Bill To:


ALLSTATE INSURANCE
3075 SANDERS ROAD - SUITE H1A
NORTHBROOK, IL 60062-7127

Services Rendered To:


Prit Shah
3408 W. Galveston Place
Broken Arrow, OK 74012
Ph# 918-625-5135
POLICY # 821274016

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
OK-59-007-22-76 06/08/2022 06/14/2022 On Receipt North 48 Fire Department

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

    $350.00
    3
    $1,050.00
  2. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00
  3. 306 Gas/Co Detector (# Used)

    $50.00
    1
    $50.00
  4. 206 Latex Gloves (Pairs Used)

    $2.00
    1
    $2.00
  5. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    3
    $300.00

  6. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Cimarron Turnpike @ MM 53 - Terlton, OK

Subtotal $1,652.00
Total Due $1,652.00


Updated
June 14, 2022 @ 12:44 pm

Invoice updated by Geoffrey.

Status Update
June 14, 2022 @ 12:44 pm

Status changed: Draft to Pending.