Bill To:


KENTUCKY FARM BUREAU MUTUAL
9201 BUNSEN PARKWAY
LOUISVILLE, KY 40220-3792

Services Rendered To:


Kelli Claypool
200 Showgait Lane
Columbia, KY 42728
Policy # 002003829


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

    $350.00
    1.5
    $525.00
  2. 103 Rescue Response (Per Hour)

    $300.00
    1.5
    $450.00
  3. 218 Cervical Collar (# Used)

    $25.00
    1
    $25.00
  4. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  5. 209 Extinguisher (# Used)

    $50.00
    1
    $50.00
  6. 310 Hydraulic Tool (# Used)

    $200.00
    1
    $200.00
  7. 206 Latex Gloves (Pairs Used)

    $2.00
    8
    $16.00
  8. 301 Hand Tool (# Used)

    $15.00
    2
    $30.00
  9. 201 Oil Absorbent Material (# Used)

    $35.00
    4
    $140.00
  10. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.5
    $150.00
  11. 215 Trauma Kit (# Used)

    $25.00
    1
    $25.00
  12. 306 Hose Per 50′ (Amt Used)

    $25.00
    2
    $50.00
  13. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  14. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 169 Chestnut Grove Road - Columbia, Kentucky

Subtotal $2,161.00
Total Due $2,161.00


Updated
October 12, 2021 @ 2:07 pm

Invoice updated by Geoffrey.

Status Update
October 12, 2021 @ 2:07 pm

Status changed: Draft to Pending.

Viewed
October 25, 2022 @ 2:37 am

Invoice viewed by 64.124.8.53 for the first time.