Bill To:


Esurance
PO Box 5250
Sioux Falls, SD 57117-5258

Services Rendered To:


Jenna Thornton
6 Lake Crest Circle
Lawton, OK 73507
Policy # 8887563959


Product
Price
Qty
Amount
  1. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    1
    $150.00
  2. 102 Engine Response (Per Hour)

    $350.00
    1
    $350.00
  3. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    1
    $150.00
  4. 218 Cervical Collar (# Used)

    $25.00
    2
    $50.00
  5. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00
  6. 313 TIC Thermal Imaging Camera (# Used)

    $100.00
    1
    $100.00
  7. 206 Latex Gloves (Pairs Used)

    $2.00
    4
    $8.00
  8. 301 Hand Tool (# Used)

    $15.00
    2
    $30.00
  9. 201 Oil Absorbent Material (# Used)

    $35.00
    10
    $350.00
  10. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  11. 407 Patient Care / Evaluation (Per Patient)

    $50.00
    1
    $50.00

  12. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 23510 State Highway 58 - Lawton, OK

Subtotal $1,588.00
Total Due $1,588.00


Updated
June 14, 2022 @ 12:10 pm

Invoice updated by Geoffrey.

Status Update
June 14, 2022 @ 12:10 pm

Status changed: Draft to Pending.

Updated
June 14, 2022 @ 12:11 pm

Invoice updated by Geoffrey.

Updated
August 3, 2022 @ 5:20 pm

Invoice updated by Karen Smith.