Bill To:


Travelers Insurance
P.O. Box 650293
Dallas, TX 75265-0293

Services Rendered To:


Jennifer Stanley
4767 County Rd 2656
Royse City, TX 75189
POLICY# 6136807192221

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-CN-310-23-519-B 07/29/2023 07/31/2023 On Receipt Lavon V.F.D.

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

    $500.00
    1
    $500.00
  2. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00
  3. 206 Latex Gloves (Pairs Used)

    $2.00
    6
    $12.00
  4. 301 Hand Tool (# Used)

    $15.00
    3
    $45.00
  5. 201 Oil Absorbent Material (# Used)

    $35.00
    1
    $35.00
  6. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00

  7. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: State Hwy 78/Lake Rd- Lavon, TX

    Ordinance Info: City of Lavon Resolution NO. 2020-03-01

Subtotal $942.00
Total Due $942.00


Updated
July 31, 2023 @ 12:20 pm

Invoice updated by Geoffrey.