Okaloosa County BOCC — May 20, 2014 — Airgas Invoice-April 2014 — reading text

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: ITT 8 Tees PALLET PUPAL UL PEGI Fe] || Pe auto ATTN ACCOUNTS PAYABLE PY A Poi Yc oi GT UT CP ba .. OKALOOSA CO EMS AIRGAS USA, LLC bese 90 COLLEGE BLVD E PO BOX 532609 : NICEVILLE FL 32578-1343 ATLANTA GA 30353-2609 000158 12519511950018823000002784bb3 NICEVILLE EMS S048 1025028897 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 S048 1025028897 03 OX USP125 S048 1 CL 1 1 14.04 Ch 14.04 N (Vol: 127 FT3) OXYGEN USP 125 Sale subtotal: 71,01 Delivery Flat Fee 13.50 SHIP TO: 1288928 Air as OKALOOSA COUNTY EMS FOR WIRE TRANSEER PAYMENTS CHRISTOPHER D TANNER, MD firgas be Lio SO COLLEGE BLVD E Act No, 9606074182 PO Box 9249 NICEVILLE Fi. 32578-1343 PNC Bank, ABA No 031000053 Marietta, GA 30065-2249 REV 1.1.19 670709 Paae 36 of 39 CONSOLIDATED RENTAL 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. FiO Box O49 a5 0949 05/05/2014f 1201991 9500188230 | 05/31/2014 | SEE SUMMARY PAGE PLEASE MARK YOUR METHOD OF PAYMENT so.pBy AIRGAS USA, LLC 922 SKIPPER AVE H Ce ard FORT WALTON BEACH FL 32547-7315 reall Vari 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: ITAL [en PLL PLA LP 11 Fen | TP | PET sutto ATTN ACCOUNTS PAYABLE M Adtis bata Uo Th bide LY OU Ee _. OKALOOSA CO EMS AIRGAS USA, LLC baa 90 COLLEGE BLVD E PO BOX 532609 NICEVILLE FL 32578-1343 ATLANTA GA 30353-2609 000158 429499119500188235000002764bb4 RRCYLMLG-OX - Rent Cyl Med Large Oxygen 18 28 28 0 18 18 0 0 $0.26/DAY RRCYLMXS-OX ~- Rent Cyl Med Xs Oxygen 135 170 169 0 136 0 136 4077 $0.22/DAY $896.94 N 153 198 197 0 154 $896.94 Important. See the Notice Regarding Cylinder Rentals/Leases and Responsibility on the Reverse sicte of this form. You will be deemed to have accepted the provisions in the said $ 896.94 Nottce 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. FOR WIRE TRANSFER PAYMENTS SHIP TO: 1288928 AIRGAS USA, LLC Airgas. CHRISTOPNER D TANNER, MD Acct No. 8606074182 + wranalrgas. , PNG Bank, ABA No 031000053 Airgas USA, LLC WW ANTGAS.COM GO COLLEGE BLVD E PO Box 9249 NICEVILLE FL 32578-1343 Marietta, GA 30065-2249 SEL - 001000 REV 1.1.13 Paae 37 of 39 Airgas USA, LLC PO Box 9249 Marietta, GA 30065-2249 Ct Airgas. CONSOLIDATED INVOICE FOR ADDRESS CORRECTIONS, PLEASE FAX NOTICE TO: 770-590-6112 INVOICE DATE PAYER INVOICE NO. DUE DATE PAY THIS AMOUNT 05/05/2014, 1291991 §f 9500188230 § 05/31/2014 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: Mt fed etal tl ballleeredliv so.osy AIRGAS USA, LLC oO Check 922 SKIPPER AVE F | credit Card FORT WALTON BEACH FL 32547-7315 reall war 850-862-5214 BILLTO. }=»=ATTN ACCOUNTS PAYABLE OKALOOSA CO EMS 90 COLLEGE BLVD E NICEVILLE FL 32578-1343 @ 000158 AIRGAS USA, LLC PO BOX 532609 ATLANTA GA 30353-2609 429199339500148423000002784bb3 10 ENSURE PROPER CREDIT, PLEASE RETURN THE Ween PORTION WITH YOUR REMITTANCE, FOR QUESTIONS ae foun ACCOUNT PLEASE CALL: 800- ae $698 SUMMARY PAGE Sales Sold Ship Ship To Name Region Inv Delivery Invoice Amount Org To To Num Number S000 1291991 1288928 OKALOOSA COUNTY EMS 9026059447 8026858350 106.26 S000 1291991 1288928 OKALOOSA COUNTY EMS 9026089311 8026906788 19.83 So00 1291991 1288928 OKALOOSA COUNTY EMS 9026089312 8026906802 38.82 SOOO 1291991 1288928 OKALOOSA COUNTY EMS 9026089313 8026943921 6.33 S000 1291991 1288928 OKALOOSA COUNTY EMS 9026134091 8026958580 26.16 S000 1291991 1288928 OKALOOSA COUNTY EMS 9026134092 8026958581 19.83 $000 1291991 1288928 OKALOOSA COUNTY EMS 9026134093 8026958582 