Bill To:


Loya Insurance Company
1800 Lee Trevino Drive, Ste. 201
El Paso, TX 79936

Services Rendered To:


Christian Myles Brewer
Policy # 66639539854

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-SH-201-C20-25727 11/13/2020 03/22/2021 On Receipt Angus Vol. Fire Department

Product
Price
Qty
Amount
  1. 104 Tanker Response (Per Hour)

    $300.00
    1.25
    $375.00
  2. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1.25
    $187.50
  3. 402 Fire/Police Services (Per Hour)    

    $100.00
    1.25
    $125.00
  4. 310 Hydraulic Tool (# Used)

    $200.00
    2
    $400.00
  5. 318 Ladder (# Used)

    $35.00
    1
    $35.00
  6. 206 Latex Gloves (Pairs Used)

    $2.00
    10
    $20.00
  7. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.25
    $125.00
  8. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00
  9. 232 N95 Mask (Per Unit/Per Use)

    $10.00
    5
    $50.00

  10. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 223 Southbound @ Interstate Highway 45 - Angus, Texas

    Ordinance Info: City of Angus Billing Authorization Item NO. 7

Subtotal $1,567.50
Total Due $1,567.50


Updated
March 19, 2021 @ 7:09 pm

Invoice updated by Geoffrey.

Status Update
March 19, 2021 @ 7:09 pm

Status changed: Draft to Pending.

Updated
March 19, 2021 @ 7:09 pm

Invoice updated by Geoffrey.

Updated
September 29, 2021 @ 5:49 pm

Invoice updated by Geoffrey.

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