Bill To:


GEICO INSURANCE
ONE GEICO BLVD
FREDERICKSBURG, VA 22412-9000

Services Rendered To:


Andrew Davis
2840 Hickory Creek Rd
Muskogee, OK 74403
POLICY# 4354670343

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
OK-49-015-23-211 02/11/2023 02/14/2023 On Receipt Tiger Mtn FD

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

    $350.00
    1.5
    $525.00
  2. 103 Rescue Response (Per Hour)

    $300.00
    1.5
    $450.00
  3. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  4. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.5
    $150.00
  5. 215 Trauma Kit (# Used)

    $25.00
    1.5
    $37.50
  6. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  7. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: I 40 EB MM 247- Henryetta, OK

    Ordinance Info: Tiger Mountain - McIntosh County Resolution 72021

Subtotal $1,662.50
Total Due $1,662.50


Updated
February 14, 2023 @ 11:32 am

Invoice updated by Geoffrey.

Status Update
February 14, 2023 @ 11:32 am

Status changed: Draft to Pending.