Bill To:


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

Services Rendered To:


Jeri Major
12134 W. Corrine Drive
El Mirage, Arizona 85335
6019281152031

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
OK-49-015-21-006 08/09/2021 08/13/2021 On Receipt Tiger Mountain Fire Dept.

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

    $150.00
    2.25
    $337.50
  2. 105 Utility Vehicle Response (Per Hour)

    $150.00
    2.25
    $337.50
  3. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  4. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  5. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: I-40 Eastbound @ MM 146 - Henryetta, OK

    Ordinance Info: Tiger Mountain - McIntosh County Resolution 72021

Subtotal $1,175.00
Total Due $1,175.00


Updated
August 12, 2021 @ 2:34 pm

Invoice updated by Geoffrey.

Status Update
August 12, 2021 @ 2:34 pm

Status changed: Draft to Pending.

Updated
August 12, 2021 @ 2:34 pm

Invoice updated by Geoffrey.

Viewed
October 13, 2021 @ 12:52 pm

Invoice viewed by Karen Smith (KarenS) for the first time.