Bill To:


Northland Insurance
P.O. Box 64816
St.Paul, MN 55164

Services Rendered To:


Blue Horse Express LLC
15214 Flintridge Lake Ln
Cypress, TX 77429
POLICY# WF013454

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-SH-201-C23-24416 09/19/2023 11/21/2023 On Receipt Angus Vol. Fire Department

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

    $250.00
    2.5
    $625.00
  2. 103 Rescue Response (Per Hour)

    $400.00
    2.5
    $1,000.00
  3. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    2.5
    $250.00
  4. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00

  5. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 224 NB IH 45- Angus, TX

    Ordinance Info: City of Angus Billing Authorization # 7

Subtotal $2,125.00
Total Due $2,125.00


Updated
November 21, 2023 @ 9:40 am

Invoice updated by Geoffrey.

Status Update
November 21, 2023 @ 9:40 am

Status changed: Draft to Pending.