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

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