Bill To:


Robert Shumake
536 Mitch Street
Saginaw, TX 76179

Services Rendered To:


Robert Shumake
536 Mitch Street
Saginaw, TX 76179

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-WB-206-2020-882 10/02/2020 10/07/2021 On Receipt Briar-Reno Fire Department

*** Please Submit this to your AUTO Insurance Company for processing and payment, OR YOU MAY CONTACT OUR OFFICE AND PROVIDE US WITH YOUR INSURANCE INFORMATION FOR PROCESSING. ***

Product
Price
Qty
Amount
  1. 104 Tanker Response (Per Hour)

    $300.00
    1
    $300.00
  2. 206 Latex Gloves (Pairs Used)

    $2.00
    3
    $6.00
  3. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  4. 215 Trauma Kit (# Used)

    $25.00
    1
    $25.00
  5. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  6. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 8106 Moran Road - Azle, Texas

    Ordinance Info: Briar-Reno Cost Recovery Resolution

Subtotal $681.00
Total Due $681.00


Updated
October 6, 2021 @ 5:07 pm

Invoice updated by Geoffrey.

Status Update
October 6, 2021 @ 5:07 pm

Status changed: Draft to Pending.

Viewed
January 9, 2022 @ 8:56 pm

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

Updated
January 20, 2022 @ 1:57 pm

Invoice updated by Geoffrey.

Updated
January 20, 2022 @ 1:57 pm

Invoice updated by Geoffrey.

Viewed
October 25, 2022 @ 2:54 pm

Invoice viewed by 64.124.8.25 for the first time.

Viewed
November 3, 2023 @ 7:39 am

Invoice viewed by 74.133.199.147 for the first time.