Bill To:


OKLAHOMA FARM BUREAU MUTUAL INSURANCE COMPANY
2501 N Stiles Ave,
Oklahoma City, OK 73105

Services Rendered To:


Verlys Wilson
39 NE McCracken Rd
Elgin, OK 73038
POLICY# PAU00278271

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
OK-16-014-23-125 12/07/2023 12/12/2023 On Receipt Edgewater Park VFD

Product
Price
Qty
Amount
  1. 103 Rescue Response (Per Hour)

    $400.00
    1.25
    $500.00
  2. 106 Battalion/Chief Vehicle Response (Per Hour)

    $200.00
    1.25
    $250.00
  3. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00
  4. 206 Latex Gloves (Pairs Used)

    $2.00
    8
    $16.00
  5. 301 Hand Tool (# Used)

    $15.00
    3
    $45.00
  6. 309 Power Tool (# Used)

    $50.00
    1
    $50.00
  7. 201 Oil Absorbent Material (# Used)

    $35.00
    1
    $35.00
  8. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.25
    $125.00

  9. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: SH 62 & Edgewater Blvd- Apache, OK

Subtotal $1,271.00
Total Due $1,271.00


Updated
December 12, 2023 @ 10:49 am

Invoice updated by Geoffrey.

Status Update
December 12, 2023 @ 10:49 am

Status changed: Draft to Pending.