Bill To:


SHELTER INSURANCE
1817 WEST BROADWAY
COLUMBIA, MO 65203-1107

Services Rendered To:


Chris Fisher
1200 Hominy Creek Rd
Burkesville, KY 42717
POLICY# 16-1-C-8801683-21

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
KY-00-921-24-3898 03/11/2024 06/06/2024 On Receipt Breeding Area VFD

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

    $500.00
    2
    $1,000.00
  2. 105 Utility Vehicle Response (Per Hour)

    $250.00
    2
    $500.00
  3. 105 Utility Vehicle Response (Per Hour)

    $250.00
    2
    $500.00
  4. 312 Portable Pump (# Used)

    $50.00
    1
    $50.00

  5. Additional Incident Info

    Incident Type: Vehicle Fire Response

    Incident Location: 2201 Greenbriar Dr- Breeding, KY

Subtotal $2,050.00
Total Due $2,050.00


Updated
June 6, 2024 @ 1:21 pm

Invoice updated by Geoffrey.

Status Update
June 6, 2024 @ 1:21 pm

Status changed: Draft to Pending.