Bill To:


GREAT WEST CASUALTY
1100 WEST 29th STREET
SOUTH SOUIX CITY, NE 68776-3130

Services Rendered To:


GFE Logistics LLC
POLICY# GRT09004A
Adjuster- Angie

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-AK-305-24-782366 05/10/2024 06/04/2024 On Receipt San Felipe Frydek 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. 103 Rescue Response (Per Hour)

    $400.00
    1
    $400.00
  4. 206 Latex Gloves (Pairs Used)

    $2.00
    10
    $20.00
  5. 301 Hand Tool (# Used)

    $15.00
    4
    $60.00
  6. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00

  7. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: FM 1458/ Sealy Rd- San Felipe, TX

Subtotal $1,230.00
Total Due $1,230.00


Updated
June 4, 2024 @ 1:19 pm

Invoice updated by Geoffrey.

Status Update
June 4, 2024 @ 1:19 pm

Status changed: Draft to Pending.