Bill To:


Liberty County Mutual
175 Berkeley Street
Boston, MA 02116

Services Rendered To:


Gilberto Gonzales
125 Texoma
Royse City, TX 75189
POLICY# Y9751651

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-CN-310-23-395-B 09/30/2023 10/03/2023 On Receipt Lavon VFD

Product
Price
Qty
Amount
  1. 101 Aerial/Ladder Response (Per Hour)

    $550.00
    1
    $550.00
  2. 106 Battalion/Chief Vehicle Response (Per Hour)

    $200.00
    1
    $200.00
  3. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00
  4. 310 Hydraulic Tool (# Used)

    $200.00
    1
    $200.00
  5. 206 Latex Gloves (Pairs Used)

    $2.00
    10
    $20.00
  6. 301 Hand Tool (# Used)

    $15.00
    3
    $45.00
  7. 201 Oil Absorbent Material (# Used)

    $35.00
    2
    $70.00
  8. 404 Scene Lighting (Per Hour)

    $75.00
    1
    $75.00
  9. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  10. 419 Environmental Spill

    $250.00
    1
    $250.00

  11. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: SH 78/ Lake Rd- Lavon, TX

    Ordinance Info: City of Lavon Resolution NO. 2020-03-01

Subtotal $1,760.00
Total Due $1,760.00


Updated
October 3, 2023 @ 11:14 am

Invoice updated by Geoffrey.