Bill To:


SAFECO INSURANCE
P.O. Box 5014
Scranton, PA 18505

Services Rendered To:


Tuff Putman
902 West Moore Street
Henryetta, OK 74437
Policy # Y9114768

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
OK-49-015-21-1504 04/15/2021 07/13/2021 On Receipt Tiger Mountain Fire Dept.

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

    $500.00
    1
    $500.00
  2. 105 Utility Vehicle Response (Per Hour)

    $500.00
    1
    $500.00
  3. 306 Hose Per 50′ (Amt Used)

    $25.00
    4
    $100.00

  4. Additional Incident Info

    Incident Type: Vehicle Fire Response

    Incident Location: I-40 Westbound @ Tiger Mountain Exit 247 - Henryetta, OK

Subtotal $1,100.00
Total Due $1,100.00


Updated
July 12, 2021 @ 7:48 pm

Invoice updated by Geoffrey.

Status Update
July 12, 2021 @ 7:48 pm

Status changed: Draft to Pending.

Updated
July 12, 2021 @ 7:49 pm

Invoice updated by Geoffrey.

Updated
July 12, 2021 @ 7:49 pm

Invoice updated by Geoffrey.

Updated
July 12, 2021 @ 7:50 pm

Invoice updated by Geoffrey.

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