Bill To:


FOREMOST INSURANCE
PO BOX 2450
GRAND RAPIDS, MI 49501-2450

Services Rendered To:


Vehicle Owner
Policy # 0078546435

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-WB-206-2021-233-B 03/09/2021 11/12/2021 On Receipt Briar-Reno Fire Department

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

    $300.00
    1
    $300.00
  2. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1
    $150.00
  3. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    1
    $150.00
  4. 218 Cervical Collar (# Used)

    $25.00
    1
    $25.00
  5. 206 Latex Gloves (Pairs Used)

    $2.00
    4
    $8.00
  6. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  7. 330 Backboard (# Used)

    $25.00
    1
    $25.00
  8. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  9. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 11600 FM 730 North - Azle, Texas

Subtotal $1,008.00
Total Due $1,008.00


Updated
November 12, 2021 @ 5:13 pm

Invoice updated by Geoffrey.

Viewed
October 24, 2022 @ 1:08 am

Invoice viewed by 64.124.8.25 for the first time.

Viewed
April 11, 2023 @ 8:30 pm

Invoice viewed by 74.80.208.20 for the first time.