Bill To:


Redpoint County Mutual Insurance Co.
13215 Bee Cave Parkway
Bldg. 2, Suite 150
Austin, TX 78738

Services Rendered To:


Marie Shalene
650 Chisholm Rd
Whitesboro, TX 76273
POLICY# BGS01012569

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-CW-201-23-3054 05/11/2023 05/11/2023 On Receipt Callisburg V.F.D.

Product
Price
Qty
Amount
  1. 102 Engine Response (Per Hour)

    $350.00
    1.25
    $437.50
  2. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    1.25
    $187.50
  3. 218 Cervical Collar (# Used)

    $25.00
    1
    $25.00
  4. 310 Hydraulic Tool (# Used)

    $200.00
    1
    $200.00
  5. 206 Latex Gloves (Pairs Used)

    $2.00
    3
    $6.00
  6. 301 Hand Tool (# Used)

    $15.00
    1
    $15.00
  7. 404 Scene Lighting (Per Hour)

    $75.00
    1.25
    $93.75
  8. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.25
    $125.00
  9. 323 Portable Radio (# Used)

    $10.00
    4
    $40.00
  10. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  11. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: CR 118 & FM 678- Whitesboro, TX

    Ordinance Info: City Of Callisburg Resolution

Subtotal $1,379.75
Total Due $1,379.75


Updated
May 11, 2023 @ 1:26 pm

Invoice updated by Geoffrey.

Status Update
May 11, 2023 @ 1:26 pm

Status changed: Draft to Pending.