Bill To:


Continental Western Group
11201 Douglas Avenue
Urbandale, IA 50322

Services Rendered To:


C and C Produce
1100 Atlantic Avenue
N. Kansas City, MO 64116
Policy # CPA3261242
CLAIM # 182267
Adjuster - Warren Lindsey

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
MO-04-308-21-1026 10/26/2021 03/23/2022 On Receipt Preston V.F.D Dept.

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

    $350.00
    3
    $1,050.00
  2. 103 Rescue Response (Per Hour)

    $300.00
    3
    $900.00
  3. 105 Utility Vehicle Response (Per Hour)

    $150.00
    3
    $450.00
  4. 218 Cervical Collar (# Used)

    $25.00
    1
    $25.00
  5. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00
  6. 206 Latex Gloves (Pairs Used)

    $2.00
    4
    $8.00
  7. 203 Oil Boom (# Used)

    $20.00
    6
    $120.00
  8. 201 Oil Absorbent Material (# Used)

    $35.00
    4
    $140.00
  9. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    3
    $300.00
  10. 207 Wetting Agent (Amt Used)

    $25.00
    3
    $75.00
  11. 306 Hose Per 50′ (Amt Used)

    $25.00
    2
    $50.00

  12. Additional Incident Info

    Incident Type: Hazardous Material Response

    Incident Location: Highway 65 and CR 50 - Cross Timbers, MO

Subtotal $3,368.00
Total Due $3,368.00


Updated
March 23, 2022 @ 5:20 pm

Invoice updated by Geoffrey.

Status Update
March 23, 2022 @ 5:20 pm

Status changed: Draft to Pending.

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Updated
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Updated
August 31, 2022 @ 5:16 pm

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