Bill To:


Manuel Elizondo
808 West Kingsbury
Sequin, TX 78155

Services Rendered To:


Manual Elizondo
808 West Kingsbury
Sequin, Texas 78155

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-HS-403-2021-35-A 02/21/2021 02/09/2021 On Receipt McQueeney V.F.D.

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

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

    $300.00
    1
    $300.00
  2. 102 Engine Response (Per Hour)

    $350.00
    1
    $350.00
  3. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    1
    $150.00
  4. 206 Latex Gloves (Pairs Used)

    $2.00
    6
    $12.00
  5. 404 Scene Lighting (Per Hour)

    $75.00
    1
    $75.00
  6. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  7. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  8. 407 Patient Care / Evaluation (Per Patient)

    $50.00
    2
    $100.00

  9. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: FM 78 and Schumann Road, McQueeney Texas

Subtotal $1,337.00
Total Due $1,337.00


Updated
February 8, 2021 @ 9:34 pm

Invoice updated by Geoffrey.

Status Update
February 8, 2021 @ 9:34 pm

Status changed: Draft to Pending.

Updated
February 8, 2021 @ 9:37 pm

Invoice updated by Geoffrey.

Updated
July 21, 2021 @ 7:48 pm

Invoice updated by Geoffrey.

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