Bill To:


Georgia Farm Bureau
1620 Bass Road
Macon, GA 31209

Services Rendered To:


Al Gabriel
236 Gassert Road
Newborn, GA 30056
Policy # BAP3209265-10

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
AL-01-811-2021-39 08/03/2021 08/23/2021 On Receipt Turkey Heaven V.F.D.

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

    $300.00
    3
    $900.00
  2. 102 Engine Response (Per Hour)

    $350.00
    3
    $1,050.00
  3. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    3
    $450.00
  4. 218 Cervical Collar (# Used)

    $25.00
    1
    $25.00
  5. 316 Cribbing – Lvl 3 (Class A Truck) (Used)

    $500.00
    1
    $500.00
  6. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  7. 310 Hydraulic Tool (# Used)

    $200.00
    3
    $600.00
  8. 206 Latex Gloves (Pairs Used)

    $2.00
    10
    $20.00
  9. 201 Oil Absorbent Material (# Used)

    $35.00
    1
    $35.00
  10. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    3
    $300.00
  11. 309 Power Tool (# Used)

    $50.00
    1
    $50.00
  12. 326 Safety Fest (# Used)

    $2.50
    10
    $25.00
  13. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00
  14. 408 Air Medical Landing Zone (Used)

    $250.00
    1
    $250.00

  15. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Highway 46 Near County Road 42 - Heflin, AL

Subtotal $4,705.00
Total Due $4,705.00


Updated
August 23, 2021 @ 4:00 pm

Invoice updated by Geoffrey.

Status Update
August 23, 2021 @ 4:00 pm

Status changed: Draft to Pending.

Updated
August 23, 2021 @ 4:01 pm

Invoice updated by Geoffrey.