Bill To:


ROOT INSURANCE COMPANY
80 EAST RICH STREET - SUITE 500
COLUMBUS, OH 43215-5249

Services Rendered To:


Michael Hulsey
POLICY# BNJHCB

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
OK-16-016-23-598 12/23/2023 01/09/2024 On Receipt Wichita Mountain Estates V.F.D.

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

    $500.00
    1.75
    $875.00
  2. 105 Utility Vehicle Response (Per Hour)

    $250.00
    1.75
    $437.50
  3. 301 Hand Tool (# Used)

    $15.00
    2
    $30.00
  4. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00

  5. Additional Incident Info

    Incident Type: Vehicle Fire Response

    Incident Location: 67 Lawton Circle- Comanche County, OK

    Ordinance Info: Wichita Mountain Estates Resolution- 1-1-23

Subtotal $1,592.50
Total Due $1,592.50


Updated
January 9, 2024 @ 1:46 pm

Invoice updated by Geoffrey.

Status Update
January 9, 2024 @ 1:46 pm

Status changed: Draft to Pending.

Viewed
July 22, 2024 @ 9:41 pm

Invoice viewed by 173.252.83.34 for the first time.