Bill To:


Farmers Insurance
PO Box 268993
Oklahoma City, OK 73126

Services Rendered To:


William Barron Allison IV
237 Tall Timber Loop
Whitney, TX 76692
POLICY# A7993029260

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-KP-401-23-19 02/08/2023 02/20/2023 On Receipt Peoria VFD

Product
Price
Qty
Amount
  1. 105 Utility Vehicle Response (Per Hour)

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

    $350.00
    1
    $350.00
  3. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    1
    $150.00
  4. 218 Cervical Collar (# Used)

    $25.00
    1
    $25.00
  5. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  6. 206 Latex Gloves (Pairs Used)

    $2.00
    1
    $2.00
  7. 301 Hand Tool (# Used)

    $15.00
    1
    $15.00
  8. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  9. 324 Traffic Cone (# Used)

    $5.00
    6
    $30.00
  10. 408 Air Medical Landing Zone (Used)

    $250.00
    1
    $250.00
  11. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  12. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: State Hwy 22 & FM 1947- Hillsboro, TX

    Ordinance Info: Recovery of Service Costs for Peoria VFD

Subtotal $1,572.00
Total Due $1,572.00


Updated
February 20, 2023 @ 11:34 am

Invoice updated by Geoffrey.

Status Update
February 20, 2023 @ 11:34 am

Status changed: Draft to Pending.