Bill To:


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

Services Rendered To:


April Creel
601 N Culberson St
Gainesville, TX 76240
POLICY# 36453989-TX-PP-002

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-CW-201-23-476026 01/04/2023 01/11/2023 On Receipt Callisburg VFD

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

    $350.00
    1
    $350.00
  2. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    1
    $150.00
  3. 201 Oil Absorbent Material (# Used)

    $35.00
    1
    $35.00
  4. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  5. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  6. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 9390 Fm 678- Gainesville, TX

Subtotal $885.00
Total Due $885.00


Updated
January 11, 2023 @ 11:04 am

Invoice updated by Geoffrey.

Status Update
January 11, 2023 @ 11:04 am

Status changed: Draft to Pending.