Bill To:


Chubb National Insurance Co
15 Mountain View Road
Warren, NJ 07059

Services Rendered To:


Gleco Fleet Trust
940 Ridgebrook Road
Sparks, MD 21152
PH# 800-282-8157
Driver: David Tilley

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
OK-59-007-22-33-A 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 @ 2:34 pm

Invoice updated by Geoffrey.

Status Update
May 15, 2022 @ 2:34 pm

Status changed: Draft to Pending.

Updated
May 15, 2022 @ 2:49 pm

Invoice updated by Geoffrey.

Viewed
October 25, 2022 @ 1:53 am

Invoice viewed by 64.124.8.53 for the first time.