Bill To:


Hanover Insurance Group
440 Lincoln Street
Worcester, MA 01653

Services Rendered To:


Ivan Soto
15107 BJ Ducek Road
Wallis, TX 77485
Policy # Z2D H891161 00

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-GS-309-F22-7283 03/11/2022 04/13/2022 On Receipt Orchard V.F.D.

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

    $350.00
    5.75
    $2,012.50
  2. 104 Tanker Response (Per Hour)

    $300.00
    5.75
    $1,725.00
  3. 309 Power Tool (# Used)

    $50.00
    1
    $50.00
  4. 402 Fire/Police Services (Per Hour)    

    $100.00
    5.75
    $575.00
  5. 205 Foam (Per Gallon)

    $65.00
    1
    $65.00
  6. 313 TIC Thermal Imaging Camera (# Used)

    $100.00
    1
    $100.00
  7. 318 Ladder (# Used)

    $35.00
    1
    $35.00
  8. 301 Hand Tool (# Used)

    $15.00
    4
    $60.00
  9. 311 PPV / Ventilation Fan (# Used)

    $50.00
    1
    $50.00
  10. 303 SCBA Breathing Apparatus (# Used)

    $50.00
    3
    $150.00
  11. 304 SCBA Cylinder (# Used)

    $25.00
    6
    $150.00
  12. 404 Scene Lighting (Per Hour)

    $75.00
    5.75
    $431.25
  13. 306 Hose Per 50′ (Amt Used)

    $25.00
    7
    $175.00

  14. Additional Incident Info

    Incident Type: Structure Fire Response

    Incident Location: 15107 BJ Ducek Road Wallis, TX 77485

Subtotal $5,578.75
Total Due $5,578.75


Updated
April 12, 2022 @ 7:17 pm

Invoice updated by Geoffrey.

Status Update
April 12, 2022 @ 7:17 pm

Status changed: Draft to Pending.

Updated
April 12, 2022 @ 7:17 pm

Invoice updated by Geoffrey.