TO: 770-590-6112 Airgas USA, ue INVOICE DATE PAYER INVOICE NO. DUE DATE PAY THIS AMOUNT Box 924 Airgas. Maree Sk 30065-2040 C101/06/2014 1291901 || 9500156047 9 01/31/2014 || SEE SUMMARY PAGE PLEASE MARK YOUR METHOD OF PAYMENT sotpBY AIRGAS USA, LLC im Check 922 SKIPPER AVE E] credit Card FORT WALTON BEACH FL 32547-7315 rear war 850-862-5214 Please visit www.airgas.com/onlinebillpay or complete the information on the reverse side of this form. PLEASE MAKE CHECKS PAYABLE AND REMIT TO: Wolfaflenbpataedpylyateqita] ALAM eof fesagr epeed apoagl auto ATTN ACCOUNTS PAYABLE Tle ee foe oe be Pe UY TC , OKALOOSA CO EMS AIRGAS USA, LLC Eee 90 COLLEGE BLVD E PO BOX 532609 i NICEVILLE FL 32578-1343 ATLANTA GA 30353-2609 000628 42949921950015604700003181544 CRESTVIEW EMS S048 1020911148 03 OX USPDA S048 3 CL 3 3 6.33 CL 18.99 N (Vol: 45 FT3) OXYGEN USP DA MED CGA 870 CRESTVIEW EMS S048 1020911148 03 OX USP125 so48 1 CL 1 1 44.04 CL 14.04 N (Vol: 127 FT3) OXYGEN USP 125 Sale subtotal: 33.03 Delivery Flat Fee 13.50 SHIP TO: 1288928 Airgas OKALOOSA COUNTY EMS . www.airgas.com CHRISTOPHER D TANNER, MD mgeusy sic ST eee on fee 00 PO Box 9249 ~ PNC Bank, ABA No 031000053 Marietta, GA 30065-2249 REV 1.1.13 S&- 001000 Page 19 of 42 CONSOLIDATED INVOICE FOR ADDRESS CORRECTIONS, PLEASE FAX NOTICE TO: 770-590-6112 - Airgas USA, phe INVOICE DATE. PAYER INVOICE NO. DUE DATE PAY THIS AMOUNT Airgas. Marnie SA: 30085-2240 cif§o1/06/20149 1291991 | 9500156047 ff 01/31/2014 | SEE SUMMARY PAGE PLEASE MARK YOUR METHOD OF PAYMENT soLpBy AIRGAS USA, LLC : oo Oo Check 922 SKIPPER AVE ‘ FORT WALTON BEACH FL 32547-7315 L) Credit Card 850-862-5214 Please visit www.airgas.com/onlinebillpay or complete the information on the reverse side of this form. PLEASE MAKE CHECKS PAYABLE AND REMIT TO: TAT Les PLO PPL || en | Pee | Pe auto ATTN ACCOUNTS PAYABLE Fie eed eae det CU TR Uf _, OKALOOSA CO EMS AIRGAS USA, LLC Sez! 90 COLLEGE BLVD E PO BOX 532609 NICEVILLE FL 32578-1343 ATLANTA GA 30353-2609 000628 429159911950015604700003181948 ESSEX ROAD S048 1021118487 03 OX USPDA S048 4 CL 4 4 - 6.33 CL 25.32 N (Vol; 60 FT3) OXYGEN USP DA MED CGA 870 ESSEX ROAD S048 1021118487 03 OX USP125 S048 2 CL 2 2 14.04 CL 28.08 N (Vol: 254 FT3) OXYGEN USP 125 Sale subtotal: 53.40 Delivery Flat Fee 13.50 SHIP TO: 1288928 Airgas OKALOOSA COUNTY EMS www.airgas.com CHRISTOPHER D TANNER, MD . 90 COLLEGE BLVD E Aut abe 8606074182 Airgas USA, LLC NICEVILLE FL 32578-1343 NG Bay PNC Bank, ABA No 031000053 Marietta, GA 30065-2249 REV 1.1.13 SEL- 091000 Page 20 of 42 pirgas US) ee he 10x 9: Airgas. § Marietta, an 30065-2249 sotpBy AIRGAS USA, LLC 922 SKIPPER AVE FORT WALTON BEACH FL 32547-7315 850-862-5214 Bitto }==ATTN ACCOUNTS PAYABLE OKALOOSA CO EMS 90 COLLEGE BLVD E fe NICEVILLE FL 32578-1343 000628 ct URE PROPER CREDIT, tee RETURN JHE Pas anata POR wee YOUR Tae FOR QUESTIONS oN yen IR ACCOUNT PLEASE. ae £00. Lar 0693 CONSOLIDATED INVOICE FOR ADDRESS CORRECTIONS, PLEASE FAX NOTICE TO: 770-590-6112 INVOICE DATE PAYER: INVOICE NO. DUE DATE PAY THIS AMOUNT 01/06/2014, 1291991 9] 9500156047 J 01/31/2014 [| SEE SUMMARY PAGE PLEASE MARK YOUR METHOD OF PAYMENT . CJ check [J credit Card Please visit www.airgas.com/onlinebillpay or complete the information on the reverse side of this form. PLEASE MAKE CHECKS PAYABLE AND REMIT To: UA ofa Moe gpl obey TT ea Here tee AIRGAS USA, LLC PO BOX 532609 ATLANTA GA 30353-2609 12519911550015604 7000031815946 NICEVILLE EMS So48 1021168419 03 OX USPDA $048 8 CL 8 8 6.33 CL 50.64 N (Vol: 120 PT3) OXYGEN USP DA MED CGA 870 Sale subtotal: 50,64 Delivery Flat Fee 13.50 a SHIP TO: 1288928 Airgas OKALOOSA COUNTY EMS . www.airgas.com CHRISTOPHER D TANNER, MD ; 90 COLLEGE BLVD E ARS OONOya aD Airgas USA, LLG NICEVILLE FL 32578-1343 Acct No. 8 PO Box 9249 Marietta, GA 30065-2249 REV 1.1.13 584- 901000 PNC Bank, ABA No 031000053 Page 21 of 42 CONSOLIDATED INVOICE FOR ADDRESS CORRECTIONS, PLEASE FAX NOTICE TO: 770-590-6112 = Airgas USA pe INVOICE DATE PAYER INVOICE NO. . DUE DATE PAY THIS AMOUNT Airgas. Mons Aa? so08s-2249 C1ffo1/06/20149 1201901 | 9500156047 § 01/31/2014 |] SEE SUMMARY PAGE PLEASE MARK YOUR METHOD OF PAYMENT . solpBy AIRGAS USA, LLC 922 SKIPPER AVE H cnet a ; FORT WALTON BEACH FL 32547-7315 Teall Var 850-862-5214 Please visit www.airgas.com/onlinebillpay or complete the information on the reverse side of this form. PLEASE MAKE CHECKS PAYABLE AND REMIT TO: Wad ffbee]peldandy tyatoy bel oT Led [TPeegtfpegyapeyeaf tpn eutto ATTN ACCOUNTS PAYABLE Unf efoa|pe Mea tele emer tie ., OKALOOSA CO EMS AIRGAS USA, LLC 90 COLLEGE BLVD E PO BOX 532609 NICEVILLE FL 32578-1343 _ ATLANTA GA 30353-2609 000828 . 