Bill To:


HARTFORD INSURANCE
ONE HARTFORD PLAZA
HARTFORD, CT 06115-1707

Services Rendered To:


James Alexander
102 Larkspur St
White Oak, TX 75693
POLICY# 9754406461221

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-HP-309-23-207 07/08/2023 07/18/2023 On Receipt White Oak VFD

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

    $200.00
    1.25
    $250.00
  2. 102 Engine Response (Per Hour)

    $500.00
    1.25
    $625.00
  3. 105 Utility Vehicle Response (Per Hour)

    $250.00
    1.25
    $312.50
  4. 102 Engine Response (Per Hour)

    $500.00
    1.25
    $625.00
  5. 218 Cervical Collar (# Used)

    $25.00
    1
    $25.00
  6. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00
  7. 206 Latex Gloves (Pairs Used)

    $2.00
    8
    $16.00
  8. 301 Hand Tool (# Used)

    $15.00
    4
    $60.00
  9. 201 Oil Absorbent Material (# Used)

    $35.00
    2
    $70.00
  10. 404 Scene Lighting (Per Hour)

    $75.00
    1.25
    $93.75
  11. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.25
    $125.00
  12. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  13. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 608 US Hwy 80- White Oak, TX

    Ordinance Info: City of White Oak Ordinance 2021-02

Subtotal $2,702.25
Total Due $2,702.25


Updated
July 18, 2023 @ 11:36 am

Invoice updated by Geoffrey.

Status Update
July 18, 2023 @ 11:36 am

Status changed: Draft to Pending.

Updated
July 18, 2023 @ 11:38 am

Invoice updated by Geoffrey.