Bill To:


SHELTER INSURANCE
1817 WEST BROADWAY
COLUMBIA, MO 65203-1107

Services Rendered To:


Tyler Tanner
2336 East 1480 Road
Lawton, OK 73507
Policy # 35-1-90553551-13

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
OK-16-016-2021-142 06/08/2021 06/11/2021 On Receipt Wichita Mountain Estates V.F.D.

Product
Price
Qty
Amount
  1. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    1.25
    $187.50
  2. 102 Engine Response (Per Hour)

    $350.00
    1.25
    $437.50
  3. 218 Cervical Collar (# Used)

    $25.00
    2
    $50.00
  4. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  5. 313 TIC Thermal Imaging Camera (# Used)

    $100.00
    1
    $100.00
  6. 206 Latex Gloves (Pairs Used)

    $2.00
    4
    $8.00
  7. 301 Hand Tool (# Used)

    $15.00
    2
    $30.00
  8. 202 Oil Absorbent Sheet (# Used)

    $2.50
    5
    $12.50
  9. 201 Oil Absorbent Material (# Used)

    $35.00
    3
    $105.00
  10. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    2.5
    $250.00
  11. 306 Hose Per 50′ (Amt Used)

    $25.00
    1
    $25.00
  12. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00
  13. 330 Backboard (# Used)

    $25.00
    1
    $25.00

  14. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 4-mile and tackle Box road - Lawton, OK

Subtotal $1,730.50
Total Due $1,730.50


Updated
June 10, 2021 @ 6:25 pm

Invoice updated by Geoffrey.

Status Update
June 10, 2021 @ 6:25 pm

Status changed: Draft to Pending.

Updated
June 10, 2021 @ 6:25 pm

Invoice updated by Geoffrey.

Viewed
June 10, 2021 @ 6:25 pm

Invoice viewed by 199.59.103.134 for the first time.