Bill To:


LIBERTY MUTUAL GROUP
PO BOX 515097
LOS ANGELES, CA 90051-5097

Services Rendered To:


Jimmie William Pierce
801 N Baskin St
Seymour, TX 76380
POLICY# BAS62172163

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-HW-404-24-33 02/02/2024 04/16/2024 On Receipt Hamilton VFD

Product
Price
Qty
Amount
  1. 103 Rescue Response (Per Hour)

    $400.00
    8.75
    $3,500.00
  2. 105 Utility Vehicle Response (Per Hour)

    $250.00
    8.75
    $2,187.50
  3. 102 Engine Response (Per Hour)

    $500.00
    8.75
    $4,375.00
  4. 331 Air Bags (# Used)

    $150.00
    2
    $300.00
  5. 316 Cribbing – Lvl 3 (Class A Truck) (Used)

    $500.00
    1
    $500.00
  6. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00
  7. 402 Fire/Police Services (Per Hour)    

    $100.00
    8.75
    $875.00
  8. 310 Hydraulic Tool (# Used)

    $200.00
    8
    $1,600.00
  9. 206 Latex Gloves (Pairs Used)

    $2.00
    3
    $6.00
  10. 301 Hand Tool (# Used)

    $15.00
    9
    $135.00
  11. 309 Power Tool (# Used)

    $50.00
    9
    $450.00
  12. 404 Scene Lighting (Per Hour)

    $75.00
    8.75
    $656.25
  13. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    8.75
    $875.00
  14. 306 Hose Per 50′ (Amt Used)

    $25.00
    9
    $225.00
  15. 372 Diamond Tip Saw 

    $350.00
    1
    $350.00

  16. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Hwy 36 W- Hamilton, TX

Subtotal $16,284.75
Total Due $16,284.75


Updated
April 16, 2024 @ 1:43 pm

Invoice updated by Geoffrey.

Status Update
April 16, 2024 @ 1:43 pm

Status changed: Draft to Pending.