42919911950015604700003181548 TO ENSURE PROPER CREOIT, ELSE AeTEN THE RESON NON PORTION Witt. YOUR ee FOR QUESTIONS ON. YOUR ACCOUNT PLEASE Pas eae Lat 0608 ocean cit 8048 1021193131 02 OX USPDA $048 1 CL 1 1 6.33 CL 6.33 N (Vol: 15 FT3) OXYGEN USP DA MED CGA 870 Sale subtotal: 6.33 SHIP TO: 1288928 Airgas OKALOOSA COUNTY EMS . www.airgas:icom CHRISTOPHER D TANNER, MD momen face ceavoe He mS UA, PO Box 9249 NICEVILLE FL 32578-1343 ; PNC Bank, ABA No 031000053 Marietta, GA 30065-2249 REV 4.1.13 SEL- 001000 Page 22 of 42 Airgas USN ble Airgas. PO Box 924 ct Marietta, aN 30065-2249 so.tpBy AIRGAS USA, LLC oO Cheok 922 SKIPPER AVE FJ credit Card FORT WALTON BEACH FL 32547-7315 redit Car 850-862-5214 BiLto ATTN ACCOUNTS PAYABLE ., OKALOOSA CO EMS fea 90 GOLLEGE BLVD E NICEVILLE FL 32578-1343 000628 Please visit www.airgas.com/onlinebillpay or complete the information on the reverse side of this form. PLEASE MAKE CHECKS PAYABLE AND REMIT TO: LeU Yeften geld agtyet [Eee tf eal needle! AIRGAS USA, LLC PO BOX 532609 ATLANTA GA 30353-2609 CONSOLIDATED INVOICE FOR ADDRESS CORRECTIONS, PLEASE FAX NOTICE TO: 770-590-6112 INVOICE DATE PAYER INVOICE NO. DUE DATE PAY THIS AMOUNT : 01/06/20148 1291991 9500156047 ff 01/31/2014 | SEE SUMMARY PAGE PLEASE MARK YOUR METHOD OF PAYMENT AMOUNT ENCLOSED 4292599445950015604700003181948 DESTIN EMS S048 1021194645 03 OX USPDA S048 2 CL 2 2 6.33 CL 12.66 N (Vol: 30 FT3) OXYGEN USP DA MED CGA 870 DESTIN EMS S048 1021194645 03 OX USP125 S048 1 CL 1 1 14.04 CL 14.04 N (Vol; 127 FT3) OXYGEN USP 125 : Sale subtotal: 26.70 Delivery Flat Fee 13.50 40.20 SHIP TO: 1288928 § Ai as OKALOOSA COUNTY EMS rg . www.airgas.com CHRISTOPHER D TANNER, MD Airgas USA, LLC 90 COLLEGE BLVD E PO Box 9249 NICEVILLE FL 32578-1343 Marietta, GA 30065-2249 REV 1.1.13 S€--001000 Page 23 of 42 FOR WIRE TRANSFER PAYMENTS AIRGAS USA, LLC Acct No. 8606074182 PNC Bank, ABA No 031000053 CONSOLIDATED INVOICE FOR ADDRESS CORRECTIONS, PLEASE FAX NOTICE TO: 770-590-6112 INVOIGE DATE PAYER INVOICE NO. ‘DUE DATE PAY THIS AMOUNT 01/06/2014 1291991 9500156047 § 01/31/2014 § SEE SUMMARY PAGE PLEASE MARK YOUR METHOD OF PAYMENT Aitaas et fhe Marietta GA. 30065-2249 C4 Airgas. ; so.osy AIRGAS USA, LLC 922 SKIPPER AVE LW aoe ard FORT WALTON BEACH FL 32547-7315 reant (ar 850-862-5214 Please visit www.airgas.com/onlinebillpay or complete the information on the reverse side of this form. PLEASE MAKE CHECKS PAYABLE AND REMIT TO: TAT Ten Len PROP LA Ped |e] | OPP | Pee eulto ATTN ACCOUNTS PAYABLE 7 ja oe Fee oe bas Pee UC OKALOOSA CO EMS AIRGAS USA, LLC 90 COLLEGE BLVD E ed fae 000628 PO BOX 532609 NICEVILLE FL 32578-1343 ATLANTA GA 30353-2609 429499134500156047000031815948 oA OKLOOSA ISLAND FD S048 1021194643 03 OX USPDA 8048 1 cL i 1 6.33 CL 6.33 N (Vol: 15 FT3) OXYGEN USP DA MED CGA 870 Sale subtotal: 6.33 Delivery Flat Fee 13.50 SHIP TO: 1288928 Airgas. OKALOOSA COUNTY EMS www. airgas. com CHRISTOPHER D TANNER, MD Airgas USA, LLC 90 COLLEGE BLVD E PO Box 9249 NICEVILLE FL 32578-1343 Marietta, GA 30065-2249 REV 1,1,13 SEL- 901000 Page 24 of 42 FOR WIRE TRANSFER PAYMENTS AIRGAS USA, LLC Acct No, 8606074182 PNC Bank, ABA No 031000053 Airgas US fhe Alrgas. ice: Marietta, aN 30065-2249 soLosy AIRGAS USA, LLC 922 SKIPPER AVE FORT WALTON BEACH FL 32547-7315 850-862-5214 sitto ATTN ACCOUNTS PAYABLE 000628 OKALOOSA CO EMS 90 COLLEGE BLVD E NICEVILLE FL 32578-1343 CONSOLIDATED INVOICE FOR ADDRESS CORRECTIONS, PLEASE FAX NOTICE TO: 770-590-6112 INVOICE DATE PAYER INVOICE NO. DUE DATE PAY THIS AMOUNT 01/06/2014 1291991 | 9500156047 | 01/31/2014 | SEE SUMMARY PAGE PLEASE MARK YOUR METHOD OF PAYMENT Cd check (1 credit Cara Please visit www.airgas.com/onlinebillpay or complete the information on the reverse side of this form. PLEASE MAKE CHECKS PAYABLE AND-REMIT TO: Baten ty el ef tf ea ene lies AIRGAS USA, LLC PO BOX 532609 ATLANTA GA 30353-2609 LEAL AFL ASOOLSEO4 7000031810948 SSB FROrER CREDIT, PLEASE cee THE STG FORTION wi YOUR EMITTANCE. FOR QUESTIONS ON YOUR ACCOUNT PLEASE ae 800-727-0693 TERN [ORDER DAI rae 1288028 T 3022864000 | “00000000 NET 30 12/20/2013 F 25 ESSEX ROAD X S048 