Bill To:


Ramon Avila
9707 Montana Sapphire Ln
Rosharon, TX 77583

Services Rendered To:


Ramon Avila
9707 Montana Sapphire Ln
Rosharon, TX 77583
POLICY# 08-TXY-948388

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-BB-326-23-78-A 05/17/2023 06/23/2023 On Receipt Rosharon VFD

*** THIS HAS BEEN SUBMITTED TO YOUR INSURANCE COMPANY AND DENIED. THIS IS NOW YOUR RESPONSIBILITY. ***

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

    $350.00
    1.25
    $437.50
  2. 103 Rescue Response (Per Hour)

    $300.00
    1.25
    $375.00
  3. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1.25
    $187.50
  4. 102 Engine Response (Per Hour)

    $350.00
    1.25
    $437.50
  5. 203 Oil Boom (# Used)

    $20.00
    5
    $100.00
  6. 419 Environmental Spill

    $250.00
    1
    $250.00
  7. 201 Oil Absorbent Material (# Used)

    $35.00
    2
    $70.00
  8. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00
  9. 301 Hand Tool (# Used)

    $15.00
    3
    $45.00

  10. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: FM 521- Rosharon, TX

    Ordinance Info: Rosharon Cost Recovery Resolution

Subtotal $2,152.50
Total Due $2,152.50


Updated
June 23, 2023 @ 11:56 am

Invoice updated by Geoffrey.

Status Update
June 23, 2023 @ 11:56 am

Status changed: Draft to Pending.

Updated
November 14, 2023 @ 3:56 pm

Invoice updated by Geoffrey.