Bill To:


Travelers Insurance
P.O. Box 650293
Dallas, TX 75265-0293

Services Rendered To:


Willie Thomas
516 W Marshall Ave
Gladewater, TX 75647
POLICY# 8106P336106
Claim# FQT2192

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-HP-401-23-4231-B 02/24/2023 03/01/2023 On Receipt Clarksville City- Warren City VFD

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

    $150.00
    1
    $150.00
  2. 102 Engine Response (Per Hour)

    $350.00
    1
    $350.00
  3. 102 Engine Response (Per Hour)

    $350.00
    1
    $350.00
  4. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  5. 206 Latex Gloves (Pairs Used)

    $2.00
    2
    $4.00
  6. 301 Hand Tool (# Used)

    $15.00
    2
    $30.00
  7. 203 Oil Boom (# Used)

    $20.00
    2
    $40.00
  8. 201 Oil Absorbent Material (# Used)

    $35.00
    5
    $175.00
  9. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00

  10. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 120 US-80- Gladewater, TX

Subtotal $1,449.00
Total Due $1,449.00


Updated
March 1, 2023 @ 12:20 pm

Invoice updated by Geoffrey.

Updated
May 10, 2023 @ 11:16 am

Invoice updated by Geoffrey.