Bill To:


Old Republic Insurance
307 N. Michigan Avenue
Chicago, IL 60601

Services Rendered To:


Enterprise
9315 Oliver Blvd
St. Louis, MO 63132
POLICY# MWTB31404120

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-WZ-208-23-2 02/01/2023 04/03/2023 On Receipt Van Zandt Midway V.F.D.

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

    $350.00
    1.25
    $437.50
  2. 102 Engine Response (Per Hour)

    $350.00
    1.25
    $437.50
  3. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    1.25
    $187.50
  4. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    1.25
    $187.50
  5. 309 Power Tool (# Used)

    $50.00
    1
    $50.00
  6. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  7. 402 Fire/Police Services (Per Hour)    

    $100.00
    1.25
    $125.00
  8. 206 Latex Gloves (Pairs Used)

    $2.00
    3
    $6.00
  9. 404 Scene Lighting (Per Hour)

    $75.00
    1.25
    $93.75
  10. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.25
    $125.00

  11. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Hwy 64 @ 4814- Ben Wheeler, TX

Subtotal $1,899.75
Total Due $1,899.75


Updated
April 3, 2023 @ 1:50 pm

Invoice updated by Geoffrey.

Status Update
April 3, 2023 @ 1:50 pm

Status changed: Draft to Pending.

Viewed
July 24, 2024 @ 3:31 am

Invoice viewed by 69.171.249.112 for the first time.