Bill To:


ALLSTATE FIRE AND CASUALTY
2775 SANDERS ROAD
NORTHBROOK, IL 60062-6110

Services Rendered To:


Christopher Hamon
8601 NW 155th Place
Edmond, OK 73013
Driver: Ashlen Grace
POLICY # 000000821129149

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
OK-16-016-22-551 08/21/2022 08/24/2022 On Receipt Wichita Mountain Estates V.F.D.

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

    $350.00
    1
    $350.00
  2. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    1
    $150.00
  3. 102 Engine Response (Per Hour)

    $350.00
    1
    $350.00
  4. 218 Cervical Collar (# Used)

    $25.00
    1
    $25.00
  5. 314 Cribbing – Lvl 1 (Passenger Vehicle) (Used)

    $100.00
    1
    $100.00
  6. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  7. 328 GlassMaster (# Used)

    $25.00
    1
    $25.00
  8. 310 Hydraulic Tool (# Used)

    $200.00
    2
    $400.00
  9. 206 Latex Gloves (Pairs Used)

    $2.00
    10
    $20.00
  10. 301 Hand Tool (# Used)

    $15.00
    2
    $30.00
  11. 309 Power Tool (# Used)

    $50.00
    1
    $50.00
  12. 201 Oil Absorbent Material (# Used)

    $35.00
    5
    $175.00
  13. 329 Stokes Basket (# Used)

    $25.00
    1
    $25.00
  14. 215 Trauma Kit (# Used)

    $25.00
    1
    $25.00
  15. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00
  16. 330 Backboard (# Used)

    $25.00
    1
    $25.00

  17. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Interstate 44 @ MM 43 - Lawton, OK

Subtotal $2,250.00
Total Due $2,250.00


Updated
August 24, 2022 @ 2:51 pm

Invoice updated by Geoffrey.

Status Update
August 24, 2022 @ 2:51 pm

Status changed: Draft to Pending.

Viewed
October 22, 2022 @ 7:05 pm

Invoice viewed by 64.124.8.36 for the first time.