Bill To:


Jamie Ramos
1703 MorningSide Dr
Gainesville, TX 76240

Services Rendered To:


Jamie Ramos
1703 MorningSide Dr
Gainesville, TX 76240
POLICY# 485 8552-G15-43 001

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-CW-201-22-464039 07/30/2022 01/23/2023 On Receipt Callisburg VFD

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

    $350.00
    2.75
    $962.50
  2. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    2.75
    $412.50
  3. 314 Cribbing – Lvl 1 (Passenger Vehicle) (Used)

    $100.00
    1
    $100.00
  4. 209 Extinguisher (# Used)

    $50.00
    2
    $100.00
  5. 402 Fire/Police Services (Per Hour)    

    $100.00
    2.75
    $275.00
  6. 310 Hydraulic Tool (# Used)

    $200.00
    2
    $400.00
  7. 206 Latex Gloves (Pairs Used)

    $2.00
    4
    $8.00
  8. 301 Hand Tool (# Used)

    $15.00
    2
    $30.00
  9. 309 Power Tool (# Used)

    $50.00
    1
    $50.00
  10. 317 Rescue Struts (# Used)

    $50.00
    2
    $100.00
  11. 303 SCBA Breathing Apparatus (# Used)

    $50.00
    2
    $100.00
  12. 304 SCBA Cylinder (# Used)

    $25.00
    2
    $50.00
  13. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    2.75
    $275.00
  14. 327 Windshield Kit (# Used)

    $25.00
    1
    $25.00
  15. 306 Hose Per 50′ (Amt Used)

    $25.00
    2
    $50.00
  16. 408 Air Medical Landing Zone (Used)

    $250.00
    1
    $250.00
  17. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  18. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: CR 163 & US Hwy 82- Gainesville, TX

Subtotal $3,438.00
Total Due $3,438.00


Updated
January 23, 2023 @ 11:23 am

Invoice updated by Geoffrey.

Status Update
January 23, 2023 @ 11:23 am

Status changed: Draft to Pending.

Updated
May 23, 2023 @ 4:45 pm

Invoice updated by Geoffrey.