Bill To:


Lewis Pittman
1621 Fresno Street, Apt. 64
Fort Smith, AR 72901

Services Rendered To:


Lewis Pittman
621 Fresno Street, Apt. 64
Fort Smith, Arkansas 72901

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
OK-49-007-2021-39 02/25/2021 03/02/2021 On Receipt F.A.I.C. V.F.D.

*** THIS HAS BEEN SUBMITTED TO YOUR INSURANCE COMPANY AND IGNORED. THIS IS NOW YOUR RESPONSIBILITY. ***

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

    $500.00
    1
    $500.00
  2. 105 Utility Vehicle Response (Per Hour)

    $500.00
    1
    $500.00
  3. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00
  4. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  5. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00

  6. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: I-40 Westbound @ MM 255 - Checotah, OK

Subtotal $1,600.00
Total Due $1,600.00


Updated
March 1, 2021 @ 1:16 pm

Invoice updated by Geoffrey.

Status Update
March 1, 2021 @ 1:16 pm

Status changed: Draft to Pending.

Updated
August 28, 2021 @ 1:13 pm

Invoice updated by Geoffrey.

Viewed
October 24, 2022 @ 6:03 am

Invoice viewed by 64.124.8.42 for the first time.