Bill To:


Loya Insurance Company
P.O. Box 972450
El Paso, TX 79997

Services Rendered To:


Eduardo Torres
20464 County Rd 818
Farmersville, TX 75442
POLICY# 65/392836859

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-CN-310-23-27891-B 02/17/2023 02/17/2023 On Receipt Lavon VFD

Product
Price
Qty
Amount
  1. 101 Aerial/Ladder Response (Per Hour)

    $400.00
    1
    $400.00
  2. 206 Latex Gloves (Pairs Used)

    $2.00
    6
    $12.00
  3. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00

  4. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: N State Hwy 78/ Bently Dr- Lavon, TX

    Ordinance Info: City of Lavon Resolution NO. 2020-03-01

Subtotal $512.00
Total Due $512.00


Updated
February 17, 2023 @ 1:21 pm

Invoice updated by Geoffrey.