Bill To:


Matthew Smith
1904 Bentwood Court
Grapevine, TX 76051

Services Rendered To:


Matthew Smith
1904 Bentwood Court
Grapevine, Texas 76051

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-SH-201-2020-29208 12/30/2020 02/09/2021 On Receipt Angus Vol. Fire Department

*** THIS HAS BEEN SUBMITTED TO YOUR INSURANCE COMPANY AND DENIED. THIS IS NOW YOUR RESPONSIBILITY. ***

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

    $300.00
    1.5
    $450.00
  2. 206 Latex Gloves (Pairs Used)

    $2.00
    4
    $8.00
  3. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.5
    $150.00
  4. 232 N95 Mask (Per Unit/Per Use)

    $10.00
    4
    $40.00
  5. 407 Patient Care / Evaluation (Per Patient)

    $50.00
    2
    $100.00

  6. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 226 South Bound on I-45 - Angus, Texas

    Ordinance Info: City of Angus Billing Authorization # 7

Subtotal $748.00
Total Due $748.00


Updated
February 9, 2021 @ 1:26 am

Invoice updated by Geoffrey.

Status Update
February 9, 2021 @ 1:26 am

Status changed: Draft to Pending.

Updated
May 29, 2021 @ 4:46 pm

Invoice updated by Geoffrey.

Viewed
July 25, 2021 @ 9:09 pm

Invoice viewed by Karen Smith (KarenS) for the first time.

Updated
August 31, 2021 @ 3:11 pm

Invoice updated by Geoffrey.

Updated
August 31, 2021 @ 3:13 pm

Invoice updated by Geoffrey.