Bill To:


Farmers Insurance
PO Box 268993
Oklahoma City, OK 73126

Services Rendered To:


Stephanie Sewell
Claim# 7003447467-1


Product
Price
Qty
Amount
  1. 104 Tanker Response (Per Hour)

    $300.00
    1
    $300.00
  2. 218 Cervical Collar (# Used)

    $25.00
    1
    $25.00
  3. 203 Oil Boom (# Used)

    $20.00
    1
    $20.00
  4. 201 Oil Absorbent Material (# Used)

    $35.00
    1
    $35.00
  5. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  6. 215 Trauma Kit (# Used)

    $25.00
    1
    $25.00
  7. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00
  8. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00
  9. 419 Environmental Spill

    $250.00
    1
    $250.00

  10. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 12021 FM 730 N- Azle, TX

    Ordinance Info: Briar Reno Cost Recovery Ordinance

Subtotal $1,255.00
Total Due $1,255.00


Updated
June 13, 2023 @ 10:55 am

Invoice updated by Geoffrey.

Status Update
June 13, 2023 @ 10:55 am

Status changed: Draft to Pending.

Updated
November 30, 2023 @ 2:14 pm

Invoice updated by Geoffrey.