Bill To:


Dakota Yarbrough
26048 CR 1480
Cyril, OK 73029

Services Rendered To:


Dakota Yarbrough
26048 C.R. 1480
Cyril, OK 73029
POLICY # 481 1754-C03-36


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

Product
Price
Qty
Amount
  1. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    1
    $150.00
  2. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1
    $150.00
  3. 218 Cervical Collar (# Used)

    $25.00
    1
    $25.00
  4. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00
  5. 206 Latex Gloves (Pairs Used)

    $2.00
    4
    $8.00
  6. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  7. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  8. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Interstate 44 @ MM 44 - Lawton, OK

Subtotal $933.00
Total Due $933.00


Updated
July 10, 2022 @ 6:58 pm

Invoice updated by Geoffrey.

Status Update
July 10, 2022 @ 6:58 pm

Status changed: Draft to Pending.

Updated
August 22, 2022 @ 8:28 pm

Invoice updated by Geoffrey.

Viewed
October 25, 2022 @ 2:44 pm

Invoice viewed by 64.124.8.25 for the first time.