Bill To:


Texas Farm Bureau
7420 Fish Pond Road
Waco, TX 76710

Services Rendered To:


Aletha Downing
1035 Meadow Oaks Street
Azle, Texas 76020
Policy # 23250283

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-WB-206-2021-43-A 01/13/2021 11/09/2021 On Receipt Briar-Reno Fire Department

Product
Price
Qty
Amount
  1. 104 Tanker Response (Per Hour)

    $300.00
    5
    $1,500.00
  2. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    5
    $750.00
  3. 105 Utility Vehicle Response (Per Hour)

    $150.00
    5
    $750.00
  4. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    5
    $750.00
  5. 314 Cribbing – Lvl 1 (Passenger Vehicle) (Used)

    $100.00
    2
    $200.00
  6. 209 Extinguisher (# Used)

    $50.00
    1
    $50.00
  7. 208 Fire Line Tap (Per Foot, Amt Used)

    $0.25
    100
    $25.00
  8. 319 Generator (Per Generator/Per Hour)

    $50.00
    5
    $250.00
  9. 310 Hydraulic Tool (# Used)

    $200.00
    1
    $200.00
  10. 301 Hand Tool (# Used)

    $15.00
    3
    $45.00
  11. 201 Oil Absorbent Material (# Used)

    $35.00
    1
    $35.00
  12. 404 Scene Lighting (Per Hour)

    $75.00
    5
    $375.00
  13. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00
  14. 302 Hand Light (# Used)

    $5.00
    2
    $10.00
  15. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  16. 306 Hose Per 50′ (Amt Used)

    $25.00
    1
    $25.00
  17. 330 Backboard (# Used)

    $25.00
    1
    $25.00

  18. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Portwood Road & FM 730 North - Azle, Texas

Subtotal $5,340.00
Total Due $5,340.00


Updated
November 8, 2021 @ 1:29 pm

Invoice updated by Geoffrey.

Status Update
November 8, 2021 @ 1:29 pm

Status changed: Draft to Pending.