Bill To:


DAIRYLAND INSURANCE
1800 NORTH POINT DRIVE
STEVENS POINT, WI 54481-1253

Services Rendered To:


D Antre Marque Smith
933 Allende Street
Sequin, TX 78155
Policy # 11406568781

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-HS-403-22-194-A 05/16/2022 05/24/2022 On Receipt McQueeney V.F.D.

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

    $350.00
    1
    $350.00
  2. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1
    $150.00
  3. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00
  4. 402 Fire/Police Services (Per Hour)    

    $100.00
    1
    $100.00
  5. 206 Latex Gloves (Pairs Used)

    $2.00
    3
    $6.00
  6. 201 Oil Absorbent Material (# Used)

    $35.00
    2
    $70.00
  7. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00

  8. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: FM 1044 and FM 78 - McQueeney, Texas

    Ordinance Info: McQueeney Cost Recovery Resolution 4521

Subtotal $1,026.00
Total Due $1,026.00


Updated
May 24, 2022 @ 2:52 pm

Invoice updated by Geoffrey.

Status Update
May 24, 2022 @ 2:52 pm

Status changed: Draft to Pending.

Viewed
October 25, 2022 @ 2:40 pm

Invoice viewed by 64.124.8.25 for the first time.