Bill To:


FOREMOST INSURANCE
PO BOX 2450
GRAND RAPIDS, MI 49501-2450

Services Rendered To:


7711 Vierick Rd
San Felipe, TX
Claim# 23-6471014

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-AK-305-23-755636-B 08/15/2023 09/01/2023 On Receipt San Felipe Frydek V.F.D.

Product
Price
Qty
Amount
  1. 104 Tanker Response (Per Hour)

    $400.00
    1.75
    $700.00
  2. 106 Battalion/Chief Vehicle Response (Per Hour)

    $200.00
    1.75
    $350.00
  3. 102 Engine Response (Per Hour)

    $500.00
    1.75
    $875.00
  4. 105 Utility Vehicle Response (Per Hour)

    $250.00
    1.75
    $437.50
  5. 104 Tanker Response (Per Hour)

    $400.00
    1.75
    $700.00
  6. 104 Tanker Response (Per Hour)

    $400.00
    1.75
    $700.00
  7. 104 Tanker Response (Per Hour)

    $400.00
    1.75
    $700.00
  8. 309 Power Tool (# Used)

    $50.00
    2
    $100.00
  9. 313 TIC Thermal Imaging Camera (# Used)

    $100.00
    1
    $100.00
  10. 303 SCBA Breathing Apparatus (# Used)

    $50.00
    4
    $200.00
  11. 304 SCBA Cylinder (# Used)

    $25.00
    8
    $200.00
  12. 306 Hose Per 50′ (Amt Used)

    $25.00
    8
    $200.00

  13. Additional Incident Info

    Incident Type: Vehicle Fire Response

    Incident Location: 7711 Vierick Rd San Felipe, TX

Subtotal $5,262.50
Total Due $5,262.50


Updated
September 1, 2023 @ 11:22 am

Invoice updated by Geoffrey.

Status Update
September 1, 2023 @ 11:22 am

Status changed: Draft to Pending.