1021194647 03 OX USPDA S048 3 CL 3 3 6.33 CL 18.99 N (Vol; 45 FT3) OXYGEN USP DA MED CGA 870 Sale subtotal: 18.99 Delivery Flat Fee 13.50 32.49 : SHIP TO: 1288928 = Se § Airgas OKALOOSA COUNTY EMS FOR WIRE TRANSFER PAYMENTS . www.airgas.com CHRISTOPHER D TANNER, MD nig isa ic Seana etna ra PO Box 9249 - Marietta, GA 30065-2249 REV 4,4,1 SEE -901000 PNC Bank, ABA No 031000053 Page 25 of 42 Aligas | Wa fhe Marlene GA’ 30065-2249 C4 Airgas. : sotpey AIRGAS USA, LLC 922 SKIPPER AVE FORT WALTON BEACH FL 32547-7315 850-862-5214 BiLLTo. ==ATTN ACCOUNTS PAYABLE OKALOOSA CO EMS 90 COLLEGE BLVD E NICEVILLE FL 32578-1343 000628 CONSOLIDATED INVOICE FOR ADDRESS CORRECTIONS, PLEASE FAX NOTICE TO: 770-590-6112 INVOICE DATE PAYER INVOICE NO. DUE DATE PAY THIS AMOUNT 01/06/2014, 1291991 9] 9500156047 § 01/31/2014 | SEE SUMMARY PAGE PLEASE MARK YOUR METHOD OF PAYMENT LI Check LJ Credit Cara Please visit www.airgas.com/onlinebillpay or complete the information on the reverse side of this form. PLEASE MAKE CHECKS PAYABLE AND REMIT TO: PEM flacd peepee A Peat heared ied AIRGAS USA, LLC PO BOX 532609 ATLANTA GA 30353-2609 42919941950015604700003181948 To ENSURE EROPER CREDIT, PLEASE RETURN THE UPPER PORTION Wu PORTION Witt YOUR EMITTANCE FOR QUESTIONS ON YOUR ACCOUNT PLEASE CALL: 800-727-0693 ORDER DATE | “1291991 "1288028 _ Een “90000000 NET 20 REV 1.1.13 CRESTVIEW EMS $048 1021278881 03 OX USPDA So48 12 CL 12 12 6.33 CL 75.96 N (Vol: 180 FT3) OXYGEN USP DA MED CGA 870 CRESTVIEW EMS Sso48 1021278881 03 OX USP125 S048 1 CL 1 1 14.04 CL 14.04 N (Vol: 127 FT3) OXYGEN USP 125 Sale subtotal: 90.00 Delivery Flat Fee 13.50 - $ 103.50 SHIP TO: 1288928" OKALOOSA COUNTY EMS Airgas. www.airgas.com Airgas USA, LLC PO Box 9249 Marietta, GA 30065-2249 .90 COLLEGE BLVD E SEL - 001000 CHRISTOPHER D TANNER, MD NICEVILLE FL 32578-1343 AIRGAS USA, LLC Acct No. 8606074182 PNC Bank, ABA No 031000053 Page 26 of 42 CONSOLIDATED INVOICE FOR ADDRESS CORRECTIONS, PLEASE FAX NOTICE TO: 770:590-6112 Airgas USA the PO Box 924 fer Marietta, aN 30065-2249 Airgas. INVOICE DATE PAYER INVOICE NO. DUE DATE PAY THIS AMOUNT 01/06/2014, 1291891 9 9500156047 Ff 01/31/2014 J SEE SUMMARY PAGE PLEASE MARK YOUR METHOD OF PAYMENT AMOUNT ENCLOSED Please visit www.airgas.com/onlinebillpay or complete the information on the reverse side of this form. PLEASE MAKE CHECKS PAYABLE AND REMIT TO: sotpBy AIRGAS USA, LLC | Check 922 SKIPPER AVE Eo credit card FORT WALTON BEACH FL 32547-7315 redit var 850-862-5214 BiLTO. ATTN ACCOUNTS PAYABLE _, OKALOOSA CO EMS fee 90 COLLEGE BLVD E “we NICEVILLE FL 32578-1343 000628 AIRGAS USA, LLC PO BOX 532609 ATLANTA GA 30353-2609 42919911950015604 700003181948 TO ae ae CREDIT, a Rerun THE aaa fae wire. YOUR REMITTANCE. FOR QUESTIONS ON YOUR ACCOUNT PLEASE CALL. BON Ter oe 0693 OChAN CITY 8048 1021208926 02 OX USPDA S048 1 CL 1 6.33 CL 6.33 N (Vol: 15 FT3) OXYGEN USP DA MED CGA 870 Sale subtotal: 6.33 $ 6.33 SHIP TO: 1288928 Ai as OKALOOSA COUNTY EMS rg . www.airgas.com CHRISTOPHER D TANNER, MD Airgas USA, LLC 90 COLLEGE BLVD E PO Box 9249 NICEVILLE FL 32578-1343 Marietta, GA 30065-2249 AV 1.1.19 SEL- 001000 Page 27 of 42 FOR WIRE TRANSFER PAYMENTS AIRGAS USA, LLC Acct No. 8606074182 PNC Bank, ABA No 031000053 CONSOLIDATED INVOICE FOR ADDRESS CORRECTIONS, PLEASE FAX NOTICE TO: 770-590-6112 Airgas | ush be INVOICE DATE. PAYER INVOICE NO. DUE DATE PAY THIS AMOUNT . Airgas. ° Marie a 30068-2249 C19) 01/06/2014] 1291991 J 9500156047 | 01/31/2014 || SEE SUMMARY PAGE , PLEASE MARK YOUR METHOD OF PAYMENT sotpey AIRGAS USA, LLC [] check 922 SKIPPER AVE [| credit card FORT WALTON BEACH FL 32547-7315 reat Var 850-862-5214 Please visit www.airgas.com/onlinebillpay or complete the Information on the reverse side of this form. PLEASE MAKE CHECKS PAYABLE AND REMIT TO: TAY ATES PRL aet PU ec UPA) | | PET sito ATTN ACCOUNTS PAYABLE flee Mop hf pe dtemee ties ..,, OKALOOSA CO EMS AIRGAS USA, LLC er 90 COLLEGE BLVD E PO BOX 532609 se NICEVILLE FL 32578-1343 ATLANTA GA 30353-2609 000628 429459941950015604700003181944 TO ENSURE PROPER CREDIT, PLEASE RETURN THE UPPER RRSP RRe No wine YOUR REMITTANCE FOR QUESTIONS: ee YOUR ACCOUNT PLEASE ae 800-727-0693 BT [ORDER DAI 1291991 1288928 o229t27o6, (0000000 ~ NET 30 12/24/2013 ESSEX ROAD $048 1021278101 03 OX USPDA S048 6 CL 6 6 6.33 CL 37.98 N (Vol: 90 FT3) OXYGEN USP DA MED CGA 870 ESSEX ROAD $048 1021278101 03 OX