Bill To:


Texas Farm Bureau Insurance Companies
7420 Fish Pond Road
Waco, TX 76710

Services Rendered To:


Marion Pierce
245 CR 231
Gatesville, Texas 76528
Policy # 20913501


Product
Price
Qty
Amount
  1. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    2.5
    $375.00
  2. 103 Rescue Response (Per Hour)

    $300.00
    2.5
    $750.00
  3. 102 Engine Response (Per Hour)

    $350.00
    2.5
    $875.00
  4. 102 Engine Response (Per Hour)

    $350.00
    2.5
    $875.00
  5. 218 Cervical Collar (# Used)

    $25.00
    1
    $25.00
  6. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  7. 319 Generator (Per Generator/Per Hour)

    $50.00
    2.5
    $125.00
  8. 328 GlassMaster (# Used)

    $25.00
    1
    $25.00
  9. 206 Latex Gloves (Pairs Used)

    $2.00
    4
    $8.00
  10. 403 Traffic Control / Road Closure (Per Hour)

    2 x 2.5 Hours each

    $100.00
    5
    $500.00
  11. 215 Trauma Kit (# Used)

    $25.00
    1
    $25.00
  12. 327 Windshield Kit (# Used)

    $25.00
    1
    $25.00
  13. 325 Turbo Flare (# Used)

    $5.00
    1
    $5.00
  14. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00
  15. 408 Air Medical Landing Zone (Used)

    $250.00
    1
    $250.00

  16. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: FM 182 and CR 216 - Gatesville, Texas

Subtotal $4,363.00
Total Due $4,363.00
Updated
July 3, 2020 @ 11:38 am

Invoice updated by Karen Smith.

Status Update
July 3, 2020 @ 11:38 am

Status changed: Draft to Pending.