Bill To:


OKLAHOMA FARM BUREAU MUTUAL INSURANCE COMPANY
2501 N Stiles Ave,
Oklahoma City, OK 73105

Services Rendered To:


Policy# FRM00135563-04
Owner: Edgar McCracken
456 NW McCracken Rd.
Lawton, OK 73538

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
OK-16-016-2021-221 09/14/2021 09/21/2021 On Receipt Wichita Mountain Estates Vol. Fire Dept.

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

    $500.00
    5.25
    $2,625.00
  2. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    5.25
    $787.50
  3. 102 Engine Response (Per Hour)

    $500.00
    5.25
    $2,625.00
  4. 104 Tanker Response (Per Hour)

    $500.00
    5.25
    $2,625.00
  5. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  6. 205 Foam (Per Gallon)

    $65.00
    10
    $650.00
  7. 306 Gas/Co Detector (# Used)

    $50.00
    2
    $100.00
  8. 319 Generator ( 3 Generators/Per 5.25 Hours)

    $150.00
    5.25
    $787.50
  9. 313 TIC Thermal Imaging Camera (# Used)

    $100.00
    3
    $300.00
  10. 318 Ladder (# Used)

    $35.00
    2
    $70.00
  11. 301 Hand Tool (# Used)

    $15.00
    5
    $75.00
  12. 309 Power Tool (# Used)

    $50.00
    5
    $250.00
  13. 311 PPV / Ventilation Fan (# Used)

    $50.00
    2
    $100.00
  14. 303 SCBA Breathing Apparatus (# Used)

    $50.00
    6
    $300.00
  15. 304 SCBA Cylinder (# Used)

    $25.00
    12
    $300.00
  16. 404 Scene Lighting (Per Hour)

    $75.00
    5.25
    $393.75
  17. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    5.25
    $525.00
  18. 207 Wetting Agent (Amt Used)

    $25.00
    1
    $25.00
  19. 306 Hose Per 50′ (Amt Used)

    $25.00
    6
    $150.00

  20. Additional Incident Info

    Incident Type: Structure Fire Response

    Incident Location: 456 NW McCracken Rd. Lawton, OK 73538

Subtotal $12,938.75
Total Due $12,938.75


Updated
September 21, 2021 @ 10:37 pm

Invoice updated by Karen Smith.

Status Update
September 21, 2021 @ 10:37 pm

Status changed: Draft to Pending.

Viewed
October 22, 2022 @ 8:20 am

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