Jeremiah w. (Jay) Nixon Governor 2729 Plaza Drive P. O. Box 236 Jefferson City, MO 65102 Telephone: 573-751-2389 George A. Lombardi Fax: 573-526-0330 Director TDD Available State of Missouri DEPARTMENT OF CORRECTIONS Ad Excelleum Conamur ?We Strive Towards Excellence February 28, 2014 TO: Terry Russell, Warden - Eastern Rece n, Diagnostic Correctional Center FROM: Dave Dormire, Director Division of Adult Institutions SUBJECT: Execution of Michael Taylor Attached are the Sequence of Chemicals and Chemical Log forms from the execution of offender Michael Taylor #990089 on February 26, 2014. Be advised that Director Lombardi and I have both reviewed and approved these forms. I am returning these forms for placement in the of?cial execution ?le on offender Taylor, which is maintained at your facility. Thank you. DD/mas Attachments c: File STATE OF MISSOURI DEPARTMENT OF CORRECTIONS SEQUENCE OF CHEMICALS OFFENDER NAME DATE OF EXECUTION Michael Taylor #990089 February 26, 2014 Write the sequential number in which a syringe was given. If the syringe was not used, indicate ?not used?. Syringe 1 (A total of 5 grams of pentobarbital will be divided into Syringes 1 2.) i Syringe 2 - 2 Syringe 3 (30 cc saline solution with Indigo carmine) Syringe 4 (A total of 5 grams of pentobarbital will be divided into Syringes 4 5.) Syringe 5 Syringe 6 (30 cc saline solution with Indigo carmine) SIGNATURE OF DEPARTMENTAL EMF LOYEE DATE my 1 SIGNATURE or DEPARTMENTAL EMPLOYEE DATE 1 I 9 Bassinets SIGNATURE or'M ef?cTA?Raven/y SIGNATURE OF PERENNEL SECOND PERSON Is DATE M2. zap/?84} My 2 Procedures for Execution of Michael Taylor, #990089 on February 26, 2014 Page 61 i: STATE OF MISSOURI DEPARTMENT OF CORRECTIONS CHEMICAL LOG OFFENDER NAME DATE OF execun ON Michael Taylor #990089 February 26, 2014 State the quantities of chemicals used and discarded. - - f1 i' entob arbital - {give em; Wig-am .25- t- Valium \fe I ANOTHER CHEM ICALWAS USED.WRITE CHEMICAL NAME BELOW. 2 ANOTHER CHEMICALWAS USED. WRITE IN THE CHEMICAL NAME BE LOW SIGNATURE OF MEDICAL PERSONNEL DATE 3 ?575/774/ SIGNATURE OF MEDICAL PERSONNEL (WHEN RSON IS PRESENT) o?Mlo Procedures for Execution of Michael Taylor, #990089 on February 26, 2014 Page 62 STATE OF MISSOURI - CSIM TRA - [n - I (a A W163 ox 0? OKMH mom 7 TO . if Tun 5.. wwgor? INS SIREMARKS i .CALL . "1 959:3} 3?95: NE SE FEE I Inventory Date: EFLULIJ cur DUTY OFFICER MEDICATION INSPECTION Inspection Week: I I Duty Of?cer Name: I Drug Name Vial Size EXpiration Date Total of Vials Diazepam Tablets Haloperidol Injection I 50mg I 10 ml I 0% . 3I?l 5" Heparin Lock Hydromorphone (Dilaudid) 50 mg 5 3? Ketamine Hydrochloride 120 ml 5? Lidocaine 1% HCI Injection I 10 mg I ml I Methylene Blue I 10 ml Flumazenil 5 ml RomaziconIS ml I34 I ll Pentobarbital I 100 ml :2 Via m4 Sodium Chloride - Bags I Spectrum Trays /0 fr; (0 - Sterile Water - Bottles RD :5 5 lg ?l m. Versed 5 ml (Midazolam HCI InjectionIii/??9 7 Z). gr (3 3 Comments: I Ir \110 I I . S?eu?cagb mm) 1? (fame. 1 I 90 Ava. QV) ?44.:ng (?beg I: I '.33. vi? 2'33 INVENTORY CONTROL NUMBER: NOTE: Ouanh'fy exprass in or Harms. EASTERN RECEPTION DIAGNOSTIC 8. CORRECTIONAL CENTER CHEMICAL CONTROL RECORD CAPITAL PUNISHMENT TRANSACTIONS ATTACHMENT A YEAR: PAGE: WE *6 -MW7 ('ADDIUSEDIDISPOSED 3 2 n: 5 DATE INVENTORY TRANSACTION a 8 a: ?2 WITNESS W4 diva!? VW Control No. MISSOURI DEPARTMENT CONFIDENTIAL EXECUTION TEAM MEMBER RECEIPT For and in consideration of services performed for the State of Missouri identi?ed as follows: DI Execution El Consultation Training El Litigation Preparation and Testimony ERG tPaid: 5 Amount Returned'l'o OffenderFinance Of?ce: 17.5. I hereby acknowledge receipt of the amou .naid tome by the Missouri De armth of Corrections, Division of Adult Institutions. Distribution: \Vhite Seri'ice Provider; Canary Director, Division of Adult Institutions; Pink - Offender Finance Of?ce Control No. A MISSOURI DEPARTMENT OF CORRECTIONS Execution Services Voucher Services Rendered: Date Amount egg/I": I 2 95' .