Bill To:


Farmer's Insurance
PO Box 0991
Carol Stream, IL 60132-0991

Services Rendered To:


John Saxton
217 Ridge Hollow Trail
Weatherford, TX 76087
Claim# SLS05458NY

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-WB-206-21-856 09/07/2021 06/12/2023 On Receipt Briar-Reno Fire Department

*** Please Submit this to your AUTO Insurance Company for processing and payment, OR YOU MAY CONTACT OUR OFFICE AND PROVIDE US WITH YOUR INSURANCE INFORMATION FOR PROCESSING. ***

Product
Price
Qty
Amount
  1. 104 Tanker Response (Per Hour)

    $300.00
    1.75
    $525.00
  2. 402 Fire/Police Services (Per Hour)    

    $100.00
    1.75
    $175.00
  3. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    1.75
    $262.50
  4. 206 Latex Gloves (Pairs Used)

    $2.00
    8
    $16.00
  5. 301 Hand Tool (# Used)

    $15.00
    3
    $45.00
  6. 404 Scene Lighting (Per Hour)

    $75.00
    1.75
    $131.25
  7. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.75
    $175.00
  8. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00

  9. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Hwy 199- Reno, TX

    Ordinance Info: Briar Reno Cost Recovery Ordinance

Subtotal $1,579.75
Total Due $1,579.75


Updated
June 12, 2023 @ 2:45 pm

Invoice updated by Geoffrey.

Status Update
June 12, 2023 @ 2:45 pm

Status changed: Draft to Pending.

Updated
March 12, 2024 @ 2:49 pm

Invoice updated by Geoffrey.

Updated
March 29, 2024 @ 4:37 pm

Invoice updated by Geoffrey.