Bill To:


TRAVELERS INSURANCE GROUP
ONE TOWER SQUARE - 5MS
HARTFORD, CT 06183-0001

Services Rendered To:


Walter Rau
P.O. Box 87
Gans, OK 74936
Policy # 35174614041
TRAVELERS CLAIM # ISE75555


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

    $300.00
    1
    $300.00
  2. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  3. 206 Latex Gloves (Pairs Used)

    $2.00
    2
    $4.00
  4. 301 Hand Tool (# Used)

    $15.00
    1
    $15.00
  5. 309 Power Tool (# Used)

    $50.00
    1
    $50.00

  6. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Mulberry Road @ South 230 Road - Henryetta, OK

    Ordinance Info: SALEM-RYAL FIRE DEPT. RESOLUTION NO. 72821

Subtotal $619.00
Total Due $619.00


Updated
February 4, 2022 @ 1:00 pm

Invoice updated by Geoffrey.

Status Update
February 4, 2022 @ 1:00 pm

Status changed: Draft to Pending.

Updated
June 29, 2022 @ 4:47 pm

Invoice updated by Geoffrey.

Updated
August 12, 2022 @ 2:46 pm

Invoice updated by Geoffrey.

Updated
August 12, 2022 @ 2:47 pm

Invoice updated by Geoffrey.