26.16 S000 1291991 1288928 OKALOOSA COUNTY EMS 9026209462 8026988727 38.82 $000 1291991 1288928 OKALOOSA COUNTY EMS 9026253781 8027056035 65.52 S000 1291991 1288928 OKALOOSA COUNTY EMS 9026297187 8027094541 85.89 S000 1291991 1288928 OKALOOSA COUNTY EMS 9026365427 8027145720 79.56 S000 1291991 1288928 OKALOOSA COUNTY EMS 9026365428 8027206733 26.16 $000 1291991 1288928 OKALOOSA COUNTY EMS 9026365429 8027206734 32.49 S000 1291991 1288928 OKALOOSA COUNTY EMS 9026365430 8027256881 6.33 S000 1291991 1288928 OKALOOSA COUNTY EMS 9026479510 8027240582 107.64 SOOO 1291991 1288928 OKALOOSA COUNTY EMS 9026520417 8027287684 92.22 S000 1291991 1288928 OKALOOSA COUNTY EMS 9026520418 8027348053 64.14 S000 1291991 1288928 OKALOOSA COUNTY EMS 9026561654 8027385677 89.46 S000 1291991 1288928 OKALOOSA COUNTY EMS 9026561935 8027431615 6.33 S000 1291991 1288928 OKALOOSA COUNTY EMS 9026594018 8027408137 51.48 S000 1291991 1288928 OKALOOSA COUNTY EMS 9026594019 8027437191 19.83 S000 1291991 1288928 OKALOOSA COUNTY EMS 9026594020 8027437192 19.83 $000 1291991 1288928 OKALOOSA COUNTY EMS 9026594021 8027437196 54.24 8000 1291991 1288928 OKALOOSA COUNTY EMS 9026664429 8027528024 12.66 $000 1291991 1288928 OKALOOSA COUNTY EMS 9026684660 8027020775 38.82 S000 1291991 1288928 OKALOOSA COUNTY EMS 9026684661 8027476263 130.20 S000 1291991 1288928 OKALOOSA COUNTY EMS 9026684662 8027532510 98.55 S000 1291991 1288928 OKALOOSA COUNTY EMS 9026752125 8027560856 118.92 $000 1291991 1288928 OKALOOSA COUNTY EMS 9026816015 8027621691 19.83 so00 1291991 1288928 OKALOOSA COUNTY EMS 9026816016 8027621692 66.90 S000 1291991 1288928 OKALOOSA COUNTY EMS 9026816017 8027670607 19.83 CONTINUED SHIP TO: OKALOOSA COUNTY EMS Airgas. Airgas USA, LLC PO Box 9249 Marietta, GA 30065-2249 wwwairgas.com CHRISTOPHER D TANNER, MD 90 COLLEGE BLVD E NICEVILLE FL 32578-1343 SEL - 001000 REV 1.1.13 Paae 38 of 39 AIRGAS USA, LLC Acct No. 8606074182 PNG Bank, ABA No 031000053 COUNSULIVAIED INVUIGE FOR ADDRESS CORRECTIONS, PLEASE FAX NOTICE TO: 770-590-6112 Alrgas | USA, gic INVOICE DATE PAYER INVOICE NO. ‘DUE DATE PAY THIS AMOUNT Airgas. ¢ iO Box 949 065-2240 ciffos05/2014} 1291991} 9500188230 f 05/31/2014 $ 2,784.66 PLEASE MARK YOUR METHOD OF PAYMENT sotpBy AIRGAS USA, LLC Cd Check 922 SKIPPER AVE i 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: Mal oflandyotboe]g Upstut Had pA) cO[] esa T fesrgyrepsed fa peagl BULTO ATTN ACCOUNTS PAYABLE ALE ed efef pode delet A Lea erage dle gu, OKALOOSA CO EMS AIRGAS USA, LLC bake 90 COLLEGE BLVD E PO BOX 532609 i NICEVILLE FL 32578-1343 ATLANTA GA 30353-2609 000158 129159911950018823000002784bb3 10 ENSURE eres CREDIT, PLEASE RETURN THE UPPER RON wil YOUR EMITTANCE: FOR QUESTIONS oe ACCOUNT PLEASE CALL: 800, BPE 0693 SUMMARY PAGE Sales Sold Ship Ship To Name Region Inv Delivery Invoice Amount Org To To Num Number So00 1291991 1288928 OKALOOSA COUNTY EMS 9026887454 8027744394 18.99 S000 1291991 1288928 OKALOOSA COUNTY EMS 9026969075 8027765732 32.49 S000 1291991 1288928 OKALOOSA COUNTY EMS 9026969076 8027816846 84.51 So00 1291991 1288928 OKALOOSA COUNTY EMS 9027120174 8027765743 78.18 S000 1291991 1288928 OKALOOSA COUNTY EMS 9027120365 8027867574 84.51 SOOO 1291991 1288928 OKALOOSA COUNTY EMS 9918644067 N/A 896.94 $ 2,784.66 SHIP TO: . OKALOOSA COUNTY EMS Airgas. www.airgas.com CHRISTOPHER D TANNER, MD AIRGAS USA, LLC 90 COLLEGE BLVD E Airgas USA, LLC PO Box 9249 NICEVILLE FL 32578-1343 Marietta, GA 30065-2249 Acct No. 8606074182 PNC Bank, ABA No 031000053 REV 1.1.19 S84-201000 Paae 39 of 39