Bill To:


Josefina Rodrigo Santa Cruz
3 Burk Ct
Freeport, TX 77541

Services Rendered To:


Josefina Rodrigo Santa Cruz
3 Burk Ct
Freeport, TX 77541
POLICY# 967586493

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-BB-326-23-27-B 02/26/2023 06/09/2023 On Receipt Rosharon VFD

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

Product
Price
Qty
Amount
  1. 103 Rescue Response (Per Hour)

    $300.00
    3.25
    $975.00
  2. 102 Engine Response (Per Hour)

    $350.00
    3.25
    $1,137.50
  3. 105 Utility Vehicle Response (Per Hour)

    $150.00
    3.25
    $487.50
  4. 301 Hand Tool (# Used)

    $15.00
    1
    $15.00
  5. 310 Hydraulic Tool (# Used)

    $200.00
    2
    $400.00
  6. 404 Scene Lighting (Per Hour)

    $75.00
    3.25
    $243.75
  7. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00

  8. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 288- Rosharon, TX

Subtotal $3,508.75
Total Due $3,508.75


Updated
June 9, 2023 @ 12:42 pm

Invoice updated by Geoffrey.

Updated
June 26, 2023 @ 2:24 pm

Invoice updated by Geoffrey.

Updated
June 26, 2023 @ 2:25 pm

Invoice updated by Geoffrey.