Bill To:


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

Services Rendered To:


Leigh Smith Maggie
300 S Donohoe
Granger, TX 76530

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-HW-404-23-132-B 05/12/2023 03/26/2024 On Receipt Hamilton VFD

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

    $400.00
    1.5
    $600.00
  2. 105 Utility Vehicle Response (Per Hour)

    $250.00
    1.5
    $375.00
  3. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00
  4. 301 Hand Tool (# Used)

    $15.00
    2
    $30.00
  5. 201 Oil Absorbent Material (# Used)

    $35.00
    2
    $70.00
  6. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    2
    $200.00
  7. 306 Hose Per 50′ (Amt Used)

    $25.00
    2
    $50.00

  8. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: SH 36- Hamilton, TX

Subtotal $1,575.00
Total Due $1,575.00


Updated
March 26, 2024 @ 3:36 pm

Invoice updated by Geoffrey.