Bill To:


Protective Ins Co
P.O. Box 7099
Indianapolis, IN 46207

Services Rendered To:


Fernando Vaquedano
1030 NE 42nd Ave
Homestead, FL 33030
POLICY# B-11841

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-SH-201-C22-25914 10/06/2022 12/15/2022 On Receipt Angus VFD

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

    $300.00
    1
    $300.00
  2. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  3. 206 Latex Gloves (Pairs Used)

    $2.00
    5
    $10.00

  4. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 221 SB IH-45- Angus, TX

    Ordinance Info: City of Angus Billing Authorization # 7

Subtotal $410.00
Total Due $410.00


Updated
December 15, 2022 @ 6:11 pm

Invoice updated by Geoffrey.

Status Update
December 15, 2022 @ 6:11 pm

Status changed: Draft to Pending.