Bill To:


GERMANIA INSURANCE COMPANY
507 Hwy. 290 E
Brenham, TX 77833

Services Rendered To:


Peter Loos
P.O. Box 520
Chireno, Texas 75937
Policy # 43043357462

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-AC-309-2021-40 07/25/2021 07/28/2021 On Receipt Zavalla Fire Department

Product
Price
Qty
Amount
  1. 103 Rescue Response (Per Hour)

    $300.00
    1
    $300.00
  2. 206 Latex Gloves (Pairs Used)

    $2.00
    4
    $8.00
  3. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  4. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  5. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Highway 147 @ Lakeview Grocery - Zavalla, Texas

Subtotal $658.00
Total Due $658.00


Updated
July 27, 2021 @ 2:47 pm

Invoice updated by Geoffrey.

Status Update
July 27, 2021 @ 2:47 pm

Status changed: Draft to Pending.

Viewed
July 28, 2021 @ 11:35 pm

Invoice viewed by Karen Smith (KarenS) for the first time.