Bill To:


Farmer's Insurance
PO Box 0991
Carol Stream, IL 60132-0991

Services Rendered To:


Nikki Brown
Urbana, MO 65767
POLICY# 531932996

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
MO-04-308-22-1222 10/12/2022 10/18/2022 On Receipt Preston VFD

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

    $300.00
    1.25
    $375.00
  2. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1.25
    $187.50
  3. 218 Cervical Collar (# Used)

    $25.00
    1
    $25.00
  4. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  5. 206 Latex Gloves (Pairs Used)

    $2.00
    4
    $8.00
  6. 309 Power Tool (# Used)

    $50.00
    1
    $50.00
  7. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.25
    $125.00

  8. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Clark St & US HWY 65- Cross Timbers, MO

Subtotal $1,020.50
Total Due $1,020.50


Updated
October 17, 2022 @ 4:54 pm

Invoice updated by Geoffrey.

Status Update
October 17, 2022 @ 4:54 pm

Status changed: Draft to Pending.