USP125 S048 2 CL 2 2 14.04 CL 28.08 N (Vol: 254 FT3) OXYGEN USP 125 Sale subtotal: 66.06 Delivery Flat Fee : 13.50 SHIP TO: 1288928 = I $79.56 Airgas OKALOOSA COUNTY EMS . www.airgas.com CHRISTOPHER D TANNER, MD : 90 COLLEGE BLVD E AIRGAS USA, LLC Acct No. 8606074182 Airgas USA, LLC PO Box 9249 NICEVILLE FL 32578-1343 PNC Bank, ABA No 031000053 Marietta, GA 30065-2249 REV 1.1.13 SEL - 001000 Page 28 of 42 Alrgas L US phe Marlehe. GA. 30065-2249 C4 Airgas. ; soppy AIRGAS USA, LLC 922 SKIPPER AVE FORT WALTON BEACH FL 32547-7315 850-862-5214 BILLTO ATTN ACCOUNTS PAYABLE |. OKALOOSA CO EMS "a! 60 COLLEGE BLVD E NICEVILLE FL 32578-1343 000628 1291091 FOR ADDRESS CORRECTIONS, PLEASE FAX NOTICE TO: 770-590-6112 INVOICE DATE PAYER INVOICE NO. ‘DUE DATE PAY THIS AMOUNT 01/06/2014, 1291991 9500156047 § 01/31/2014 § SEE SUMMARY PAGE ate ENSURE EROFER CREDIT, aa Bean THE HERE RR PORTION wie OUR fe FOR QUESTIONS oN YOUR ACCOUNT PLEASE CALL: £00. -727-0693 CONSOLIDATED INVOICE PLEASE MARK YOUR METHOD OF PAYMENT * (J Check [_] Credit Card Please visit www.airgas.com/onlinebillpay or complete the information on the reverse side of this form. PLEASE MAKE CHECKS PAYABLE AND REMIT TO: This Wid Coie Th be UY AIRGAS USA, LLC PO BOX 532609 ATLANTA GA 30353-2609 12939911950015604700003181548 ORDERDATE: “200026 | oozsaizrea | 50000000 | NET 30 12/25/2013 a_i NICEVILLE EMS $048 1021275297 03 OX USPDA S048 6 CL 6 6 6.33 CL 37.98 N (Vol: 90 FT3) OXYGEN USP DA MED CGA 870 NICEVILLE EMS $048 1021275297 03 OX USP125 $048 2 CL 2 2 14.04 CL 28.08 N (Vol: 254 FT3) OXYGEN USP 125 Sale subtotal: 66.06 Delivery Flat Fee 13.50 $ 79.56 SHIP TO: 1288928 Airgas. www.airgas.com CHAISTORNER D ANiiCe, MD Airgas USA, LLC 90 COLLEGE BLVD E PO Box 9249 Marietta, GA 30065-2249 REV 1.1.13 S#L- 001000 NICEVILLE FL 32578-1343 FOR WIRE TRANSFER PAYMENTS AIRGAS USA, LLC Acct No. 8606074182 PNC Bank, ABA No 031000053 Page 29 of 42 CONSOLIDATED INVOICE FOR ADDRESS CORRECTIONS, PLEASE FAX NOTICE TO: 770-590-6112 Airgas L ) fhe INVOICE DATE PAYER INVOICE NO. DUE DATE PAY THIS AMOUNT Airgas. : Mea eh soqes-2240 C1 01/06/2014 1291991 ] 9500156047 | 01/31/2014 | SEE SUMMARY PAGE . PLEASE MARK YOUR METHOD OF PAYMENT soLpsy AIRGAS USA, LLC [1 check 922 SKIPPER AVE FORT WALTON BEACH FL 32547-7315 [_] Credit Card 850-862-5214 Please visit www.airgas.com/onlinebillpay or complete the information on the reverse side of this form. PLEASE MAKE CHECKS PAYABLE AND REMIT TO: TATA ed LLP Pe eT en || ene ato ATTN ACCOUNTS PAYABLE TT Aicis Li FTL ch boo ae TT UL oY OKALOOSA CO EMS AIRGAS USA, LLC 90 COLLEGE BLVD E . PO BOX 532609 NICEVILLE FL 32578-1343 ATLANTA GA 30353-2609 000628 429159911950015604 700003181948 DESTIN EMS S048 1021279232 03 OX USPDA 8048 4 CL 4 4 6.33 CL "25.32 N (Vol: 60 FT3) OXYGEN USP DA MED CGA 870 Sale subtotal: 25.32 Delivery Flat Fee 13.50 SHIP TO: 1288928 # 38.82 Airgas OKALOOSA COUNTY EMS www.airgas.com CHRISTOPHER D TANNER, MD peste RSE Fr 9 reat ore PO Box 9249 - PNC Bank, ABA No 031000053 Marietta, GA 30065-2249 REV 1.1.13 SEL 001000 ; Page 30 of 42 CONSOLIDATED INVOICE FOR ADDRESS CORRECTIONS, PLEASE FAX NOTICE TO: 770-590-6112 Airgas USA, fic INVOICE DATE. PAYER INVOICE NO. DUE DATE PAY THIS AMOUNT Airgas. Mere 228° so0es-2049 Caffo1soe/2014 1201991 | 9800156047 | 01/31/2014 |] SEE SUMMARY PAGE PLEASE MARK YOUR METHOD. OF PAYMENT sotpsy AIRGAS USA, LLC 922 SKIPPER AVE H ne ard FORT WALTON BEACH FL 32547-7315 red var 850-862-5214 Please visit www.airgas.com/onlinebilipay or complete the information on the reverse side of this form. PLEASE MAKE CHECKS PAYABLE AND REMIT TO: WalfafesfyoULas Dp Uy alefMed AP EUD [oo | Ppereppeaeeddppeagl sito. ATTN ACCOUNTS PAYABLE AE Mpepoe pede a Melt AP emer thes OKALOOSA CO EMS AIRGAS USA, LLC bas 90 COLLEGE BLVD E PO BOX 532609 NICEVILLE FL 32578-1343 ATLANTA GA 30353-2609 000628 429199119500156047000031815948 ENSURE PROPER. SREDIT, FLEASE AETURN THE cen EC wit ee Re TNE. FOR QUESTIONS. a saNe ACCOUNT PLEASE CALL: 800: ae 0693 DESTIN FD 8048 1021279231 03 OX USPDA So48 3 CL 3 3 6.33 CL 18.99 N (Vol: 45 FYT3) OXYGEN USP DA MED CGA 870 Sale subtotal: 18.99 Delivery Flat Fee 13.50 32.49 SHIP TO: 1288928 = : § Airgas OKALOOSA COUNTY EMS . www.airgas.com CHRISTOPHER D TANNER, MD Airgas USA, LLG 90 COLLEGE BLVD E AaINo, senen7462 PO Box 9249 NICEVILLE FL 32578-1343 PNC Bank, ABA No 031000053 Marietta, GA 30065-2249 REV 1.1.49 S&L 001000 Page 31 of 42 CONSOLIDATED INVOICE FOR ADDRESS CORRECTIONS, PLEASE FAX NOTICE TO: 770-590-6112 Alrgas USA fic INVOICE DATE PAYER INVOICE NO. DUE DATE PAY THIS AMOUNT Airgas. : FIO Box 9240 | as 004g Ciho1/06/2014§ 1291991 J 9500156047 | 01/31/2014 If SEE SUMMARY PAGE PLEASE MARK YOUR METHOD OF PAYMENT ‘sotpByY AIRGAS USA, LLC . 