Bill To:


ELEPHANT INSURANCE
PO BOX 5005
GLEN ALLEN, VA 23058-5005

Services Rendered To:


Timothy Wilson
1437 East Francis
Pampa, Texas 79065
Policy # 244-002-422-47


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

    $350.00
    1
    $350.00
  2. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    1
    $150.00
  3. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  4. 206 Latex Gloves (Pairs Used)

    $2.00
    4
    $8.00
  5. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  6. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Highway 58 Northbound - Lawton, OK

Subtotal $1,008.00
Total Due $1,008.00


Updated
April 20, 2021 @ 7:31 pm

Invoice updated by Geoffrey.

Status Update
April 20, 2021 @ 7:31 pm

Status changed: Draft to Pending.

Viewed
October 25, 2022 @ 5:39 pm

Invoice viewed by 64.124.8.36 for the first time.