Bill To:


Jose Vasquez
1213 CR 1200
Dangerfield, TX 75638

Services Rendered To:


Jose Vazquez
1213 County Road 1200
Daingerfield, TX 75638
Policy # 943737336

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-BY-205-2021-0807 08/07/2021 08/14/2021 On Receipt Douglassville V.F.D.

*** THIS HAS BEEN SUBMITTED TO YOUR INSURANCE COMPANY AND DENIED. THIS IS NOW YOUR RESPONSIBILITY. ***

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

    $300.00
    1.5
    $450.00
  2. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1.5
    $225.00
  3. 301 Hand Tool (# Used)

    $15.00
    1
    $15.00
  4. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00
  5. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.5
    $150.00
  6. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  7. 409 Manpower (Per Hour)

    4 Firefighters x 1.5 Hours

    $50.00
    6
    $300.00

  8. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Intersection of State Highway 8 & State Highway 77 - Douglassville, Texas

Subtotal $1,640.00
Total Due $1,640.00


Updated
August 13, 2021 @ 4:10 pm

Invoice updated by Geoffrey.

Status Update
August 13, 2021 @ 4:10 pm

Status changed: Draft to Pending.

Updated
August 13, 2021 @ 4:11 pm

Invoice updated by Geoffrey.

Updated
August 13, 2021 @ 4:14 pm

Invoice updated by Geoffrey.

Updated
September 23, 2021 @ 1:31 pm

Invoice updated by Geoffrey.

Updated
December 29, 2021 @ 4:12 pm

Invoice updated by Geoffrey.

Updated
June 13, 2022 @ 1:08 am

Invoice updated by Karen Smith.

Updated
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Invoice updated by Karen Smith.

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

Updated
June 27, 2022 @ 5:49 pm

Invoice updated by Geoffrey.

Updated
June 27, 2022 @ 5:53 pm

Invoice updated by Geoffrey.

Updated
June 29, 2022 @ 3:22 pm

Invoice updated by Karen Smith.

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