922 SKIPPER AVE H one ; FORT WALTON BEACH FL. 32547-7315 rea war 850-862-5214 Please visit www.airgas.com/onlinabillpay or complete the information on the reverse side of this form. PLEASE MAKE CHECKS PAYABLE AND REMIT TO: TAT A LH Pee PLE PPT eT | PPT PIT suto ATTN ACCOUNTS PAYABLE Ep flee gett ele eerie tie OKALOOSA CO EMS AIRGAS USA, LLC 90 COLLEGE BLVD E PO BOX 532609 NICEVILLE FL 32578-1343 ATLANTA GA 30353-2609 000628 B291L5911950015604 7000051815948 ESSEX ROAD 8048 1021279289 03 OX USPDA $048 8 CL 8 8 6.33 CL 50.64 N (Vol: 120 FT3) OXYGEN USP DA MED CGA 870 ‘ Sale subtotal: 50.64 Delivery Flat Fee 13.50 SHIP TO: 1288928 Airgas OKALOOSA GOUNTY EMS . www.airgas.com CHRISTOPHER D TANNER, MD Airgas USA, LLC 90 COLLEGE BLVD E AatNo. se0go74182 PO Box 9249 NICEVILLE FL 32578-1343 __ PNG Bank, ABA No 031000053 Marietta, GA 30065-2249 REV 1.1.13 SFL-001000 Page 32 of 42 Ai Airuas t USN gt? gas. ; Mariel, oN 30065-2249 sotpBy AIRGAS USA, LLC 922 SKIPPER AVE FORT WALTON BEACH FL 32547-7315 850-862-5214 BILLTO ATTN ACCOUNTS PAYABLE . OKALOOSA CO EMS ge 90 COLLEGE BLVD E i NICEVILLE FL 32578-1343 000628 CONSOLIDATED INVOICE FOR ADDRESS CORRECTIONS, PLEASE FAX NOTICE TO: 770-590-6112 INVOICE DATE PAYER INVOICE NO. DUE ‘DATE PAY THIS AMOUNT 01/06/2014 1291991 §f 9500156047 ff 01/31/2014 | SEE SUMMARY PAGE PLEASE MARK YOUR METHOD OF PAYMENT oO Check LJ Credit Card Please visit www.airgas.com/oniinebillpay or complete the information on the reverse side of this form. PLEASE MAKE CHECKS PAYABLE AND REMIT. TO: PU ORL Ter ci TUR AIRGAS USA, LLC PO BOX 532609 ATLANTA GA 30353-2609 4259499145950015604700003181948 Crestview EMS so48 1021384032 03 OX USPDA 8048 17 CL 17 17 6.33 CL 107.61 N (Vol: 255 FT3) OXYGEN USP DA MED CGA 870 Sale subtotal: 107.61 Delivery Flat Fee 13.50 SHIP TO: 1288928 atk § 121.11 Airgas OKALOOSA COUNTY EMS . www.airgas.comn CHRISTOPHER D TANNER, MD 90 COLLEGE BLVD E AIRGAS USA, LLC Airgas USA, LLC PO Box 9249 Marietta, GA 30065-2249 REV 1.1.19 58! 001000 NICEVILLE FL 32578-1343 Acct No. 8606074182 PNC Bank, ABA No 031000053 Page 33 of 42 CONSOLIDATED INVOICE FOR ADDRESS CORRECTIONS, PLEASE FAX NOTICE TO: 770-590-6112 i Alrgas | USA, fhe INVOICE DATE PAYER INVOICE NO, DUE DATE PAY THIS AMOUNT Airgas. : FIO Box 9240 as op4g CAM o106/2014f 1291991} 9500156047 | 01/31/2014 | SEE SUMMARY PAGE : PLEASE MARK YOUR METHOD OF PAYMENT sotpBY AIRGAS USA, LLC 922 SKIPPER AVE [1] Check FORT WALTON BEACH FL 32547-7315 850-862-5214 C] Credit Card Please visit www.airgas.com/onlinebillpay or complete the information on the reverse side of this form. PLEASE MAKE CHECKS PAYABLE AND REMIT TO: ITA BLM Pee PAL CL Fd | Peet alto ATTN ACCOUNTS PAYABLE EE flee ge lo le tener tes 7 OKALOOSA CO EMS AIRGAS USA, LLC 90 COLLEGE BLVD E PO BOX 532609 NICEVILLE FL 32578-1343 : . ATLANTA GA 30353-2609 00628 129159911950015604 700003161948 TQ ENSURE BROPER CREDIT PLEASE RETURN THE UPPER LEPER FORTION wi WITH YOUR RENITTAN E. FOR QUESTIONS ON YOUR B ACCOUNT PLEASE CALL: 800-727-0693 OLD: iu = [ORDER DATE: ocean city f/d S048 1021428050 02 OX USPDA S048 1 CL 1 1 6.33 CL 6.33 N (Vol: 15 FT3) OXYGEN USP DA MED CGA 870 Sale subtotal: 6.33 SHIP TO: 1288928 $ 6.33 . Airgas. www.airgas.com Airgas USA, LLG. PO Box 9249 Marietta, GA 30065-2249 REV 1.1.13 S84 90000 OKALOOSA COUNTY EMS CHRISTOPHER D TANNER, MD 90 COLLEGE BLVD E NICEVILLE FL 32578-1343 Page 34 of 42 FOR WIRE TRANSFER PAYMENTS AIRGAS USA, LLC Acct No. 8606074182 PNC Bank, ABA No 031000053 CONSOLIDATED INVOICE FOR ADDRESS CORRECTIONS, PLEASE FAX NOTICE. TO: 770-590-6112 - Airgas | Use fic INVOICE DATE PAYER INVOICE NO. DUE DATE PAY THIS AMOUNT Airgas. : Meas ae 30065-2249 C1§01/06/20149 1291991 |} 9500156047 J 01/31/2014 || SEE SUMMARY PAGE PLEASE MARK YOUR METHOD OF PAYMENT so_pBy AIRGAS USA, LLC oO Check 922 SKIPPER AVE ; FORT WALTON BEACH FL. 32547-7315 L_] credit Cara 850-862-5214 Please visit www.airgas.com/onlinebillpay or complete the infarmation on the reverse side of this form. PLEASE MAKE CHECKS PAYABLE AND REMIT