Paid

Invoice

From:

300 Ballardvale St
Andover, MA 01810

306 Main St
Worcester, MA 01608

Invoice Number webId_ACCT# 4004
Order Number OMAHA STORM DBA SOUTH OMAHA ATHLETICS- ACCT# 4004
Invoice Date May 21, 2024
Total Due $0.00
To:
ESP Bill Pay General Account

INVOICE FOR OMAHA STORM DBA SOUTH OMAHA ATHLETICS- ACCT# 4004

Qty Service Rate/PriceSub Total
1 GL PACKAGE- HCC
$1,385.36$1,385.36
1 PARTICIPANT MEDICAL PACKAGE - AIG
$1,500.00$1,500.00
1 COACHES MEDICAL PACKAGE - AIG
$125.00$125.00
1 D&O PACKAGE - GREAT AMERICAN $600.00$600.00
Sub Total $3,610.36
Site and Service Fee (3.0%) $108.31
Paid -$3,718.67
Total Due $0.00