Bill To:


Mohave Insurance Center
1875 Robinson Avenue
Kingman, AZ 86401

Services Rendered To:


Singh is King Transport, LLC
465 Maltbie Street, # 302
Lawrenceville, GA 30046
Driver: Anthony Matthew Navarro
Policy # 4R03027
CLAIM # 491149309

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-AK-305-22-69 04/08/2022 04/25/2022 On Receipt San Felipe Frydek V.F.D.

Product
Price
Qty
Amount
  1. 102 Engine Response (Per Hour)

    $350.00
    2.25
    $787.50
  2. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    2.25
    $337.50
  3. 105 Utility Vehicle Response (Per Hour)

    $150.00
    2.25
    $337.50
  4. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00
  5. 402 Fire/Police Services (Per Hour)    

    $100.00
    2.25
    $225.00
  6. 301 Hand Tool (# Used)

    $15.00
    2
    $30.00
  7. 417 Spill Containment – MICROBLAZE 5 Gallons

    MICROBLAZE is an emergency liquid spill control product for spill response and spill containment.

    $200.00
    1
    $200.00

  8. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 725 Interstate 10 Eastbound - Sealy, Texas

Subtotal $2,167.50
Total Due $2,167.50


Updated
April 25, 2022 @ 1:40 pm

Invoice updated by Geoffrey.

Status Update
April 25, 2022 @ 1:41 pm

Status changed: Draft to Pending.

Updated
April 25, 2022 @ 1:41 pm

Invoice updated by Geoffrey.

Updated
May 19, 2022 @ 4:01 pm

Invoice updated by Geoffrey.

Updated
July 12, 2022 @ 7:19 pm

Invoice updated by Geoffrey.

Updated
August 23, 2022 @ 4:11 pm

Invoice updated by Geoffrey.

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