TO: bad faPdecQ aM Daf ppdyelaP Tha fal fo] [PP seg ]focpygpepred f ppeagl eLLTO ATTN ACCOUNTS PAYABLE eae flos fgets ft let alte tiie OKALOOSA CO EMS AIRGAS USA, LLC 90 COLLEGE BLVD E PO BOX 532609 NICEVILLE FL 32578-1343 ATLANTA GA 30353-2609 000628 1294994195001 5604 700005L81948 CRESTVIEW EMS S048 1021385855 03 OX USPDA S048 2 CL 2 2 6.33 CL 12.66 N (Vol: 30 FT3) OXYGEN USP DA MED CGA 870 CRESTVIEW EMS So48 1021385855 03 OX USP125 S048 3 CL 3 3 14.04 Ch 42.12 N (Vol: 381 FT3) OXYGEN USP 125 Sale subtotal: 54.78 Delivery Flat Fee 13,50 68.28 SHIP TO: 1288928 — § Airyas OKALOOSA COUNTY EMS FOR WIRE TRANSFER PAYMENTS . www.airgas.com CHRISTOPHER D TANNER, MD 90 COLLEGE BLVD E AIRGAS SA ALG Airgas USA, LLC Acct No. 8606074182 PO Box 9249 NICEVILLE FL 32578-1343 PNC Bank, ABA No 031000053 Marietta, GA 30065-2249 REV 1.1.1 SEL -001000 Page 35 of 42 CONSOLIDATED INVOICE FOR ADDRESS CORRECTIONS, PLEASE FAX NOTICE TO: 770-590-6112 Airgas | USA Lc , INVOICE DATE PAYER INVOICE NO, DUE DATE PAY THIS AMOUNT Airgas. ; Moro 92%9 30065-2249 C1 01/06/2014 1291991 9500156047 J 01/31/2014 {| SEE SUMMARY PAGE PLEASE MARK YOUR METHOD OF PAYMENT sotpay AIRGAS USA, LLC 922 SKIPPER AVE H eee ard FORT WALTON BEACH FL 32547-7315 realt Gal 850-862-5214 Please visit www.airgas.com/onlinebillpay or complete the information on the reverse side of this form. PLEASE MAKE CHECKS PAYABLE AND REMIT TO: Walpapleafpstlee dppb aleflle ALD fea perce fppeat Bito ATTN ACCOUNTS PAYABLE [PEM pleedpe tog epee al tenner lie OKALOOSA CO EMS AIRGAS USA, LLC be 90 COLLEGE BLVD E PO BOX 532609 NICEVILLE FL 32578-1343 ATLANTA GA 30353-2609 000628 129195914950015604700003181748 oe ENSURE PROPER CREDIT, PLEAS! OLDe E RETURN THE UPPER PORTION WITH YOUR REMITTANCE, FOR QUESTIONS ON YOUR ACCOUNT PLEASE CALL: 800-727-0693 ee TO: = 5: STERM TREGIONINV.NG| 1291991 1288928 CRESTVIEW FD so48 1021386771 03 OX USPDA S048 3 CL 3 3 6.33 CL 18.99 N (Vol: 45 FT3) OXYGEN USP DA MED CGA 870 . Sale subtotal: 18.99 . Delivery Flat Fee . 13.50 SHIP TO: 1288928 Airgas OKALOOSA COUNTY EMS . www.airgas.com CHRISTOPHER D TANNER, MD Airgas USA, LLC 90 OT LEE BLN DE post Ne 3606074182 PO Box 9249 NICEVILLE FL 32578-1343 PNC Bank, ABA No 031000053 Marietta, GA 30065-2249 oe REV 1.1.13 SEL- 001000 Page 36 of 42 CONSOLIDATED INVOICE FOR ADDRESS CORRECTIONS, PLEASE FAX NOTICE TO: 770-590-6112 INVOICE DATE PAYER INVOICE NO. DUE DATE PAY THIS AMOUNT 01/08/2014 1291991 9500156047 § 01/31/2014 ff SEE SUMMARY PAGE PLEASE MARK YOUR METHOD OF PAYMENT (1 check [-] Credit Card Please visit www.airgas.com/onlinebillpay or complete the information on the reverse side of this form. Airgas ey LLC Ai a PO Box 9249 C1 . Marietta, GA 30065-2249 so.pay AIRGAS USA, LLC 922 SKIPPER AVE FORT WALTON BEACH FL 32547-7315 850-862-5214 PLEASE MAKE CHECKS PAYABLE AND REMIT TO: TATA (Pe ee POPLAR | PRES eLTo ATTN ACCOUNTS PAYABLE et Be Mellel el eee tie arys, OKALOOSA CO EMS AIRGAS USA, LLC tet 90 COLLEGE BLVD E PO BOX 532609 NICEVILLE FL 32578-1343 ATLANTA GA 30353-2609 000628 4251991195001 56047000031L8L948 SRECRNCAW Nee: RR ITTANCE, CALL: 800. PELE 0693 1201004 1288028 523071143 | 00000000 NET 30 12/31/2018 a ESSEX ROAD $048 1021419107 03 OX USPDA S048 7 CL 7 7 6.33 CL 44.31 N (Vol: 105 FT3) OXYGEN USP DA MED CGA 870 Sale subtotal: 44,31 Delivery Flat Fee 13.50 57.81 SHIP TO: 1288928 $ 87-8 Airgas OKALOOSA COUNTY EMS www.airgas.com CHRISTOPHER D TANNER, MD Airgas USA, LLC 80. COLLEGE BLVD E font No, 8606074182 PO Box 9249 . PNC Bank, ABA No 031000053 Marietta, GA 30065-2249 FEV 1.1.19 5b 001000 Page 37 of 42 CONSOLIDATED INVOICE FOR ADDRESS CORRECTIONS, PLEASE FAX NOTICE TO: 770-590-6112 Airgas | USA, jic INVOICE DATE PAYER INVOICE NO. DUE DATE PAY THIS AMOUNT Airgas. ‘ FiO Box 024 og5-2240 cilfo1/06/2014] 1201901 | 9600156047 | 01/31/2014 || SEE SUMMARY PAGE PLEASE MARK YOUR METHOD OF PAYMENT sotpBy AIRGAS USA, LLC 922 SKIPPER AVE HT nek 4 FORT WALTON BEACH FL 32547-7315 eat van 850-862-5214 Please visit www.airgas.com/onlinebillpay or complete the information on the reverse side of this form. PLEASE MAKE CHECKS PAYABLE AND REMIT TO: Weal Paftoafpeddeedpptyalef Mad olf IP feogd {trey pa eree|f prea puto ATTNACCOUNTS PAYABLE VLE a otro Ta ol a TT To OKALOOSA CO EMS AIRGAS USA, LLC 90 COLLEGE BLVD E PO BOX 532609 NICEVILLE FL 32578-1343 , ATLANTA GA 30353-2609 000628 1291991195001 5604700005L815948 TO