Bill To:


American Modern Insurance Group
PO Box 5323
Cincinnati, OH 45201-5323

Services Rendered To:


Christin Fischer
486 County Rd 125
Whitesboro, TX 76273
Claim # 846157AA

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-CW-201-22-475054 12/23/2022 12/27/2022 On Receipt Callisburg VFD

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

    $350.00
    2.75
    $962.50
  2. 104 Tanker Response (Per Hour)

    $300.00
    2.75
    $825.00
  3. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    2.75
    $412.50
  4. 318 Ladder (# Used)

    $35.00
    1
    $35.00
  5. 309 Power Tool (# Used)

    $50.00
    1
    $50.00
  6. 320 Portable Pond (# Used)

    $150.00
    1
    $150.00
  7. 303 SCBA Breathing Apparatus (# Used)

    $50.00
    6
    $300.00
  8. 304 SCBA Cylinder (# Used)

    $25.00
    6
    $150.00
  9. 306 Hose Per 50′ (Amt Used)

    $25.00
    10
    $250.00

  10. Additional Incident Info

    Incident Type: Structure Fire Response

    Incident Location: 486 County Rd 125 Whitesboro, TX 76273

Subtotal $3,135.00
Total Due $3,135.00


Updated
December 27, 2022 @ 5:21 pm

Invoice updated by Geoffrey.

Status Update
December 27, 2022 @ 5:21 pm

Status changed: Draft to Pending.

Viewed
March 29, 2024 @ 9:48 pm

Invoice viewed by 66.249.72.6 for the first time.