Bill To:


ENCOMPASS INSURANCE
PO BOX 1623
Winston-Salem, NC 27102-1623

Services Rendered To:


Christina Bassetti
325 Warwick Road
Deptford, NJ 08096-6023
Policy # 282570728

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-HS-403-2021-430-B 09/30/2021 10/08/2021 On Receipt McQueeney V.F.D.

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

    $350.00
    1.25
    $437.50
  2. 103 Rescue Response (Per Hour)

    $300.00
    1.25
    $375.00
  3. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    1.25
    $187.50
  4. 218 Cervical Collar (# Used)

    $25.00
    2
    $50.00
  5. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  6. 402 Fire/Police Services (Per Hour)    

    $100.00
    1.25
    $125.00
  7. 206 Latex Gloves (Pairs Used)

    $2.00
    6
    $12.00
  8. 201 Oil Absorbent Material (# Used)

    $35.00
    5
    $175.00
  9. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.25
    $125.00
  10. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  11. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: FM 78 & FM 1044 - McQueeney, Texas

    Ordinance Info: McQueeney Cost Recovery Resolution 4521

Subtotal $1,987.00
Total Due $1,987.00


Updated
October 7, 2021 @ 3:53 pm

Invoice updated by Geoffrey.

Viewed
October 22, 2022 @ 9:24 am

Invoice viewed by 64.124.8.31 for the first time.