Bill To:


FEDERATED MUTUAL INSURANCE
121 EAST PARK SQUARE
OWATONNA, MN 55060-3046

Services Rendered To:


Equipment Leasing Specialties
1111 N Graham St
Stephenville, TX 76401
POLICY# 9239360

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-HW-405-23-43 04/15/2023 04/17/2023 On Receipt Hico VFD

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

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

    $150.00
    1
    $150.00
  3. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1
    $150.00
  4. 102 Engine Response (Per Hour)

    $350.00
    1
    $350.00

  5. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: US 281 N @ FM 219- Hamilton, TX

Subtotal $950.00
Total Due $950.00


Updated
April 17, 2023 @ 1:13 pm

Invoice updated by Geoffrey.

Status Update
April 17, 2023 @ 1:13 pm

Status changed: Draft to Pending.