Bill To:


BERKLEY INSURANCE
475 STEAMBOAT ROAD - FLOOR 1
GREENWICH, CT 06830-7144

Services Rendered To:


Louis V. Lepak Trucking
821 N. Portland Avenue
Oklahoma City, OK 73107
Driver: James Palmer
Policy # UPK6502567-2


Product
Price
Qty
Amount
  1. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1
    $150.00
  2. 206 Latex Gloves (Pairs Used)

    $2.00
    3
    $6.00
  3. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  4. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  5. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 5800 & 36800 Terlton, OK

Subtotal $506.00
Total Due $506.00


Updated
July 10, 2022 @ 2:23 pm

Invoice updated by Geoffrey.

Status Update
July 10, 2022 @ 2:23 pm

Status changed: Draft to Pending.