Bill To:


Samuel Martinz
1220 Sapling Way #2104
Houston, TX 77031

Services Rendered To:


Samuel Martinz
1220 Sapling Way #2104
Houston, TX 77031
POLICY# APM-498993-0003

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-BB-326-23-86 05/28/2023 06/23/2023 On Receipt Rosharon VFD

*** THIS HAS BEEN SUBMITTED TO YOUR INSURANCE COMPANY AND DENIED. THIS IS NOW YOUR RESPONSIBILITY. ***

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

    $350.00
    1.25
    $437.50
  2. 104 Tanker Response (Per Hour)

    $300.00
    1.25
    $375.00
  3. 102 Engine Response (Per Hour)

    $350.00
    1.25
    $437.50
  4. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.25
    $125.00
  5. 306 Hose Per 50′ (Amt Used)

    $25.00
    2
    $50.00
  6. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00

  7. Additional Incident Info

    Incident Type: Vehicle Fire Response

    Incident Location: FM 288- Rosharon, TX

    Ordinance Info: Rosharon Cost Recovery Resolution

Subtotal $1,675.00
Total Due $1,675.00


Updated
June 23, 2023 @ 12:06 pm

Invoice updated by Geoffrey.

Status Update
June 23, 2023 @ 12:06 pm

Status changed: Draft to Pending.

Updated
February 15, 2024 @ 11:26 am

Invoice updated by Geoffrey.