Bill To:


USAA CASUALTY INSURANCE
9800 FREDERICKSBURG ROAD
SAN ANTONIO, TX 78240-4100

Services Rendered To:


Bradley Starling
2500 Richland Drive
Edmond, OK 73012-3660
Driver: Rook Starling
POLICY # 01959 46 75R 7101

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
OK-49-015-22-819 08/19/2022 08/24/2022 On Receipt Tiger Mountain Fire Dept.

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

    $350.00
    1
    $350.00
  2. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1
    $150.00
  3. 206 Latex Gloves (Pairs Used)

    $2.00
    2
    $4.00
  4. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  5. 215 Trauma Kit (# Used)

    $25.00
    1
    $25.00
  6. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  7. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Interstate 40 Westbound @ MM 250 - Henryetta, OK

    Ordinance Info: Tiger Mountain - McIntosh County Resolution 72021

Subtotal $879.00
Total Due $879.00


Updated
August 24, 2022 @ 2:16 pm

Invoice updated by Geoffrey.

Status Update
August 24, 2022 @ 2:16 pm

Status changed: Draft to Pending.

Viewed
October 22, 2022 @ 7:16 pm

Invoice viewed by 64.124.8.36 for the first time.