Bill To:


Camden Alvarez
109 Mill Crossing E
Colleyville, TX 76034

Services Rendered To:


Camden Alvarez
109 Mill Crossing E
Colleyville, TX 76034
Policy# 4322-25-96-82

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-WB-206-2020-849 09/24/2020 09/22/2021 On Receipt Briar-Reno Fire Dept.

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

Product
Price
Qty
Amount
  1. 104 Tanker Response (Per Hour)

    $300.00
    1
    $300.00
  2. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  3. 206 Latex Gloves (Pairs Used)

    $2.00
    4
    $8.00
  4. 404 Scene Lighting (Per Hour)

    $75.00
    1
    $75.00
  5. 215 Trauma Kit (# Used)

    $25.00
    1
    $25.00
  6. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1
    $150.00
  7. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00
  8. 322 Turn Out Gear / PPE (Per FireFighter)

    $250.00
    3
    $750.00

  9. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Old Reno Rd. & Tim Hall Rd., Reno/Azle, TX

Subtotal $1,808.00
Total Due $1,808.00


Updated
September 21, 2021 @ 11:43 pm

Invoice updated by Karen Smith.

Status Update
September 21, 2021 @ 11:43 pm

Status changed: Draft to Pending.

Updated
December 30, 2021 @ 6:49 pm

Invoice updated by Geoffrey.

Viewed
December 30, 2021 @ 6:50 pm

Invoice viewed by GEOFFREY SMITH (Geoffrey) for the first time.

Updated
December 30, 2021 @ 6:54 pm

Invoice updated by Geoffrey.

Updated
December 30, 2021 @ 6:55 pm

Invoice updated by Geoffrey.

Updated
June 12, 2022 @ 4:55 pm

Invoice updated by Karen Smith.

Updated
June 12, 2022 @ 4:56 pm

Invoice updated by Karen Smith.

Viewed
October 23, 2022 @ 1:30 am

Invoice viewed by 64.124.8.45 for the first time.