Bill To:


Mercury/American Ins
2310 East 15th
Tulsa, OK 74014

Services Rendered To:


Daniel/Marry Gellner
413740 East 1060 Rd
Council Hill, OK 74428
POLICY# OKHP000035103

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
OK-49-016-22-160 12/25/2022 02/02/2023 On Receipt Paradise Point FD

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

    $150.00
    6
    $900.00
  2. 105 Utility Vehicle Response (Per Hour)

    $150.00
    6
    $900.00
  3. 105 Utility Vehicle Response (Per Hour)

    $150.00
    6
    $900.00
  4. 102 Engine Response (Per Hour)

    $350.00
    6
    $2,100.00
  5. 103 Rescue Response (Per Hour)

    $300.00
    6
    $1,800.00
  6. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    6
    $900.00
  7. 209 Extinguisher (# Used)

    $50.00
    1
    $50.00
  8. 319 Generator (Per Generator/Per Hour)

    $50.00
    6
    $300.00
  9. 318 Ladder (# Used)

    $35.00
    2
    $70.00
  10. 301 Hand Tool (# Used)

    $15.00
    6
    $90.00
  11. 311 PPV / Ventilation Fan (# Used)

    $50.00
    1
    $50.00
  12. 303 SCBA Breathing Apparatus (# Used)

    $50.00
    6
    $300.00
  13. 304 SCBA Cylinder (# Used)

    $25.00
    6
    $150.00
  14. 306 Hose Per 50′ (Amt Used)

    $25.00
    14
    $350.00
  15. 208 Fire Line Tap (Per Foot, Amt Used)

    $0.25
    100
    $25.00
  16. 309 Power Tool (# Used)

    $50.00
    3
    $150.00

  17. Additional Incident Info

    Incident Type: Structure Fire Response

    Incident Location: 413740 East 1060 Rd Council Hill, OK 74428

    Ordinance Info: Paradise Point Cost Recovery Resolution 1621

Subtotal $9,035.00
Total Due $9,035.00


Updated
February 2, 2023 @ 11:57 am

Invoice updated by Geoffrey.

Status Update
February 2, 2023 @ 11:57 am

Status changed: Draft to Pending.