Bill To:


Texas Farm Bureau
7420 Fish Pond Road
Waco, TX 76710

Services Rendered To:


Marilyn Stultz
412 FM 2228
Douglasville, TX 75560
POLICY# 23179187

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-BY-205-23-710-2 07/10/2023 07/14/2023 On Receipt Douglassville V.F.D.

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

    $500.00
    1
    $500.00
  2. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  3. 301 Hand Tool (# Used)

    $15.00
    1
    $15.00
  4. 201 Oil Absorbent Material (# Used)

    $35.00
    1
    $35.00
  5. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00

  6. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: TX Hwy 8 N 250 South St- Douglasville, TX

    Ordinance Info: Douglassville Volunteer Fire Dept. Resolution

Subtotal $900.00
Total Due $900.00


Updated
July 14, 2023 @ 3:28 pm

Invoice updated by Geoffrey.

Status Update
July 14, 2023 @ 3:28 pm

Status changed: Draft to Pending.

Viewed
April 17, 2024 @ 7:20 pm

Invoice viewed by Karen Meder - Smith (KarenS) for the first time.