Bill To:


Progressive Northwestern Insurance Company
6300 Wilson Mills Road
Cleveland, OH 44143

Services Rendered To:


Eric Gates
401 S. Vine St
Harrison, Arkansas 72601
POLICY# 8007764737

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
OK-49-015-22-1126 11/26/2022 11/28/2022 On Receipt Tiger Mtn FD

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

    $350.00
    1.75
    $612.50
  2. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1.75
    $262.50
  3. 103 Rescue Response (Per Hour)

    $300.00
    1.75
    $525.00
  4. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  5. 211 Salvage Cover (Amt Used)           

    $35.00
    1
    $35.00
  6. 303 SCBA Breathing Apparatus (# Used)

    $50.00
    3
    $150.00
  7. 304 SCBA Cylinder (# Used)

    $25.00
    3
    $75.00
  8. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.75
    $175.00
  9. 306 Hose Per 50′ (Amt Used)

    $25.00
    2
    $50.00

  10. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: I-40 East Bound MM 247- Henryetta, OK

    Ordinance Info: Tiger Mountain - McIntosh County Resolution 72021

Subtotal $2,135.00
Total Due $2,135.00


Updated
November 28, 2022 @ 11:51 am

Invoice updated by Geoffrey.

Status Update
November 28, 2022 @ 11:51 am

Status changed: Draft to Pending.