Bill To:


Farmer's Insurance
PO Box 0991
Carol Stream, IL 60132-0991

Services Rendered To:


Jana Pederson
1112 Poe Street
Azle, Texas 46020
Policy # 44435530

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-WB-206-22-433 04/12/2022 04/22/2022 On Receipt Briar-Reno Fire Department

Product
Price
Qty
Amount
  1. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    1
    $150.00
  2. 104 Tanker Response (Per Hour)

    $300.00
    1
    $300.00
  3. 313 TIC Thermal Imaging Camera (# Used)

    $100.00
    1
    $100.00
  4. 301 Hand Tool (# Used)

    $15.00
    2
    $30.00
  5. 303 SCBA Breathing Apparatus (# Used)

    $50.00
    2
    $100.00
  6. 304 SCBA Cylinder (# Used)

    $25.00
    2
    $50.00

  7. Additional Incident Info

    Incident Type: Vehicle Fire Response

    Incident Location: 1951 Northwest Parkway - Sanctuary, Texas

    Ordinance Info: Briar Reno Cost Recovery Resolution

Subtotal $730.00
Total Due $730.00


Updated
April 21, 2022 @ 3:56 pm

Invoice updated by Geoffrey.

Status Update
April 21, 2022 @ 3:56 pm

Status changed: Draft to Pending.

Updated
April 21, 2022 @ 3:56 pm

Invoice updated by Geoffrey.

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