Bill To:


STATE FARM INSURANCE
PO BOX 52250
PHOENIX, AZ 85072-2250

Services Rendered To:


Kodah Gregory
3216 Bermuda Ave
Sand Springs, OK 74063
POLICY# 469-7014-F23-36

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
OK-41-013-23-363 11/19/2023 11/27/2023 On Receipt Wellston FD

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

    $500.00
    1.5
    $750.00
  2. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00
  3. 208 Fire Line Tap (Per Foot, Amt Used)

    $0.25
    100
    $25.00
  4. 402 Fire/Police Services (Per Hour)    

    $100.00
    1.5
    $150.00
  5. 206 Latex Gloves (Pairs Used)

    $2.00
    8
    $16.00
  6. 301 Hand Tool (# Used)

    $15.00
    2
    $30.00
  7. 201 Oil Absorbent Material (# Used)

    $35.00
    1
    $35.00
  8. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.5
    $150.00

  9. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Turner Turnpike MM161- Wellston, OK

Subtotal $1,406.00
Total Due $1,406.00


Updated
November 27, 2023 @ 9:46 pm

Invoice updated by Geoffrey.

Status Update
November 27, 2023 @ 9:46 pm

Status changed: Draft to Pending.