Bill To:


FARM BUREAU INSURANCE
5400 UNIVERSITY AVENUE
WEST DES MOINES, IA 50266-5997

Services Rendered To:


Brandon Cofer
11774 US-69
Huntington, TX 75949
POLICY# 23461638

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-AC-501-24-4129 04/29/2024 06/04/2024 On Receipt Moffett VFD

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

    $400.00
    1.25
    $500.00
  2. 102 Engine Response (Per Hour)

    $500.00
    1.25
    $625.00
  3. 105 Utility Vehicle Response (Per Hour)

    $250.00
    1.25
    $312.50
  4. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00
  5. 206 Latex Gloves (Pairs Used)

    $2.00
    6
    $12.00
  6. 202 Oil Absorbent Sheet (# Used)

    $2.50
    5
    $12.50
  7. 203 Oil Boom (# Used)

    $20.00
    1
    $20.00
  8. 201 Oil Absorbent Material (# Used)

    $35.00
    2
    $70.00
  9. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.25
    $125.00
  10. 215 Trauma Kit (# Used)

    $25.00
    1
    $25.00

  11. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: St Hwy 103 E & Old Ewing Rd- Lufkin, TX

Subtotal $1,952.00
Total Due $1,952.00


Updated
June 4, 2024 @ 1:26 pm

Invoice updated by Geoffrey.

Status Update
June 4, 2024 @ 1:26 pm

Status changed: Draft to Pending.