Bill To:


Gainsco Insurance
3333 Lee Parkway #1200
Dallas, TX 75219

Services Rendered To:


Steven Polley - Driver
Jesse James Johnson - Owner
7428 Goodman Lane
Azle, Texas 76020
Policy # 03MGEP1257792-00

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-WB206-2019-917 12/09/2019 12/15/2019 On Receipt Briar - Reno Fire Department

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

    Unit # T49

    $300.00
    1
    $300.00
  2. 106 Battalion/Chief Vehicle Response (Per Hour)

    Unit # C49

    $150.00
    1
    $150.00
  3. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  4. 208 Fire Line Tap (Per Foot, Amt Used)

    $0.25
    50
    $12.50
  5. 206 Latex Gloves (Pairs Used)

    $2.00
    3
    $6.00
  6. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  7. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  8. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Liberty School Road and Deeds Court, Tarrant County Texas

Subtotal $1,068.50
Total Due $1,068.50
Updated
December 15, 2019 @ 3:10 pm

Invoice updated by Karen Smith.

Status Update
December 15, 2019 @ 3:10 pm

Status changed: Draft to Pending.

Viewed
October 25, 2022 @ 4:48 pm

Invoice viewed by 64.124.8.35 for the first time.

Viewed
October 25, 2022 @ 5:06 pm

Invoice viewed by 64.124.8.36 for the first time.