Bill To:


MERCURY INSURANCE
4484 WILSHIRE BOULEVARD
LOS ANGELES, CA 90010-3710

Services Rendered To:


Jason Roddy
517 Brooks
Nevada, TX 75173
POLICY# TXAP0000195659

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-CN-310-23-348-B 05/30/2023 05/31/2023 On Receipt Lavon V.F.D.

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

    $350.00
    1.5
    $525.00
  2. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    1.5
    $225.00
  3. 314 Cribbing – Lvl 1 (Passenger Vehicle) (Used)

    $100.00
    2
    $200.00
  4. 402 Fire/Police Services (Per Hour)    

    $100.00
    1.5
    $150.00
  5. 206 Latex Gloves (Pairs Used)

    $2.00
    4
    $8.00
  6. 301 Hand Tool (# Used)

    $15.00
    1
    $15.00
  7. 317 Rescue Struts (# Used)

    $50.00
    1
    $50.00
  8. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.5
    $150.00

  9. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: FM 6 & Creekview Dr- Lavon, TX

    Ordinance Info: City of Lavon Resolution NO. 2020-03-01

Subtotal $1,323.00
Total Due $1,323.00


Updated
May 31, 2023 @ 10:22 am

Invoice updated by Geoffrey.