Bill To:


Zurich North America
1299 Zurich Way
schaumburg, IL 60196-1056

Services Rendered To:


Policy# BAP9296619-10
Owner: Red Dirt Construction Company LLC
916 N. Academy
Guthrie, OK 73044
Driver: Michael Williams
8781 Overlook Dr.
Guthrie, OK 73044

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
OK-49-007-23-0012 01/16/2023 01/17/2023 On Receipt F.A.I.C. Fire Department

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

    $1,000.00
    1.75
    $1,750.00
  2. 301 Hand Tool (# Used)

    $15.00
    3
    $45.00
  3. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.75
    $175.00
  4. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  5. 201 Oil Absorbent Material (# Used)

    $35.00
    1
    $35.00

  6. Additional Incident Info

    Incident Type: Hazardous Material Response

    Incident Location: I-40, EB, MM 256.5, Checotah, OK

Subtotal $2,255.00
Total Due $2,255.00


Updated
January 17, 2023 @ 1:42 pm

Invoice updated by Karen Smith.

Status Update
January 17, 2023 @ 1:42 pm

Status changed: Draft to Pending.

Updated
January 17, 2023 @ 1:57 pm

Invoice updated by Karen Smith.