Okaloosa County BOCC — August 19, 2014 — FUEL INVOICE — reading text

Okaloosa County Clerk of the Circuit Court **PLEASE RETURN YELLOW FORM Ni ee mo WITH THE RESUBMITTED CONTRACT**** To: Fleet & From: Jodi K Gates, Financial Services Manager) Date: 7/14/14 \ Re: —_ Return Payment Request Notification REFERENCE MATERIAL: e The County’s Policy and Procedure Manual and forms are available online at http://www.co.okaloosa.fl.us/Purchasing Documents.html. e All contracts/leases can be viewed at http://www2.co.okaloosa.fl.us/contracts/defaultpage.aspx. THE FOLLOWING PAYMENT REQUEST IS BEING RETURN DUE TO ONE OR MORE OF THE FOLLOWING REASONS: Pricing/rates are not contracted values. Confirm. O Invoiced items not covered under contract. C1 Invoice removed from contract payment form for the following reason: Invoice #: Invoice Date: Invoice Amount Other After the Fact P/O. P/o was not approved on requested or order date. ****NOTE: 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 OKALOOSA COUNTY BOARD OF COUNTY COMMISSIONERS SEND ALL INVOICES TO: OKALOOSA COUNTY FINANCE DEPARTMENT 302 N Wilson Street, Suite 203 Crestview, FL 32536 PURCHASE ORDER NO. PAGE NO. 1 FLORIDA SALES TAX EXEMPT #85-8013105818C-2 21401569 FEDERAL TAX IDENTIFICATION VENDOR 21300299 RETIF OIL & FUEL LLC DEPT # 2000 #59-6000765 SHIP FLEET OPERATIONS Y: READY AVENUE FT WALTON BEACH FL P O BOX 62600 32548 NEW ORLEANS LA 70162-2600 ATTN: JOE ORDERDATE: 06/27/14 suver NATHAN REQ. #: R1401731 reg. pate:06/25/14 TERMS: NET 30 DAYS FOB!) DESTINATION Desc: GASOLINE FUEL DELIVERY FO ITEM NO. QUANTITY DESCRIPTION UNIT PRICE EXTENSION Fuel delivery must arrive on Friday 6-27-14 by 3pm and include a bill lading. The invoice must be done in net gallons. o1 7500.00 EA 7500 GALLONS GASOLINE FUEL FOR TANK #2 2.9310 21,982.50 IN FORT WALTON BEACH READY AVE LOCATION. 02 7500.00 EA POLLUTION TAX -0207 155.25 03 7500.00 EA FL EXCISE TAX 1723 1, 292.25 04 7500.00 EA FEDERAL LUST -0010 7.50 05 7500.00 EA FEDERAL SUPERFUND -0017 12.675 06 7500.00 EA OKALOOSA COUNTY TAX -0610 457.50 07 7500.00 EA FL MIN GAS TAX -1080 810.00 ‘\ 4 DEPT NO. ACCOUNT AMOUNT PROJECT CODE] PAGE TOTAL $24,717.75 5200 552014 24,717.75 pene Fol {30/1 AUTHORIZED/APPROVED SIGNATURE ! Retif Oil & Fuel, LLC Original Invoice PO Box 62600 * Dept 2000 Page | New Orleans, LA 70162-2600 RETIF OIL & FUEL Ph (504) 349-9000 * (800) 349-9000 Invoice No: 000832684 Invoice Date: 06/27/2014 Order No: 075263200 Load Date: 06/27/2014 Purchase Order No: 214015669 Reference No: 0 Bill of Lading No: 981445 Shipped Via: RETIF OIL & FUEL LLC LW/TS/DEL 6/27/TANK# 2 Bill To: 15253 Ship To: 15253A Okaloosa County Commissioners Okaloosa County Commissi 302 N Wilson St 84 Ready Ave Suite 203 WM 390666 Crestview, FL 32536 Fort Walton Bea, FL 32548 Product Description Price Order Qty Ship Qty Extended Price 30QB ~—00 Unleaded E-10 Gas 87 (9.0 LB) 2.931 7,500.00 7,380.00 $21,630.78 GASOLINE ETHANOL BLEND, 3, UN1203, PG II