Bill To:


JMA, LLC
150 S. Central St., Apt. B
Broadway, GA 22815

Services Rendered To:


JMA, LLC.
150 S. Central St., Apt. G
Broadway, VA 22815

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
FL-51-061-024-071 04/03/2024 04/15/2024 On Receipt Ponce de Leon Volunteer Fire Dept.

*** Please Submit this to your AUTO Insurance Company for processing and payment, OR YOU MAY CONTACT OUR OFFICE AND PROVIDE US WITH YOUR INSURANCE INFORMATION FOR PROCESSING. ***

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

    $500.00
    2
    $1,000.00
  2. 104 Tanker Response (Per Hour)

    $400.00
    2
    $800.00
  3. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  4. 205 Foam (Per Gallon)

    $65.00
    6
    $390.00
  5. 301 Hand Tool (# Used)

    $15.00
    1
    $15.00
  6. 201 Oil Absorbent Material (# Used)

    $35.00
    2
    $70.00
  7. 303 SCBA Breathing Apparatus (# Used)

    $50.00
    2
    $100.00
  8. 304 SCBA Cylinder (# Used)

    $25.00
    2
    $50.00
  9. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    2
    $200.00
  10. 306 Hose Per 50′ (Amt Used)

    $25.00
    6
    $150.00

  11. Additional Incident Info

    Incident Type: Vehicle Fire Response

    Incident Location: 1-10, MM 96, WB, off ramp, Ponce de Leon, FL 32455

Subtotal $3,025.00
Total Due $3,025.00


Updated
April 14, 2024 @ 6:06 pm

Invoice updated by Karen Smith.

Status Update
April 14, 2024 @ 6:06 pm

Status changed: Draft to Pending.

Updated
April 14, 2024 @ 6:09 pm

Invoice updated by Karen Smith.