Bill To:


Peerless Insurance
464 West Street
Keene, NH 03431-2453

Services Rendered To:


Oliver Fealto
2032 CR 2348
Marietta, Texas 75566
Policy # Y7295019

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-BY205-2020-1022 10/22/2020 11/03/2020 On Receipt Douglassville V.F.D.

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

    $350.00
    1.75
    $612.50
  2. 103 Rescue Response (Per Hour)

    $300.00
    1.75
    $525.00
  3. 302 Hand Light (# Used)

    $5.00
    2
    $10.00
  4. 301 Hand Tool (# Used)

    $15.00
    2
    $30.00
  5. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00
  6. 409 Manpower (Per Hour)

    3 Firefighters 1.75 Hours each

    $50.00
    5.25
    $262.50

  7. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Stae Highway 77 West and County Road 2338 - Cass County Texas

Subtotal $1,690.00
Total Due $1,690.00


Updated
November 2, 2020 @ 6:27 pm

Invoice updated by Geoffrey.

Status Update
November 2, 2020 @ 6:27 pm

Status changed: Draft to Pending.

Updated
October 4, 2021 @ 10:34 pm

Invoice updated by Geoffrey.

Updated
October 4, 2021 @ 10:35 pm

Invoice updated by Geoffrey.

Updated
October 4, 2021 @ 10:37 pm

Invoice updated by Geoffrey.

Viewed
October 24, 2022 @ 12:07 pm

Invoice viewed by 64.124.8.30 for the first time.