Bill To:


Sentry Insurance
1800 N. Point Drive
Stevens Point, WI 54481

Services Rendered To:


Andrew Brazie
1577 Hazlewood Rd
Sherman, TX 75092
POLICY# 228 0852-C01-43G 001
Claim# 61A242817 Adjuster Sarah Zelewski 715-346-9597

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-CW-201-24-4041 03/04/2024 04/16/2024 On Receipt Callisburg V.F.D.

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

    $500.00
    1.25
    $625.00
  2. 106 Battalion/Chief Vehicle Response (Per Hour)

    $200.00
    1.25
    $250.00
  3. 209 Extinguisher (# Used)

    $50.00
    2
    $100.00
  4. 402 Fire/Police Services (Per Hour)    

    $100.00
    1.25
    $125.00
  5. 301 Hand Tool (# Used)

    $15.00
    2
    $30.00
  6. 201 Oil Absorbent Material (# Used)

    $35.00
    3
    $105.00
  7. 404 Scene Lighting (Per Hour)

    $75.00
    1.25
    $93.75
  8. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.25
    $125.00
  9. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00
  10. 324 Traffic Cone (# Used)

    $5.00
    5
    $25.00
  11. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00

  12. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: US 82 & County Rd 147- Oak Ridge, TX

    Ordinance Info: City Of Callisburg Resolution

Subtotal $1,978.75
Total Due $1,978.75


Updated
April 16, 2024 @ 11:54 am

Invoice updated by Geoffrey.

Status Update
April 16, 2024 @ 11:54 am

Status changed: Draft to Pending.

Updated
May 14, 2024 @ 2:08 pm

Invoice updated by Geoffrey.