Bill To:


United Security Health & Cas.
6640 S Cicero Ave
Bedford Park, IL 60638

Services Rendered To:


Breasha Schmidt
15251 E Waterloo Rd
Arcadia, OK 73007
POLICY# PA0115356-01


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

    $400.00
    1.25
    $500.00
  2. 105 Utility Vehicle Response (Per Hour)

    $250.00
    1.25
    $312.50
  3. 105 Utility Vehicle Response (Per Hour)

    $250.00
    1.25
    $312.50
  4. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00
  5. 301 Hand Tool (# Used)

    $15.00
    1
    $15.00
  6. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.25
    $125.00

  7. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Hwy 177 & 1010 Rd- Meeker, OK

Subtotal $1,515.00
Total Due $1,515.00


Updated
May 14, 2024 @ 12:53 pm

Invoice updated by Geoffrey.

Status Update
May 14, 2024 @ 12:53 pm

Status changed: Draft to Pending.