Bill To:


Braydon Oliver
128 S. Brookdale Road
Apache, OK 73006

Services Rendered To:


Braydon Oliver
128 S. Brookdale Road
Apache, OK 73006
Policy # 195710013

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
OK-16-016-2022-246 01/18/2022 01/19/2022 On Receipt Wichita Mountain Estates V.F.D.

*** THIS HAS BEEN SUBMITTED TO YOUR INSURANCE COMPANY AND DENIED. THIS IS NOW YOUR RESPONSIBILITY. ***

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

    $350.00
    1.25
    $437.50
  2. 104 Tanker Response (Per Hour)

    $300.00
    1.25
    $375.00
  3. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  4. 209 Extinguisher (# Used)

    $50.00
    2
    $100.00
  5. 205 Foam (Per Gallon)

    $65.00
    3
    $195.00
  6. 313 TIC Thermal Imaging Camera (# Used)

    $100.00
    1
    $100.00
  7. 301 Hand Tool (# Used)

    $15.00
    2
    $30.00
  8. 201 Oil Absorbent Material (# Used)

    $35.00
    2
    $70.00
  9. 303 SCBA Breathing Apparatus (# Used)

    $50.00
    2
    $100.00
  10. 304 SCBA Cylinder (# Used)

    $25.00
    4
    $100.00
  11. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.25
    $125.00
  12. 207 Wetting Agent (Amt Used)

    $25.00
    1
    $25.00
  13. 306 Hose Per 50′ (Amt Used)

    $25.00
    4
    $100.00

  14. Additional Incident Info

    Incident Type: Vehicle Fire Response

    Incident Location: Interstate 44 @ MM 47 - Lawton, OK

Subtotal $2,007.50
Total Due $2,007.50


Updated
January 18, 2022 @ 6:16 pm

Invoice updated by Geoffrey.

Status Update
January 18, 2022 @ 6:16 pm

Status changed: Draft to Pending.

Updated
April 27, 2022 @ 6:14 pm

Invoice updated by Geoffrey.

Viewed
October 22, 2022 @ 8:19 am

Invoice viewed by 64.124.8.27 for the first time.