Bill To:


USAA CASUALTY INSURANCE
9800 FREDERICKSBURG ROAD
SAN ANTONIO, TX 78240-4100

Services Rendered To:


Michael Blankenship
689 Gallagher Road
McQueeney, Texas 78123
Policy # 013748870V71036

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-HS-403-2022-17-C 01/13/2022 01/19/2022 On Receipt McQueeney V.F.D.

Product
Price
Qty
Amount
  1. 103 Rescue Response (Per Hour)

    $300.00
    1
    $300.00
  2. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1
    $150.00
  3. 106 Battalion/Chief Vehicle Response (Per Hour)

    Chief

    $150.00
    1
    $150.00
  4. 102 Engine Response (Per Hour)

    $350.00
    1
    $350.00
  5. 106 Battalion/Chief Vehicle Response (Per Hour)

    ASST. Chief

    $150.00
    1
    $150.00
  6. 331 Air Bags (# Used)

    $150.00
    3
    $450.00
  7. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  8. 209 Extinguisher (# Used)

    $50.00
    1
    $50.00
  9. 402 Fire/Police Services (Per Hour)    

    $100.00
    1
    $100.00
  10. 206 Latex Gloves (Pairs Used)

    $2.00
    9
    $18.00
  11. 309 Power Tool (# Used)

    $50.00
    3
    $150.00
  12. 201 Oil Absorbent Material (# Used)

    $35.00
    5
    $175.00
  13. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  14. 215 Trauma Kit (# Used)

    $25.00
    1
    $25.00
  15. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  16. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 6000 Block of FM 725 - McQueeney, Texas

    Ordinance Info: RESOLUTION-McQueeney Cost Recovery Resolution 4521

Subtotal $2,668.00
Total Due $2,668.00


Updated
January 18, 2022 @ 5:40 pm

Invoice updated by Geoffrey.

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May 15, 2022 @ 2:28 pm

Invoice viewed by Karen Smith (KarenS) for the first time.

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October 22, 2022 @ 7:22 pm

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