Bill To:


DAIRYLAND INSURANCE
1800 NORTH POINT DRIVE
STEVENS POINT, WI 54481-1253

Services Rendered To:


Tequilla Washington
195 Holman
Jefferson, Texas 75694

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-KB-403-2020-25681 12/14/2020 12/28/2020 On Receipt Woodlawn Fire / Harrison County ESD #6

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

    $350.00
    1.5
    $525.00
  2. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1.5
    $225.00
  3. 404 Scene Lighting (Per Hour)

    $75.00
    1.5
    $112.50
  4. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.5
    $150.00

  5. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Us highway 59 @ FM 1997

Subtotal $1,012.50
Total Due $1,012.50
Updated
December 27, 2020 @ 4:14 pm

Invoice updated by Geoffrey.

Status Update
December 27, 2020 @ 4:14 pm

Status changed: Draft to Pending.

Updated
December 27, 2020 @ 4:14 pm

Invoice updated by Geoffrey.

Viewed
October 25, 2023 @ 11:15 pm

Invoice viewed by 89.183.111.58 for the first time.