Bill To:


Texas Farm Bureau
7420 Fish Pond Road
Waco, TX 76710

Services Rendered To:


Ilda Lopez- Villarreal
881 RS County Rd 1399
Point, TX 75472
POLICY# 23398900

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-WZ-205-23-155-B 12/13/2023 12/19/2023 On Receipt Edom VFD

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

    $500.00
    1
    $500.00
  2. 105 Utility Vehicle Response (Per Hour)

    $250.00
    1
    $250.00
  3. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  4. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00
  5. 218 Cervical Collar (# Used)

    $25.00
    1
    $25.00

  6. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: St Hwy 64 & FM 314- Ben Wheeler, TX

Subtotal $1,125.00
Total Due $1,125.00


Updated
December 19, 2023 @ 11:34 am

Invoice updated by Geoffrey.

Viewed
April 17, 2024 @ 7:17 pm

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