ENSURE porn CREDIT, aac noe THE aa rae woe YOUR REMITTANCE, FOR QUESTIONS ON. ee ACCOUNT PLEASE CALL: SRD E Coa aera 0693 FD Niceville S048 1021424247 03 OX USPDA S048 2 CL 2 2 6.33 CL 12.66 N (Vol; 30 FET3) OXYGEN USP DA MED CGA 870 Sale subtotal: 12.66 Delivery Flat Fee 13.50 SHIP TO: 1288928 Airgas. OKALOOSA COUNTY EMS . www.airdas.com CHRISTOPHER D TANNER, MD Ages USAC SO.COLLEGE BLVD E fcet No. 8506074182 PO Box 9249 NICEVILLE FL 32578-1343 PNC Bank, ABA No 031000053 Marietta, GA 30065-2249 REV 1.1.13 SEE-90t000 Page 38 of 42 CONSOLIDATED INVOICE FOR ADDRESS CORRECTIONS, PLEASE FAX NOTICE TO: 770-590-6112 : Aitgas | USA, fhe INVOICE DATE PAYER INVOICE NO, BUE DATE PAY THIS AMOUNT Airgas. © Morea ode 30065-2249 C1fotos2014§ 1201901} 9500156047 J 01/31/2014 || SEE SUMMARY PAGE PLEASE MARK YOUR METHOD OF PAYMENT sotoByY AIRGAS USA, LLC (I check 922 SKIPPER AVE FORT WALTON BEACH FL 32547-7315 L] Credit Card 850-862-5214 Please visit www.airgas.com/onlinebillpay or complete the information on the reverse side of this form. PLEASE MAKE CHECKS PAYABLE AND REMIT TO: TUR Led Reo PP ced Ld Peed 10 capped pet BLLTO ATTN ACCOUNTS PAYABLE ADEN fp Mot tye allen lie OKALOOSA CO EMS AIRGAS USA, LLC 90 COLLEGE BLVD E PO BOX 532609 NICEVILLE FL 32578-1343 ATLANTA GA 30353-2609 000628 4259155934950015604700003181948 NICEVILLE EMS so48 1021424246 03 OX USPDA 8048 4 CL 4 4 6.33 CL 25.32 N (Vol: 60 FT3) OXYGEN USP DA MED CGA 870 NICEVILLE EMS $048 1021424246 03 OX USP125 so48 2 CL 2 2 14.04 CL 28.08 N (Vol: 254 FT3) OXYGEN USP 125 Sale subtotal: 53.40 Delivery Flat Fee 13.50 66.90 SHIP TO: 1288928 : $ Airgas OKALOOSA COUNTY EMS www.airgas.com CHRISTOPHER D TANNER, MD nigga utc Sn ee tet No S610 PO Box 9249 ~ PNC Bank, ABA No 031000053 Marietta, GA 30065-2249 REV 1.1.13 S&+-001000 Page 39 of 42 REV 1.1.13 Airgas USN phe PO Box Marlette on 30065-2249 Airgas. soLosy AIRGAS USA, LLC 922 SKIPPER AVE FORT WALTON BEACH FL 32547-7315 850-862-5214 BILLTO ATTN ACCOUNTS PAYABLE OKALOOSA CO EMS 90 COLLEGE BLVD E NICEVILLE FL 32578-1343 000628 T0 ENSURE FROFE FROPER CREDI, PLEASE RET CREDIT, PLEASE RETU RESICNINVNG CONSOLIDATED RENTAL INVOICE FOR ADDRESS CORRECTIONS, PLEASE FAX NOTICE TO: 770-590-6112 INVOICE DATE PAYER INVOICE NO. DUE DATE PAY THIS AMOUNT 01/06/2014 1291991 [| 9500156047 ff 01/31/2014 |] SEE SUMMARY PAGE PLEASE MARK YOUR METHOD OF PAYMENT L] Check [[] Credit Card Please visit www.airgas.com/onlinebillpay or complete the information on the reverse side of this form. PLEASE MAKE CHECKS PAYABLE AND REMIT TO: Pls © bod Foe FTL EP AIRGAS USA, LLC PO BOX 532609 ATLANTA GA 30353-2609 225945941950015604700003181948 ERA S NVOICE DA Ee GEA Ko [9915684755 <—ce 1288028 “RENT Pytoaot4 ae ET 30 RRCYLMLG-OX ~- Rent Cyl Med Large Oxygen 37 34 34 0 37 25 12 372 $0.26/DAY $96.72 N IRRCYLMXS-OX - Rent Cyl Med Xs Oxygen 137 194 194 0 137 1) 137 4247 $0,.22/DAY $934.34 N 174 228 228 0 174 $1,031.06 Important. See the Notice Regarding Cylinder Rentals/Leases and Responsibility on the Reverse sl - SHIP TO: 1288928 Airgas USA, LLC PO Box 9249 Marietta, GA 30065-2249 SEL - 001000 ide of this form. You will be deemed to have accepted the provisions in the said Notice as part of the contractual arrangements between you and us, unless you reject such provisions by written advice to us within (15) days after the date of this document. OKALOOSA COUNTY EMS www.airgas.com CHRISTOPHER D TANNER, MD 90 COLLEGE BLVD E NICEVILLE FL 32578-1343 FOR WIRE TRANSFER PAYMENTS AIRGAS USA, LLC Acct No. 8606074182 PNC Bank, ABA No 031000053 Page 40 of 42 CONSOLIDATED INVOICE FOR ADDRESS CORRECTIONS, PLEASE FAX NOTICE TO: 770-590-6112 Airgas USM gt INVOICE DATE PAYER INVOICE Ni DUE DATE PAY THIS AMOUNT Airgas. Moree ai? so0es-2249 ciffo1/06/20149 1291991 | 9500156047 J 01/31/2014 |] SEE SUMMARY PAGE PLEASE MARK YOUR METHOD OF PAYMENT solpBy AIRGAS USA, LLC oO Check 922 SKIPPER AVE . FORT WALTON BEACH FL 32547-7315 L] credit Card 850-862-5214 Please visit www.airgas.com/onlinebillpay or complete the information on the reverse side of this form. PLEASE MAKE CHECKS PAYABLE AND REMIT TO: MaMpopbeaf ylang ab yotey iat olfe Mfoap [Pp eapapepead fp yee auto ATTN ACCOUNTS PAYABLE LRN opea fetta pele eye ener thet OKALOOSA CO EMS AIRGAS USA, LLC bee 90 COLLEGE BLVD E PO BOX 532609 NICEVILLE FL 32578-1343 ATLANTA GA 30353-2609 000628 12919911950015604 7000031815948 SUMMARY