Bill To:


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

Services Rendered To:


Richard Taylor
912 NW 22nd St
Moore, OK 73160
POLICY# Y9736842

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
OK-41-013-23-394 12/21/2023 01/25/2024 On Receipt Wellston FD

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

    $400.00
    1
    $400.00
  2. 102 Engine Response (Per Hour)

    $500.00
    1
    $500.00
  3. 402 Fire/Police Services (Per Hour)    

    $100.00
    1
    $100.00
  4. 206 Latex Gloves (Pairs Used)

    $2.00
    8
    $16.00
  5. 301 Hand Tool (# Used)

    $15.00
    2
    $30.00
  6. 326 Safety Fest (# Used)

    $2.50
    5
    $12.50
  7. 324 Traffic Cone (# Used)

    $5.00
    5
    $25.00
  8. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00

  9. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Tuner Turnpike MM 164- Wellston, OK

Subtotal $1,333.50
Total Due $1,333.50


Updated
January 25, 2024 @ 12:24 pm

Invoice updated by Geoffrey.

Status Update
January 25, 2024 @ 12:24 pm

Status changed: Draft to Pending.

Viewed
March 28, 2024 @ 11:33 am

Invoice viewed by 66.249.72.2 for the first time.

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March 30, 2024 @ 6:50 am

Invoice viewed by 66.249.72.4 for the first time.