Bill To:


Cheyann Hachett
29592 Hwy AA
Lebanon, MO 65536

Services Rendered To:


Cheyann Hachett
29592 Hwy AA
Lebanon, MO
POLICY# 95706-4836

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
MO-05-307-23-135 09/19/2023 09/25/2023 On Receipt Eldridge 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)

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

    $250.00
    1
    $250.00
  3. 106 Battalion/Chief Vehicle Response (Per Hour)

    $200.00
    1
    $200.00
  4. 206 Latex Gloves (Pairs Used)

    $2.00
    6
    $12.00
  5. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00

  6. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Nodaway/ Jewell- Lebanon, MO

Subtotal $1,062.00
Total Due $1,062.00


Updated
September 25, 2023 @ 2:05 pm

Invoice updated by Geoffrey.

Status Update
September 25, 2023 @ 2:05 pm

Status changed: Draft to Pending.

Updated
December 21, 2023 @ 12:36 pm

Invoice updated by Geoffrey.