Bill To:


Texas Farm Bureau
7420 Fish Pond Road
Waco, TX 76710

Services Rendered To:


Donna Steadman
1817 CR 314
Cleburne, TX 76031
POLICY# 23249814

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-SH-201-C23-25755-B 10/05/2023 11/21/2023 On Receipt Angus Vol. Fire Department

Product
Price
Qty
Amount
  1. 103 Rescue Response (Per Hour)

    $400.00
    1
    $400.00
  2. 102 Engine Response (Per Hour)

    $500.00
    1
    $500.00
  3. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  4. 206 Latex Gloves (Pairs Used)

    $2.00
    3
    $6.00
  5. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  6. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: IH 45 & FM 256- Streetman, TX

    Ordinance Info: City of Angus Billing Authorization # 7

Subtotal $1,256.00
Total Due $1,256.00


Updated
November 21, 2023 @ 9:56 am

Invoice updated by Geoffrey.