Bill To:


Farmers Insurance
PO Box 268993
Oklahoma City, OK 73126

Services Rendered To:


Jose Orta
1811 Wesley Street
Greenville, Texas 75401
Policy # 45661893

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-CN-310-2021-205 05/14/2021 05/26/2021 On Receipt Lavon V.F.D.

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

    $350.00
    1
    $350.00
  2. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    1
    $150.00
  3. 313 TIC Thermal Imaging Camera (# Used)

    $100.00
    1
    $100.00
  4. 303 SCBA Breathing Apparatus (# Used)

    $50.00
    3
    $150.00
  5. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  6. 306 Hose Per 50′ (Amt Used)

    $25.00
    2
    $50.00
  7. 324 Traffic Cone (# Used)

    $5.00
    3
    $15.00

  8. Additional Incident Info

    Incident Type: Vehicle Fire Response

    Incident Location: 121 PR 5681 - Lavon, Texas 75166

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

Subtotal $915.00
Total Due $915.00


Updated
May 25, 2021 @ 3:46 pm

Invoice updated by Geoffrey.

Status Update
May 25, 2021 @ 3:46 pm

Status changed: Draft to Pending.

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