Bill To:


Safeway Insurance
1505 LBJ Freeway, Suite # 170
Dallas, TX 75234

Services Rendered To:


Billie Fennell
1474 County Rd 136
Gainesville, TX 76240
POLICY# 1219981-TX-PP-025

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-CW-201-22-473222-A 11/29/2022 12/06/2022 On Receipt Callisburg VFD

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

    $150.00
    1
    $150.00
  2. 102 Engine Response (Per Hour)

    $350.00
    1
    $350.00
  3. 209 Extinguisher (# Used)

    $50.00
    1
    $50.00
  4. 204 Flate (# Used)

    $8.00
    4
    $32.00
  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. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  8. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 7750 E Hwy 82- Gainesville, TX

Subtotal $1,007.00
Total Due $1,007.00


Updated
December 6, 2022 @ 2:39 pm

Invoice updated by Geoffrey.

Status Update
December 6, 2022 @ 2:39 pm

Status changed: Draft to Pending.

Viewed
July 21, 2024 @ 8:05 pm

Invoice viewed by 173.252.87.12 for the first time.