Bill To:


ALLSTATE FIRE AND CASUALTY
2775 SANDERS ROAD
NORTHBROOK, IL 60062-6110

Services Rendered To:


Isaac Kennedy
605 S Dawson St
Meeker, OK 74855
POLICY# 000000831941578

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
OK-41-016-23-170 10/21/2023 10/24/2023 On Receipt Jacktown Fire Protection District

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

    $250.00
    1
    $250.00
  2. 102 Engine Response (Per Hour)

    $500.00
    1
    $500.00
  3. 105 Utility Vehicle Response (Per Hour)

    $250.00
    1
    $250.00
  4. 218 Cervical Collar (# Used)

    $25.00
    1
    $25.00
  5. 206 Latex Gloves (Pairs Used)

    $2.00
    4
    $8.00
  6. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  7. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  8. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Hwy 62 & 3350 Rd- Meeker, OK

    Ordinance Info: Jacktown Cost Recovery Resolution

Subtotal $1,383.00
Total Due $1,383.00


Updated
October 24, 2023 @ 12:53 pm

Invoice updated by Geoffrey.

Status Update
October 24, 2023 @ 12:53 pm

Status changed: Draft to Pending.