Bill To:


Texas Farm Bureau
7420 Fish Pond Road
Waco, TX 76710

Services Rendered To:


Daniel Kots
4503 Beechwood Dr
Rosenberg, TX 77471
POLICY# 23390657


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

    $250.00
    1
    $250.00
  2. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  3. 301 Hand Tool (# Used)

    $15.00
    1
    $15.00
  4. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00

  5. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: FM 1458 @ i-10 frontage- San Felipe, TX

Subtotal $615.00
Total Due $615.00


Updated
December 2, 2022 @ 1:50 pm

Invoice updated by Geoffrey.

Status Update
December 2, 2022 @ 1:50 pm

Status changed: Draft to Pending.