Bill To:


Farmers Insurance
PO Box 268993
Oklahoma City, OK 73126

Services Rendered To:


Victor Clark
9400 Russell Drive
Yukon, OK 71765-9440
POLICY # N/A ON SCENE
OK - DRIVER LIC. # D001031641


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

    $350.00
    1
    $350.00
  2. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1
    $150.00
  3. 215 Trauma Kit (# Used)

    $25.00
    1
    $25.00
  4. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  5. Additional Incident Info

    Incident Type: Fire Department Response

    Incident Location: I-40 EASTBOUND @ MM 247 - HENRYETTA, OK

    Ordinance Info: Tiger Mountain - McIntosh County Resolution 72021

Subtotal $775.00
Total Due $775.00


Updated
July 25, 2022 @ 6:02 pm

Invoice updated by Geoffrey.

Status Update
July 25, 2022 @ 6:02 pm

Status changed: Draft to Pending.