Bill To:


Missouri Farm Bureau
701 S. Country Club Drive P.O. Box 658
Jefferson City, MO 65102

Services Rendered To:


Ginger Smith
41 Tupper Rd
Camdenton, MO 65020
POLICY# APV0702714


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

    $500.00
    1
    $500.00
  2. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00
  3. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  4. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00

  5. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: N Hwy 5 & Hwy E- Lebanon, MO

Subtotal $1,100.00
Total Due $1,100.00


Updated
November 27, 2023 @ 8:00 pm

Invoice updated by Geoffrey.

Status Update
November 27, 2023 @ 8:00 pm

Status changed: Draft to Pending.