Bill To:


Zachary Hash
19126 Knoll Road
Lebanon, MO 65536

Services Rendered To:


Zachary Hash
19126 Knoll Road
Lebanon, MO 65536
Policy # AUM 000000612827

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
MO-05-307-2021-0015 02/16/2021 07/23/2021 On Receipt Eldridge V.F.D.

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

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

    $500.00
    1
    $500.00
  2. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  3. 313 TIC Thermal Imaging Camera (# Used)

    $100.00
    1
    $100.00
  4. 303 SCBA Breathing Apparatus (# Used)

    $50.00
    1
    $50.00
  5. 404 Scene Lighting (Per Hour)

    $75.00
    1
    $75.00
  6. 207 Wetting Agent (Amt Used)

    $25.00
    1
    $25.00
  7. 306 Hose Per 50′ (Amt Used)

    $25.00
    1
    $25.00

  8. Additional Incident Info

    Incident Type: Vehicle Fire Response

    Incident Location: 19126 Knoll Road Lebanon, MO 65536

Subtotal $1,025.00
Total Due $1,025.00


Updated
July 23, 2021 @ 5:26 pm

Invoice updated by Geoffrey.

Status Update
July 23, 2021 @ 5:26 pm

Status changed: Draft to Pending.

Updated
August 27, 2021 @ 3:40 pm

Invoice updated by Geoffrey.

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Invoice viewed by 64.124.8.25 for the first time.

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