Bill To:


Danna Robinson
30096 Orchard Drive
Lebanon, MO 65536

Services Rendered To:


Danna Robinson
30096 Orchard drive
Lebanon, MO 65536
Policy # N/A on Scene

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
MO-05-309-2021-15 07/19/2021 07/27/2021 On Receipt Sleeper V.F.D.

*** THIS HAS BEEN SUBMITTED TO YOUR INSURANCE COMPANY AND DENIED. THIS IS NOW YOUR RESPONSIBILITY. ***

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

    $350.00
    2.25
    $787.50
  2. 103 Rescue Response (Per Hour)

    $300.00
    2.25
    $675.00
  3. 306 Gas/Co Detector (# Used)

    $50.00
    2
    $100.00
  4. 303 SCBA Breathing Apparatus (# Used)

    $50.00
    1
    $50.00
  5. 304 SCBA Cylinder (# Used)

    $25.00
    2
    $50.00
  6. 306 Hose Per 50′ (Amt Used)

    $25.00
    4
    $100.00

  7. Additional Incident Info

    Incident Type: Hazardous Material Response

    Incident Location: 30096 Orchard Drive - Lebanon, MO

Subtotal $1,762.50
Total Due $1,762.50


Updated
July 26, 2021 @ 12:31 pm

Invoice updated by Geoffrey.

Status Update
July 26, 2021 @ 12:31 pm

Status changed: Draft to Pending.

Updated
February 14, 2022 @ 4:47 pm

Invoice updated by Geoffrey.

Updated
February 14, 2022 @ 4:47 pm

Invoice updated by Geoffrey.

Updated
April 27, 2022 @ 5:38 pm

Invoice updated by Geoffrey.

Updated
August 1, 2022 @ 7:20 pm

Invoice updated by Geoffrey.

Viewed
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