Bill To:


UNITED SERVICES AUTO. ASSOC. / USAA
9800 FREDERICKSBURG ROAD
SAN ANTONIO, TX 78240-4100

Services Rendered To:


Mark Wong
3341 FM 933
Whitney, TX 76692
POLICY# 01384 65 17U

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-KP-401-23-59 04/05/2023 04/18/2023 On Receipt Peoria V.F.D.

Product
Price
Qty
Amount
  1. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1
    $150.00
  2. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00
  3. 206 Latex Gloves (Pairs Used)

    $2.00
    4
    $8.00
  4. 404 Scene Lighting (Per Hour)

    $75.00
    1
    $75.00
  5. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00

  6. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: FM 3050 & SH 22- Whitney, TX

    Ordinance Info: Recovery of Service Costs for Peoria VFD

Subtotal $583.00
Total Due $583.00


Updated
April 18, 2023 @ 10:58 am

Invoice updated by Geoffrey.

Status Update
April 18, 2023 @ 10:58 am

Status changed: Draft to Pending.