Bill To:


WilsonArt LLC
2501 Wilsonart Drive P.O. Box 6110
Temple, TX 76503

Services Rendered To:


Wilson Art LLC
VIN# 3AKJHHDR0LSMC3337
POLICY# AS2631510797012

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
AL-01-717-22-1209 12/09/2022 12/21/2022 On Receipt Tri Community VFD

*** 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
    7.75
    $2,325.00
  2. 309 Power Tool (# Used)

    $50.00
    1
    $50.00
  3. 310 Hydraulic Tool (# Used)

    $200.00
    2
    $400.00
  4. 206 Latex Gloves (Pairs Used)

    $2.00
    12
    $24.00
  5. 301 Hand Tool (# Used)

    $15.00
    1
    $15.00
  6. 404 Scene Lighting (Per Hour)

    $75.00
    7.75
    $581.25
  7. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    7.75
    $775.00
  8. 215 Trauma Kit (# Used)

    $25.00
    1
    $25.00
  9. 306 Hose Per 50′ (Amt Used)

    $25.00
    1
    $25.00
  10. 302 Hand Light (# Used)

    $5.00
    3
    $15.00

  11. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 68875 Hwy 9- Goodwater, AL

Subtotal $4,235.25
Total Due $4,235.25


Updated
December 21, 2022 @ 1:39 pm

Invoice updated by Geoffrey.

Status Update
December 21, 2022 @ 1:39 pm

Status changed: Draft to Pending.

Updated
May 18, 2023 @ 2:49 pm

Invoice updated by Geoffrey.

Updated
May 24, 2023 @ 2:31 pm

Invoice updated by Geoffrey.