Bill To:


GERMANIA INSURANCE COMPANY
507 Hwy. 290 E
Brenham, TX 77833

Services Rendered To:


Tonya Olsen Mallory
19449 FM 2252
Garden Ridge, Texas 78130-0000
Policy # 430410645262

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-HS-403-2021-0047 09/17/2021 10/08/2021 On Receipt McQueeney V.F.D.

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

    $350.00
    1
    $350.00
  2. 103 Rescue Response (Per Hour)

    $300.00
    1
    $300.00
  3. 105 Utility Vehicle Response (Per Hour)

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

    $25.00
    2
    $50.00
  5. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  6. 402 Fire/Police Services (Per Hour)    

    $100.00
    1
    $100.00
  7. 204 Flare (# Used)

    $8.00
    5
    $40.00
  8. 206 Latex Gloves (Pairs Used)

    $2.00
    5
    $10.00
  9. 215 Trauma Kit (# Used)

    $25.00
    1
    $25.00
  10. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  11. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: FM 725 & Old San Antonio Road - McQueeney, Texas

    Ordinance Info: McQueeney Cost Recovery Resolution 4521

Subtotal $1,525.00
Total Due $1,525.00


Updated
October 7, 2021 @ 1:33 pm

Invoice updated by Geoffrey.

Status Update
October 7, 2021 @ 1:33 pm

Status changed: Draft to Pending.