Bill To:


Louis Duke
153 Lindsey Hill Road
Dover, AR 72837

Services Rendered To:


Louis Duke
153 Lindsey Hill Rd.
Dover, AR 72837
Policy # 331 7878-E03-43J-001

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-AC-309-2021-22 03/17/2021 03/22/2021 On Receipt Zavalla Fire Department

*** THIS HAS BEEN SUBMITTED TO YOUR INSURANCE COMPANY AND DENIED. THIS IS NOW YOUR RESPONSIBILITY. ***

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

    $300.00
    1.75
    $525.00
  2. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    1.75
    $262.50
  3. 206 Latex Gloves (Pairs Used)

    $2.00
    6
    $12.00
  4. 404 Scene Lighting (Per Hour)

    $75.00
    1.75
    $131.25
  5. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.75
    $175.00
  6. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  7. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 22000 Block of Highway 69 South - Zavalla, Texas

Subtotal $1,355.75
Total Due $1,355.75


Updated
March 19, 2021 @ 12:17 pm

Invoice updated by Geoffrey.

Status Update
March 19, 2021 @ 12:17 pm

Status changed: Draft to Pending.

Updated
December 13, 2021 @ 4:09 pm

Invoice updated by Geoffrey.

Updated
December 13, 2021 @ 4:09 pm

Invoice updated by Geoffrey.

Updated
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Invoice updated by Karen Smith.

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