Bill To:


Vicky Burch
3048 SW 57th St
Oklahoma City, OK 73119

Services Rendered To:


Vicky Burch
3048 SW 57th St
OKC, OK 73119
POLICY# 6052-63-89-93

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
OK-49-007-23-57 05/07/2023 05/11/2023 On Receipt F.A.I.C FD

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

Product
Price
Qty
Amount
  1. 105 Utility Vehicle Response (Per Hour)

    $500.00
    1.5
    $750.00
  2. 105 Utility Vehicle Response (Per Hour)

    $500.00
    1.5
    $750.00
  3. 105 Utility Vehicle Response (Per Hour)

    $500.00
    1.5
    $750.00
  4. 303 SCBA Breathing Apparatus (# Used)

    $50.00
    1
    $50.00
  5. 304 SCBA Cylinder (# Used)

    $25.00
    1
    $25.00
  6. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.5
    $150.00
  7. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  8. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: I-40 MM 253 WB- Checotah, OK

    Ordinance Info: F.A.I.C Resolution

Subtotal $2,725.00
Total Due $2,725.00


Updated
May 11, 2023 @ 3:48 pm

Invoice updated by Geoffrey.

Status Update
May 11, 2023 @ 3:48 pm

Status changed: Draft to Pending.

Updated
August 2, 2023 @ 3:32 pm

Invoice updated by Geoffrey.