Bill To:


Texas Farm Bureau
7420 Fish Pond Road
Waco, TX 76710

Services Rendered To:


Jayla Gunn
10995 SH 8 North
Douglasville, TX 75560
POLICY# 23484640

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-BY-205-23-1006 10/06/2023 10/13/2023 On Receipt Douglassville V.F.D.

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

    $400.00
    1
    $400.00
  2. 105 Utility Vehicle Response (Per Hour)

    $250.00
    1
    $250.00
  3. 301 Hand Tool (# Used)

    $15.00
    1
    $15.00
  4. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00

  5. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: SH 77 W & FM 96- Douglasville, TX

    Ordinance Info: Douglassville Volunteer Fire Dept. Resolution

Subtotal $915.00
Total Due $915.00


Updated
October 13, 2023 @ 12:17 pm

Invoice updated by Geoffrey.

Status Update
October 13, 2023 @ 12:17 pm

Status changed: Draft to Pending.

Viewed
April 17, 2024 @ 7:19 pm

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