- Cj 323;, U. i. A Offender Name Offender ID. Date of Execution 19/ re; Funds Disbursed By: fr Date .1 r' -. Fun lire-m a - -f . Distribution: White Offender Of?ce: Canary -- Division of Adult Institutia .- Jeremiah W. (Jay) Nixon Governor 2729 Plaza Drive P. O. Box 236 Jefferson City, MO 65102 Telephone: 573-751-2389 George A. Lombardi - Fax: 573-751-4099 Director TDD Available State of Missouri DEPARTMENT OF CORRECTIONS Ad Excelleum Conamur ?We Strive Towards Excellence? CON FIDENTIAL EMORANDUM February 21, 2014 TO: Lenny Lenger, Comptroller Fiscal Mana ment Unit FROM: Dave Dormire, Director Division of Adult Institutions SUBJECT: Payment for Contracted Providers Assisting in Executions I am requesting $12,578.88 for payment of execution services to one contracted provider associated with the execution of Michael Taylor #990089 on February 26, 2014. One provider - $7,178.88 One provider - $3,000 One provider - $2,400 Thank you. DD/mas 0: File STATE OF MISSOURI . PURCHASE ORDER ORDER NUMBER MODIFICATIONHUMBEFI LINKING-0N AOENOYOROANIZATION ORDERDATE SC 931 951/3120 02-19-2014 REOUISITION NUMBER VENDOR CODE PAGE 01 CONTACT PERSONS NAME AND PHONE NUMBER TERMS DELIVERY DATE F.O.B. 573-526-6400 03-19-2014 SEE BELOW SHIP TO: (ORDER NUMBER MUST ADREAR ON SHIPPING HO DEPARTMENT OF CORRECTIONS CORR INMATE ACCOUNT FUND DIR-DIV OF ADULT INSTITUTIONS PO BOX 1609 2715 PLAZA DRIVE-LOWER LEVEL JEFFERSON CITY: MO 65109 JEFFERSON CITY MO 65102-1609 BILL TO: ORIGINAL AND THREE COPIES) ORDER NUMBER MUST APPEAR ON ALL OOPIES HO DEPARTMENT OF CORRECT IONS PAYABL THIS ORDER ISSUE ECT TO THE TERMS AND CONDITI 0 Box 2 5 6 .1 ONS NUMBER THE REFERENOED SOLICITATION DOOLIUENT As WELL AS THOSE ATTACHEDHERETO- JEFFERSON CITY MO 65102 ORD QUANTITY . UNIT COMMODITY CODE AND DESCRIPTION LINE ORDERED UNIT PRICE AMOUNT 0/5 CODE: 94943 001 HEDICAL CONSULTING HEDICAL SERVICES PAYHENT FOR CONTRACTED PROVIDERS ASSIST IN EXECUTIONS ATTENTION ACCOUNTS PAYABLE COORDINATE FAYHENT THROUGH LENNY LEHGER I VENDOR ?rx N. 6 0101.3120.9860.Y603.2453 FINAL PAGE TOTAL 18000.00 AUTHORIZED SIGNATUREISI I CERTIFY THAT THE OBIJGATION REPRESENTED HEREON HAS BEEN CHARGED AGAINST THE UNENCUMBERED BALANCE OF THE APPROPRIATION AND THE EXPENDITURE AUTHORIZED IS WITHIN THE PURPOSE OF THE APPROPRIATION. COMMISSIONER OF MINISTRATION SIGNATURE MILL. 300 14.35 12-95; VENDOR COPY UAII: - -. STATE OF MISSOURI 02/19f14 DEPARTMENT OF DIVISION SECTION INSTITUTION DAI/Centrai Office - Director's office SAGE 1 OF 1 PURCHASE DEPARTMENTAL PURCHASE ORDER {soon - $3000.00} POO OR DEPARTMENT CREDIT CARD LOCAL PURCHASE (53000.01 - 524399.99) PDQ OR 505 CANTEEN PURCHASE ONE TIME PURCHASE (525.000 AND MVE PURCHASE (ANY AMOUNT) I: CONTRACT PURCHASE (ANY 3 - PGO OR SC CONTRACT CONTRACT (INCLUDING AOC. CANTEEN. MOU. PARTNERSHIP-COMMUNITY AGREEMENT. SDA. WORK AGREEMENT. ETC.) [3 AMEND A CONTRACT CURRENT CONTRACT ESTABLISH A CONTRACT (NEW OR REPLACEMENT) RENEWIEXTEND A CONTRACT REVENUE GENERATING (LE. LAUNDRY. LEASES. RECYCLING. SCRAP METAL. WASTE TIRE. ETC.) YEARLY VENDOR NAME VENDOR A Corrections Inmate Account Fund ADDRESS FAX CONTACT PHONE E-MAIL [3 ADDITIONAL VENDORS LISTED ON AN ATTACHED SHEET COMM EXTENDED RIPTIO UNIT COST No_ SE OF ITEM Is RVICES COQE OTY UNIT COST 001 Payment for Contracted Providers who Assist in 1 ea 5 18,000.00 5 18,000.00 Executions REASON FOR PURCHASE Payment for Contracted Providers who Assist in Executions PAGE TOTAL 5 18 000 00 SHIP TO ADDRESS SHIP 0 CODE PM TO CODE . . ORDER TDTA 2729 PIaza Drive. Jefferson Clty, MO 65109 Y70 13,000.00 FUND: UCANTEEN UFEDERAL GRANT-CAT A [3 GENERAL REVENUE IRP [3 WORKING CAPITAL OTHER ITEM No QTY 2-3 FUND AGENCY APR UNIT ACTIVITY OBJ SUB AMOUNT AUTHORIZED SIGNATURE DATE SIGNATURE DATE STED BY NAME LE 1 . 3'de DDSINESS MANAGER SIGNATURE i NAME-TITLE Mo 9314333 Iacs: .-REDUESTOR