Bill To:


RLI Claims Dept.
P.O. Box 3961
Peoria, IL 61612

Services Rendered To:


Keith Roberts
Driver Phone# 318-294-6862
POLICY# 2520013312


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

    $500.00
    1
    $500.00
  2. 104 Tanker Response (Per Hour)

    $400.00
    1
    $400.00
  3. 205 Foam (Per Gallon)

    $65.00
    1
    $65.00
  4. 303 SCBA Breathing Apparatus (# Used)

    $50.00
    2
    $100.00
  5. 304 SCBA Cylinder (# Used)

    $25.00
    4
    $100.00
  6. 306 Hose Per 50′ (Amt Used)

    $25.00
    1
    $25.00
  7. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00

  8. Additional Incident Info

    Incident Type: Vehicle Fire Response

    Incident Location: 67/167- Newport, AR

Subtotal $1,440.00
Total Due $1,440.00


Updated
September 22, 2023 @ 11:02 am

Invoice updated by Geoffrey.

Status Update
September 22, 2023 @ 11:02 am

Status changed: Draft to Pending.