Bill To:


Gainsco Insurance
3333 Lee Parkway #1200
Dallas, TX 75219

Services Rendered To:


Ryan Gummer
607 Cactus St
Fulton, TX 78385
POLICY# 03MGEP1675498-00

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-AD-505-23-568 12/10/2023 12/12/2023 On Receipt Rock Port VFD

Product
Price
Qty
Amount
  1. 106 Battalion/Chief Vehicle Response (Per Hour)

    $200.00
    1
    $200.00
  2. 102 Engine Response (Per Hour)

    $500.00
    1
    $500.00
  3. 104 Tanker Response (Per Hour)

    $400.00
    1
    $400.00
  4. 102 Engine Response (Per Hour)

    $500.00
    1
    $500.00
  5. 102 Engine Response (Per Hour)

    $500.00
    1
    $500.00
  6. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  7. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00

  8. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 1800 W Market St- Rockport, TX

Subtotal $2,450.00
Total Due $2,450.00


Updated
December 12, 2023 @ 4:58 pm

Invoice updated by Geoffrey.

Status Update
December 12, 2023 @ 4:58 pm

Status changed: Draft to Pending.