Bill To:


Liberty County Mutual
175 Berkeley Street
Boston, MA 02116

Services Rendered To:


Bruce Myers
2290 Springfield Road
Springtown, TX 76082
Policy # Y8954707

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-WB-206-2021-62-B 01/18/2021 11/09/2021 On Receipt Briar-Reno Fire Department

Product
Price
Qty
Amount
  1. 104 Tanker Response (Per Hour)

    Unit # T 49

    $300.00
    1
    $300.00
  2. 105 Utility Vehicle Response (Per Hour)

    Unit # FM 49

    $150.00
    1
    $150.00
  3. 105 Utility Vehicle Response (Per Hour)

    Unit # A 249

    $150.00
    1
    $150.00
  4. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  5. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00
  6. 402 Fire/Police Services (Per Hour)    

    $100.00
    1
    $100.00
  7. 322 Turn Out Gear / PPE (Per FireFighter)

    $250.00
    4
    $1,000.00
  8. 326 Safety Fest (# Used)

    $2.50
    4
    $10.00

  9. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 4400 East Highway 199 Westbound - Springtown, Texas

Subtotal $2,060.00
Total Due $2,060.00


Updated
November 8, 2021 @ 3:22 pm

Invoice updated by Geoffrey.

Updated
November 8, 2021 @ 3:23 pm

Invoice updated by Geoffrey.

Viewed
October 22, 2022 @ 2:59 pm

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