Bill To:


Farmers Insurance
PO Box 268993
Oklahoma City, OK 73126

Services Rendered To:


Albert Hormann
147 Landmark Rd
Lawton, OK 73507
POLICY# 765158865
CLAIM# 7005602635

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
OK-16-016-23-237 01/27/2023 02/01/2023 On Receipt Wichita Mountain Estates VFD

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

    $150.00
    27.75
    $4,162.50
  2. 102 Engine Response (Per Hour)

    $350.00
    27.75
    $9,712.50
  3. 102 Engine Response (Per Hour)

    $350.00
    27.75
    $9,712.50
  4. 104 Tanker Response (Per Hour)

    $300.00
    27.75
    $8,325.00
  5. 105 Utility Vehicle Response (Per Hour)

    $150.00
    27.75
    $4,162.50
  6. 309 Power Tool (# Used)

    $50.00
    5
    $250.00
  7. 208 Fire Line Tap (Per Foot, Amt Used)

    $0.25
    100
    $25.00
  8. 319 Generator (Per Generator/Per Hour)

    $50.00
    27.75
    $1,387.50
  9. 319 Generator (Per Generator/Per Hour)

    $50.00
    27.75
    $1,387.50
  10. 313 TIC Thermal Imaging Camera (# Used)

    $100.00
    2
    $200.00
  11. 318 Ladder (# Used)

    $35.00
    3
    $105.00
  12. 301 Hand Tool (# Used)

    $15.00
    10
    $150.00
  13. 311 PPV / Ventilation Fan (# Used)

    $50.00
    1
    $50.00
  14. 303 SCBA Breathing Apparatus (# Used)

    $50.00
    6
    $300.00
  15. 304 SCBA Cylinder (# Used)

    $25.00
    12
    $300.00
  16. 404 Scene Lighting (Per Hour)

    $75.00
    15
    $1,125.00
  17. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    27.75
    $2,775.00
  18. 306 Hose Per 50′ (Amt Used)

    $25.00
    46
    $1,150.00

  19. Additional Incident Info

    Incident Type: Structure Fire Response

    Incident Location: 147 Landmark Rd- Lawton, OK 73507

Subtotal $45,280.00
Total Due $45,280.00


Updated
January 31, 2023 @ 11:59 pm

Invoice updated by Geoffrey.

Status Update
January 31, 2023 @ 11:59 pm

Status changed: Draft to Pending.