Bill To:


Texas Farm Bureau
7420 Fish Pond Road
Waco, TX 76710

Services Rendered To:


Chad Douglas
1253 CR 1455
Mt. Pleasant, TX 75455
Policy # 21914614

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-XR-403-22-29-B 02/06/2022 04/23/2022 On Receipt Electra Fire Department

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

    $350.00
    1.5
    $525.00
  2. 103 Rescue Response (Per Hour)

    $300.00
    1.5
    $450.00
  3. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1.5
    $225.00
  4. 309 Power Tool (# Used)

    $50.00
    4
    $200.00
  5. 327 Windshield Kit (# Used)

    $25.00
    1
    $25.00
  6. 310 Hydraulic Tool (# Used)

    $200.00
    3
    $600.00
  7. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  8. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Harrold Truck Stop - Vernon, Texas

    Ordinance Info: City of Electra Resolution NO. 2018-05

Subtotal $2,275.00
Total Due $2,275.00


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