Bill To:


Texas Farm Bureau
7420 Fish Pond Road
Waco, TX 76710

Services Rendered To:


Regina Chisum
2200 County Rd 155
Whitesboro, TX 76273
POLICY# 21552049

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-CW-201-22-473222-B 11/29/2022 12/06/2022 On Receipt Callisburg VFD

Product
Price
Qty
Amount
  1. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    1
    $150.00
  2. 102 Engine Response (Per Hour)

    $350.00
    1
    $350.00
  3. 209 Extinguisher (# Used)

    $50.00
    1
    $50.00
  4. 204 Flate (# Used)

    $8.00
    4
    $32.00
  5. 404 Scene Lighting (Per Hour)

    $75.00
    1
    $75.00
  6. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  7. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  8. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 7750 E Hwy 82- Gainesville, TX

Subtotal $1,007.00
Total Due $1,007.00


Updated
December 6, 2022 @ 2:42 pm

Invoice updated by Geoffrey.