Bill To:


GREAT WEST CASUALTY
1100 WEST 29th STREET
SOUTH SOUIX CITY, NE 68776-3130

Services Rendered To:


Blackhawk Transport
3800 Milwaukee Rd
Beloit, WI 53511
POLICY# GWP09835T


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

    $500.00
    2.75
    $1,375.00
  2. 105 Utility Vehicle Response (Per Hour)

    $250.00
    2.75
    $687.50
  3. 206 Latex Gloves (Pairs Used)

    $2.00
    2
    $4.00
  4. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    2.75
    $275.00
  5. 327 Windshield Kit (# Used)

    $25.00
    1
    $25.00

  6. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: EB I-40 MM 246- Henryetta, OK

    Ordinance Info: Tiger Mountain - McIntosh County Resolution 72021

Subtotal $2,366.50
Total Due $2,366.50


Updated
September 25, 2023 @ 2:32 pm

Invoice updated by Geoffrey.

Status Update
September 25, 2023 @ 2:32 pm

Status changed: Draft to Pending.