Bill To:


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

Services Rendered To:


Flores
7307 LE Havre Road
Houston, Texas 77033
POLICY # GO1 1884764 00

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-AK-305-22-97 06/10/2022 06/16/2022 On Receipt San Felipe Frydek V.F.D.

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

    $350.00
    1
    $350.00
  2. 105 Utility Vehicle Response (Per Hour)

    $250.00
    1
    $250.00
  3. 301 Hand Tool (# Used)

    $15.00
    4
    $60.00
  4. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00

  5. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 725 Eastbound on Interstate 10 - Sealy, Texas

Subtotal $760.00
Total Due $760.00


Updated
June 16, 2022 @ 3:48 pm

Invoice updated by Geoffrey.

Status Update
June 16, 2022 @ 3:48 pm

Status changed: Draft to Pending.

Viewed
October 22, 2022 @ 8:26 am

Invoice viewed by 64.124.8.27 for the first time.