Bill To:


Kraus-Anderson Insurance
420 Gateway Blvd
Burnsville, MN 55337

Services Rendered To:


Braun Intertec Corp
11001 Hamshire Ave
Minneapolis, MN 55438
POLICY# 8109N171016

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
OK-16-016-23-546 11/14/2023 11/28/2023 On Receipt Wichita Mountain Estates V.F.D.

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

    $500.00
    1
    $500.00
  2. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  3. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  4. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: ST Hwy 49 @ Hwy 44- Medicine Park, OK

    Ordinance Info: Wichita Mountain Estates Resolution- 1-1-23

Subtotal $850.00
Total Due $850.00


Updated
November 28, 2023 @ 1:04 pm

Invoice updated by Geoffrey.

Status Update
November 28, 2023 @ 1:04 pm

Status changed: Draft to Pending.