FEGEX FEDERAL GASOLINE EXCISE EXEMPT 0.000 7,380.00 $0.00 State Agency FEGLT FEDERAL GASOLINE LUST TAX 0.001 7,380.00 $7.38 FESET FED SUPERFND/ETHANL ADJ .00171 0.00171 7,380.00 $12.62 FL46GS FL OKALOOSA CO LOCAL OPT GAS 0.062 7,380.00 $457.56 FLGET FLORIDA GASOLINE EXCISE TAX 0.17225 7,380.00 $1,271.21 FLPT FL POLLUTANT FUEL TX (COMBINED 0.02072 7,380.00 $152.91 FMINGS FL LOCAL OPTION MIN GAS TAX 0.110 7,380.00 $811.80 Date Due: 07/27/2014 Invoice Total: $24,344.26 VENDOR Department ACCOUNT, INT. DATE. —, — =ANap= RETIF OIL & FUEL = == —_ Dept, 2000 * P.O. Box 62600 + New Orleans, LA 70162-2600 =N se = (504) 349-9000 + 1-800;349-9000 + Fax (504) 349-9009 Invoice Date = ™ New Orleans © Lafayette e Houma * Mobile * Dothan 832684 06/27/14 Order No. Ship Date 752632,00 06/27/14 Bill To Number Ship To Number Cust.P.O.# BL # Terr./Sales 15253 15253A 214015649 981445 47 al LW/TS/DEL 6/27/TANK# 2 BILL TO SHIP TO Okaloosa County Commissioners Okaloosa County Commissi 302 N Wilson St 84 Ready Ave Suite 203 WM 390666 Crestview FL 32536 Fort Walton Bea FL 32548 Shipped Via RETIF OIL & FUEL LLC Number Pkg Description Quantity Price Amount 300B 00 GaL. Unleaded E-10 Gas 87 (9.0 L 981445 ©.7,380.0 2.93100 21,630.78 GASOLINE ETHANOL BLEND, 3, UN1203, PG IT Sub-Total : 21,630.78 ). FEDERAL GASOLINE EXCISE EXEMPT 7,380.0 0.00000 0.00 State Agency : FEDERAL GASOLINE LUST TAX 7,380.0 0.00100 7.38 FED 'SUPERFND/ETHANL ADJ .00171 : 7,380.0 0.00171 12.62 FL. OKALOOSA CO LOCAL OPT GAS 7,380.0 0.06200 457.56 FLORIDA GASOLINE EXCISE TAX » 7,380.0 0.17225 1,271.21 FL. POLLUTANT. FUEL TX (COMBINED lL 7,380.0 0.02072 152.91 FL LOCAL OPTION MIN GAS TAX : 7,380.0 0.11000 811.80 Invoice Total 24,344.26 mya 7 ANTS 4 Due 3.30 Days Terms: Net Upon Receipt Material Safety Data Sheets Available Upon Request 24 Hour Emergency Contact Number (800) 535-5053 INFO TRAC 15007 e RETIF OIL & FUEL 39 OU Dept. 20 100 - P.O. Box 62600 + New. Orleans, LA:70162-2600 (504) 349-9000 + 1-800-349-9000 » Fax (504) 349-9009 New/Orleans - Lafayette = Houma * Mobile * Dothan DIESEL - OIL GREASE GASOLINE = BULK OIL FUEL DOCK =: PAINT CHEMICAL -| SOLVENT | i | i | a SOLD To: Okeb 50 (Zoe Conerat $cionert ADDRESS: Fe Reacts, Aue. Fart Hera Ee el £0. B25 9% Boel Get Fist 220 Lote [Rote een ea] NO. | KIND PRODUCT DESCRIPTION GAL Tas, | UNIT PRICE]. AMOUNT | | NA1993; Diesél Fuel, 3, PG Ill : i | i | DATE DYED DIESEL FUEL Nontaxable Use Only Penalty For Taxable Use Not Legal For Motor Vehicle Use: NA: 1993, Diesel Fuel, 3,:PG-It '| Diesel - Road Tax ‘This, Diesel Fuel Does Not Contain i Visible Evidence of Dye i UN1203, Gasoline, 3, PG Il Extra Unleaded 5 UNi203, Gasoline, 3. PGT ; i Plus = Unleaded BAe i Lie i | UNTZ03. Gasoline. 3. PGT ; on Es 18.50} 8). \Gnieaces: | T5OO | 87.E-/0 Federel Superfund i Underground Storage Tank Fee 24 Hour Emergency Contact Number 800-535-5053 INFOTRAC Material Safety Data Sheets Upon Repues i Driver Ki Cun | ‘IRectd by x CL mine amD 423279