Bill To:


Timmy Ray Sharp Miller
11600 SSR-E
Eldridge, MO 65463

Services Rendered To:


Timmy Ray Sharp Miller
11600 Hwy E
Eldridge, MO 65463
POLICY# R01356125800

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
MO-05-307-23-164 12/12/2023 12/28/2023 On Receipt Eldridge V.F.D.

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

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

    $500.00
    1
    $500.00
  2. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00
  3. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00

  4. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Johnson Rd- Eldridge, MO

Subtotal $850.00
Total Due $850.00


Updated
December 28, 2023 @ 1:37 pm

Invoice updated by Geoffrey.

Status Update
December 28, 2023 @ 1:37 pm

Status changed: Draft to Pending.

Updated
January 23, 2024 @ 2:38 pm

Invoice updated by Geoffrey.