Bill To:


SOUTHWESTERN INSURANCE SERVICES
4375 Palm Avenue
Hialeah, FL 33012

Services Rendered To:


Queens Truck Rental
1426 Banyan Way
Weston, Florida 33327
POLICY# WHI01000000772-0

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-KB-509-22-029173 11/20/2022 11/28/2022 On Receipt Harrison County ESD 4

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

    $350.00
    8.75
    $3,062.50
  2. 102 Engine Response (Per Hour)

    $350.00
    8.75
    $3,062.50
  3. 105 Utility Vehicle Response (Per Hour)

    $150.00
    8.75
    $1,312.50
  4. 105 Utility Vehicle Response (Per Hour)

    $150.00
    8.75
    $1,312.50
  5. 102 Engine Response (Per Hour)

    $350.00
    8.75
    $3,062.50
  6. 104 Tanker Response (Per Hour)

    $300.00
    8.75
    $2,625.00
  7. 204 Flate (# Used)

    $8.00
    10
    $80.00
  8. 319 Generator (Per Generator/Per Hour)

    3 Generators x 8.75 hrs 

    $150.00
    8.75
    $1,312.50
  9. 313 TIC Thermal Imaging Camera (# Used)

    $100.00
    1
    $100.00
  10. 206 Latex Gloves (Pairs Used)

    $2.00
    6
    $12.00
  11. 301 Hand Tool (# Used)

    $15.00
    5
    $75.00
  12. 309 Power Tool (# Used)

    $50.00
    2
    $100.00
  13. 404 Scene Lighting (Per Hour)

    $75.00
    8.75
    $656.25
  14. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    8.75
    $875.00
  15. 302 Hand Light (# Used)

    $5.00
    5
    $25.00

  16. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Int 20 Mile Marker 613 Westbound- Marshall, TX

Subtotal $17,673.25
Total Due $17,673.25


Updated
November 28, 2022 @ 10:57 am

Invoice updated by Geoffrey.

Status Update
November 28, 2022 @ 10:57 am

Status changed: Draft to Pending.

Viewed
January 26, 2023 @ 2:26 pm

Invoice viewed by Karen Meder - Smith (KarenS) for the first time.

Viewed
January 26, 2023 @ 2:28 pm

Invoice viewed by Karen Meder - Smith (KarenS) for the first time.

Updated
January 26, 2023 @ 2:32 pm

Invoice updated by Karen Smith.

Viewed
January 26, 2023 @ 2:32 pm

Invoice viewed by Karen Meder - Smith (KarenS) for the first time.