Bill To:


FOREMOST INSURANCE
PO BOX 2450
GRAND RAPIDS, MI 49501-2450

Services Rendered To:


Steven Weinel
7075 Base Street
Azle, Texas 76020
Policy # G01034382200


Product
Price
Qty
Amount
  1. 104 Tanker Response (Per Hour)

    $300.00
    1
    $300.00
  2. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1
    $150.00
  3. 218 Cervical Collar (# Used)

    $25.00
    1
    $25.00
  4. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  5. 206 Latex Gloves (Pairs Used)

    $2.00
    6
    $12.00
  6. 301 Hand Tool (# Used)

    $15.00
    2
    $30.00
  7. 201 Oil Absorbent Material (# Used)

    $35.00
    1
    $35.00
  8. 404 Scene Lighting (Per Hour)

    $75.00
    1
    $75.00
  9. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  10. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 14250 North FM 730 - Azle, Texas

    Ordinance Info: City of Briar-Reno Cost recovery Amendment

Subtotal $1,127.00
Total Due $1,127.00
Updated
December 1, 2020 @ 3:46 pm

Invoice updated by Geoffrey.

Status Update
December 1, 2020 @ 3:46 pm

Status changed: Draft to Pending.