Bill To:


ELEPHANT INSURANCE
PO BOX 5005
GLEN ALLEN, VA 23058-5005

Services Rendered To:


Jeremie Foreman
907 CR 1243
Linden, TX 75563
POLICY# 24400336642

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-BY-205-23-930 01/03/2023 01/12/2023 On Receipt Douglassville VFD

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

    $350.00
    3
    $1,050.00
  2. 103 Rescue Response (Per Hour)

    $300.00
    3
    $900.00
  3. 302 Hand Light (# Used)

    $5.00
    2
    $10.00
  4. 404 Scene Lighting (Per Hour)

    $75.00
    3
    $225.00
  5. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    3
    $300.00

  6. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: SH 8 & 995- Redhill, TX

Subtotal $2,485.00
Total Due $2,485.00


Updated
January 12, 2023 @ 11:32 am

Invoice updated by Geoffrey.

Status Update
January 12, 2023 @ 11:32 am

Status changed: Draft to Pending.