Bill To:


Philadelphia Insurance
One Bala Plaza, Ste. 100
Bala Cynwyd, PA 19004-0950

Services Rendered To:


Robert Browning
21215 Flight Ln
Tecumseh, OK 74873
POLICY# PHPK2290987

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
OK-41-013-22-100 07/19/2023 11/27/2023 On Receipt Wellston FD

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

    $500.00
    1.5
    $750.00
  2. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00
  3. 310 Hydraulic Tool (# Used)

    $200.00
    2
    $400.00
  4. 206 Latex Gloves (Pairs Used)

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

    $15.00
    2
    $30.00
  6. 309 Power Tool (# Used)

    $50.00
    1
    $50.00
  7. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.5
    $150.00

  8. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Turner Turnpike MM166- Wellston, OK

Subtotal $1,646.00
Total Due $1,646.00


Updated
November 27, 2023 @ 8:57 pm

Invoice updated by Geoffrey.

Status Update
November 27, 2023 @ 8:57 pm

Status changed: Draft to Pending.