Bill To:


Roger Howton
415730 E. 1093 Rd.
Checotah, OK 74426

Services Rendered To:


Policy# 195740810
Roger Howton
415730 E. 1093 Rd.
Checotah, OK 74426

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
OK-49-015-22-205 05/02/2022 05/05/2022 On Receipt Tiger Mountain Fire Dept.

*** THIS HAS BEEN SUBMITTED TO YOUR INSURANCE COMPANY AND DENIED. THIS IS NOW YOUR RESPONSIBILITY. ***

Product
Price
Qty
Amount
  1. 103 Rescue Response (Per Hour)

    $500.00
    1.25
    $625.00
  2. 102 Engine Response (Per Hour)

    $500.00
    1.25
    $625.00
  3. 105 Utility Vehicle Response (Per Hour)

    $500.00
    1.25
    $625.00
  4. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.25
    $125.00
  5. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  6. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: I 40 WB, MM256, Henryetta, OK

    Ordinance Info: Tiger Mountain - McIntosh County Resolution 72021

Subtotal $2,250.00
Total Due $2,250.00


Updated
May 4, 2022 @ 12:07 pm

Invoice updated by Karen Smith.

Status Update
May 4, 2022 @ 12:07 pm

Status changed: Draft to Pending.

Updated
March 28, 2023 @ 11:44 am

Invoice updated by Geoffrey.

Viewed
March 28, 2023 @ 11:44 am

Invoice viewed by GEOFFREY SMITH (Geoffrey) for the first time.

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November 1, 2023 @ 5:37 pm

Invoice viewed by 77.100.104.39 for the first time.

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Invoice viewed by 195.113.175.60 for the first time.