Bill To:


Skyler Martin
119 Sutters Mill Ct
Azle, TX 76020

Services Rendered To:


Skyler Martin
119 Sutters Mill Ct
Azle, TX 76020
POLICY# TXAP000139045

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-WB-206-22-425 04/10/2022 12/12/2023 On Receipt Briar-Reno Fire Department

*** Please Submit this to your AUTO Insurance Company for processing and payment, OR YOU MAY CONTACT OUR OFFICE AND PROVIDE US WITH YOUR INSURANCE INFORMATION FOR PROCESSING. ***

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

    $400.00
    1
    $400.00
  2. 206 Latex Gloves (Pairs Used)

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

    $100.00
    1
    $100.00
  4. 215 Trauma Kit (# Used)

    $25.00
    1
    $25.00
  5. 322 Turn Out Gear / PPE (Per FireFighter)

    $250.00
    2
    $500.00
  6. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00

  7. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 12975 Liberty School Rd- Azle, TX

    Ordinance Info: Briar Reno Cost Recovery Ordinance

Subtotal $1,283.00
Total Due $1,283.00


Updated
December 12, 2023 @ 12:25 pm

Invoice updated by Geoffrey.

Status Update
December 12, 2023 @ 12:25 pm

Status changed: Draft to Pending.

Updated
January 23, 2024 @ 2:25 pm

Invoice updated by Geoffrey.