Bill To:


ROOT INSURANCE COMPANY
80 EAST RICH STREET - SUITE 500
COLUMBUS, OH 43215-5249

Services Rendered To:


Yakhalra Moody
1821 NW 92nd Street
Lawton, OK 73505
Claim # N8RD87OK

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
OK-49-007-2021-11 01/16/2021 01/21/2021 On Receipt F.A.I.C. V.F.D.

Product
Price
Qty
Amount
  1. 105 Utility Vehicle Response (Per Hour)

    $500.00
    1
    $500.00
  2. 105 Utility Vehicle Response (Per Hour)

    $500.00
    1
    $500.00
  3. 407 Patient Care / Evaluation (Per Patient)

    $50.00
    2
    $100.00

  4. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: I-40 MM 254.5 West Bound - Checotah, OK

Subtotal $1,100.00
Total Due $1,100.00


Updated
January 20, 2021 @ 6:55 pm

Invoice updated by Geoffrey.

Status Update
January 20, 2021 @ 6:55 pm

Status changed: Draft to Pending.

Updated
January 20, 2021 @ 6:58 pm

Invoice updated by Geoffrey.

Updated
January 20, 2021 @ 7:01 pm

Invoice updated by Geoffrey.

Updated
January 20, 2021 @ 7:04 pm

Invoice updated by Geoffrey.

Viewed
June 24, 2021 @ 4:50 pm

Invoice viewed by Karen Smith (KarenS) for the first time.

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October 22, 2022 @ 6:46 am

Invoice viewed by 64.124.8.31 for the first time.