Bill To:


Duncan Brandon Wayne
33 Fallen Drive, Lot 1
Eminence, KY 40019

Services Rendered To:


Duncan Brandon Wayne
33 Fallen Drive, Lot 1
Eminence, KY 40019
Liberty Mutual Insurance
POLICY # AFBIL001047-00

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-HS-403-22-233 06/16/2022 06/21/2022 On Receipt McQueeney V.F.D.

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

Product
Price
Qty
Amount
  1. 102 Engine Response (Per Hour)

    $350.00
    1.25
    $437.50
  2. 102 Engine Response (Per Hour)

    $350.00
    1.25
    $437.50
  3. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00
  4. 402 Fire/Police Services (Per Hour)    

    $100.00
    1.25
    $125.00
  5. 201 Oil Absorbent Material (# Used)

    $35.00
    5
    $175.00
  6. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.25
    $125.00

  7. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 196 Pecan Loop - McQueeney, Texas

    Ordinance Info: McQueeney Cost Recovery Resolution 4521

Subtotal $1,550.00
Total Due $1,550.00


Updated
June 20, 2022 @ 12:56 pm

Invoice updated by Geoffrey.

Status Update
June 20, 2022 @ 12:56 pm

Status changed: Draft to Pending.

Updated
August 22, 2022 @ 5:19 pm

Invoice updated by Geoffrey.