Bill To:


GREAT WEST CASUALTY
1100 WEST 29th STREET
SOUTH SOUIX CITY, NE 68776-3130

Services Rendered To:


Groendyke Transport
2510 Rock Island Blvd
Enid, OK 73701
Policy # GWP37571P

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
OK-59-007-22-33-B 03/09/2022 05/16/2022 On Receipt North 48 Fire Department

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

    $350.00
    6.5
    $2,275.00
  2. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    6.5
    $975.00
  3. 105 Utility Vehicle Response (Per Hour)

    $150.00
    6.5
    $975.00
  4. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00
  5. 205 Foam (Per Gallon)

    $65.00
    3
    $195.00
  6. 306 Gas/Co Detector (# Used)

    $50.00
    1
    $50.00
  7. 313 TIC Thermal Imaging Camera (# Used)

    $100.00
    1
    $100.00
  8. 201 Oil Absorbent Material (# Used)

    $35.00
    1
    $35.00
  9. 303 SCBA Breathing Apparatus (# Used)

    $50.00
    4
    $200.00
  10. 404 Scene Lighting (Per Hour)

    $75.00
    6.5
    $487.50
  11. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    6.5
    $650.00
  12. 306 Hose Per 50′ (Amt Used)

    $25.00
    5
    $125.00
  13. 323 Portable Radio (# Used)

    $10.00
    6
    $60.00
  14. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  15. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Highway 412 Cimarron Turnpike @ MM 54 - Terlton, Oklahoma

Subtotal $6,627.50
Total Due $6,627.50


Updated
May 15, 2022 @ 2:56 pm

Invoice updated by Geoffrey.

Viewed
October 22, 2022 @ 8:17 am

Invoice viewed by 64.124.8.27 for the first time.

Viewed
May 22, 2024 @ 12:52 am

Invoice viewed by 4.236.21.148 for the first time.

Viewed
May 25, 2024 @ 5:47 am

Invoice viewed by 172.181.55.133 for the first time.