Bill To:


Mohave Transportation Insurance
2200 S. 75th Ave
Phoenix, AZ 85043

Services Rendered To:


Sukhbir Singh
1411 Green Willow Way
Tracy, CA 95376
Claim# 230612022132703

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
OK-49-007-23-74 06/11/2023 09/01/2023 On Receipt F.A.I.C FD

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

    $500.00
    4.75
    $2,375.00
  2. 102 Engine Response (Per Hour)

    $500.00
    4.75
    $2,375.00
  3. 102 Engine Response (Per Hour)

    $500.00
    4.75
    $2,375.00
  4. 105 Utility Vehicle Response (Per Hour)

    $250.00
    4.75
    $1,187.50
  5. 105 Utility Vehicle Response (Per Hour)

    $250.00
    4.75
    $1,187.50
  6. 105 Utility Vehicle Response (Per Hour)

    $250.00
    4.75
    $1,187.50
  7. 105 Utility Vehicle Response (Per Hour)

    $250.00
    4.75
    $1,187.50
  8. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    4.75
    $475.00

  9. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: I-40mm 251- Checotah, OK

    Ordinance Info: FAIC Resolution

Subtotal $12,350.00
Total Due $12,350.00


Updated
September 1, 2023 @ 1:21 pm

Invoice updated by Geoffrey.

Status Update
September 1, 2023 @ 1:21 pm

Status changed: Draft to Pending.

Updated
September 8, 2023 @ 12:23 pm

Invoice updated by Geoffrey.

Updated
September 13, 2023 @ 1:33 pm

Invoice updated by Geoffrey.