Bill To:


SAFECO INSURANCE
P.O. Box 5014
Scranton, PA 18505

Services Rendered To:


Jammie Ball
21765 Perry Lucas Lane
Newalla, OK 74857
POLICY # 16003322226-OY0502638

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
OK-55-024-22-133 07/03/2022 08/05/2022 On Receipt Newalla Fire Department

Product
Price
Qty
Amount
  1. 104 Tanker Response (Per Hour)

    $300.00
    2.5
    $750.00
  2. 105 Utility Vehicle Response (Per Hour)

    $150.00
    2.5
    $375.00
  3. 103 Rescue Response (Per Hour)

    $300.00
    2.5
    $750.00
  4. 309 Power Tool (# Used)

    $50.00
    1
    $50.00
  5. 318 Ladder (# Used)

    $35.00
    1
    $35.00
  6. 301 Hand Tool (# Used)

    $15.00
    7
    $105.00
  7. 303 SCBA Breathing Apparatus (# Used)

    $50.00
    2
    $100.00
  8. 404 Scene Lighting (Per Hour)

    $75.00
    2.5
    $187.50
  9. 306 Hose Per 50′ (Amt Used)

    $25.00
    6
    $150.00

  10. Additional Incident Info

    Incident Type: Structure Fire Response

    Incident Location: 21765 Perry Lucas Lane Newalla, OK 74857

Subtotal $2,502.50
Total Due $2,502.50


Updated
August 4, 2022 @ 2:59 pm

Invoice updated by Geoffrey.

Status Update
August 4, 2022 @ 2:59 pm

Status changed: Draft to Pending.

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