PAGE Sales Sold Ship Ship To Name Region Inv Delivery Invoice Amount Org To To Num Number S000 1291991 1288928 OKALOOSA COUNTY EMS 9022262855 8022914464 109.83 S000 1291991 1288928 OKALOOSA COUNTY EMS 9022262856 8023008436 12.66 $000 1291991 1288928 OKALOOSA COUNTY EMS 9022319422 8023008410 92.22 S000 1291991 1288928 OKALOOSA COUNTY EMS 9022337960 8023000533 38.82 S000 1291991 1288928 OKALOOSA COUNTY EMS 9022337961 8023048712 26.16 S000 1291991 1288928 OKALOOSA COUNTY EMS 9022337962 8023048713 84.51 $000 1291991 1288928 OKALOOSA COUNTY EMS 9022384010 8023045517 60.57 S000 1291991 1288928 OKALOOSA COUNTY EMS 9022384011 8023092354 19.83 S000 1291991 1288928 OKALOOSA COUNTY EMS 9022384012 8023133554 132,96 $000 1291991 1288928 OKALOOSA COUNTY EMS 9022384013 8023168634 6.33 $000 1291991 1288928 OKALOOSA COUNTY EMS 9022448014 8023196449 12.66 S000 1291991 1288928 OKALOOSA COUNTY EMS 9022482748 8023179148 131.58 S000 1291991 1288928 OKALOOSA COUNTY EMS 9022482749 8023226967 71.85 $000 1291991 1288928 OKALOOSA COUNTY EMS 9022540989 8023279179 112,59 S000 1291991 1288928 OKALOOSA COUNTY EMS 9022558961 8023279177 32.49 S000 1291991 1288928 OKALOOSA COUNTY EMS 9022558962 8023314323 32,49 $000 1291991 1288928 OKALOOSA COUNTY EMS 9022558963 8023314324 19,83 So00 1291991 1288928 OKALOOSA COUNTY EMS 9022673261 8023361678 93.60 S000 1291991 1288928 OKALOOSA COUNTY EMS 9022716385 8023428198 46.53 $000 1291991 1288928 OKALOOSA COUNTY EMS 9022735313 8023467175 66.90 S000 1291991 1288928 OKALOOSA COUNTY EMS 9022735314 8023518091 64.14 $000 1291991 1288928 OKALOOSA COUNTY EMS 9022735585 8023546017 6.33 S000 1291991 1288928 OKALOOSA COUNTY EMS 9022793301 8023551336 40.20 $000 1291991 1288928 OKALOOSA COUNTY EMS 9022793302 8023551338 19.83 So00 1291991 1288928 OKALOOSA COUNTY EMS 9022854890 8023597479 32.49 S000 1291991 1288928 OKALOOSA COUNTY EMS 9022912721 8023643118 103.50 S000 1291991 1288928 OKALOOSA COUNTY EMS 9022912722 8023563786 6.33 S000 1291991 1288928 OKALOOSA COUNTY EMS 9022912723 8023672789 79.56 S000 1291991 1288928 OKALOOSA COUNTY EMS 9022912724 8023677113 79.56 $000 1291991 1288928 OKALOOSA COUNTY EMS 9022945417 8023706979 38.82 $000 1291991 1288928 OKALOOSA COUNTY EMS 9022945418 8023713230 32.49 CONTINUED SHIP TO: Airgas OKALOOSA COUNTY EMS . www.airgas.com CHRISTOPHER D TANNER, MD ss usnne cocouect ava ARCHOS PO Box 9249 ICEVILLE FL. 32578-1343 PNG Bank, ABA No 031000083 Marietta, GA 30065-2249 REV 1.1.1 SEL-001000 Page 41 of 42 CONSOLIDATED INVOICE FOR ADDRESS CORRECTIONS, PLEASE FAX NOTICE TO: 770-590-6112 Airgas ush Le INVGICE DATE PAYER INVOICE NO. DUE DATE PAY THIS AMOUNT Airgas. FO Box 8249 oo ng5-2240 Ci 01/06/2014] 1291991 | 9500156047 | 01/31/2014 $ 3,181.04 PLEASE MARK YOUR METHOD OF PAYMENT soLpBy AIRGAS USA, LLC 1 check 922 SKIPPER AVE FORT WALTON BEACH FL 32547-7315 LJ Credit Card 850-862-5214 Please visit www.airgas.com/onlinebillpay or complete the information on the reverse side of this form. PLEASE MAKE CHECKS PAYABLE AND REMIT TO: Midis fy Aa Lo TR Wo TUT cere TF BILLTO. ATTN ACCOUNTS PAYABLE . OKALOOSA CO EMS AIRGAS USA, LLC Pat 90 COLLEGE BLVD E PO BOX 532609 VA g NICEVILLE FL 32578-1343 ATLANTA GA 30353-2609 000628 4291.591159500156049700003181548 TO ENSURE PROPER CREDIT, PLEASE RETURN THE RES EARI We PORTION woH YOUR REMITTANCE, FOR QUESTION: ON ee SOLD T TERNS: g 5 TAGE: ee SUMMARY PAGE Sales Sold Ship Ship To Name Region Inv Delivery Invoice Amount Org To To Num Number $000 1291991 1288928 OKALOOSA COUNTY EMS 9022984941 8023739306 64.14 S000 1291991 1288928 OKALOOSA COUNTY EMS 9023004550 8023762473 121.11 $000 1291991 1288928 OKALOOSA COUNTY EMS 9023004551 8023521483 6.33 S000 1291991 1288928 OKALOOSA COUNTY EMS 9023004552 8023782165 68.28 $000 1291991 1288928 OKALOOSA COUNTY EMS 9023004553 8023782169 32.49 SoO00 1291991 1288928 OKALOOSA COUNTY EMS 9023071143 8023795637 57.81 S000 1291991 1288928 OKALOOSA COUNTY RMS 9023087633 8023811280 26.16 S000 1291991 1288928 OKALOOSA COUNTY EMS 9023087634 8023811281 66.90 S000 1291991 1288928 OKALOOSA COUNTY EMS 9915684755 N/A 1,031.06 ship To: $ 3,181.94 Airgas OKALOOSA COUNTY EMS www.airgas.com CHRISTOPHER D TANNER, MD 90 COLLEGE BLVD E Ans Bo0e074182 Airgas USA, LLC NICEVILLE FL 32578-1343 Ne Be PO Box 9249 Marietta, GA 30065-2249 PNC Bank, ABA No 031000053 REV 1.1.13 S54- 001000 . 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