Bill To:


SHELTER INSURANCE
1817 WEST BROADWAY
COLUMBIA, MO 65203-1107

Services Rendered To:


James Cook
106800 S. 4110 Road
Checotah, OK 74426
Policy # GL2993590
CLAIM # GL2993590

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
OK-49-007-2021-68 04/01/2021 04/07/2021 On Receipt F.A.I.C. V.F.D.

Product
Price
Qty
Amount
  1. 103 Rescue Response (Per Hour)

    $500.00
    2
    $1,000.00
  2. 102 Engine Response (Per Hour)

    $500.00
    2
    $1,000.00
  3. 105 Utility Vehicle Response (Per Hour)

    $500.00
    2
    $1,000.00

  4. Additional Incident Info

    Incident Type: Structure Fire Response

    Incident Location: 106800 S. 4110 Road Checotah, OK 74426

Subtotal $3,000.00
Total Due $3,000.00


Updated
April 7, 2021 @ 4:50 pm

Invoice updated by Geoffrey.

Status Update
April 7, 2021 @ 4:50 pm

Status changed: Draft to Pending.

Updated
April 7, 2021 @ 4:51 pm

Invoice updated by Geoffrey.

Updated
April 7, 2021 @ 4:54 pm

Invoice updated by Geoffrey.

Updated
August 28, 2021 @ 1:28 pm

Invoice updated by Geoffrey.

Updated
August 28, 2021 @ 1:30 pm

Invoice updated by Geoffrey.

Updated
October 4, 2021 @ 2:20 pm

Invoice updated by Geoffrey.

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