Bill To:


Falcon Insurance Company
P.O. Box 3577
Oak Brook, IL 60522

Services Rendered To:


Hector Jose Villasmil-Zerpa
5075 Pear Ridge, Apt. # 436
Dallas, TX 75287
POLICY # 0200635848

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-SH-201-C22-16881 07/09/2022 07/19/2022 On Receipt Angus Vol. Fire Department

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

    $300.00
    1.25
    $375.00
  2. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1.25
    $187.50
  3. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00
  4. 404 Scene Lighting (Per Hour)

    $75.00
    1.25
    $93.75
  5. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.25
    $125.00
  6. 306 Hose Per 50′ (Amt Used)

    $25.00
    2
    $50.00

  7. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 227 Northbound on Interstate 45 - Corsicana, Texas

    Ordinance Info: City of Angus Billing Authorization # 7

Subtotal $1,081.25
Total Due $1,081.25


Updated
July 18, 2022 @ 5:57 pm

Invoice updated by Geoffrey.

Status Update
July 18, 2022 @ 5:57 pm

Status changed: Draft to Pending.

Viewed
October 24, 2022 @ 12:44 am

Invoice viewed by 64.124.8.53 for the first time.