Bill To:


Consumers County Mutual Insurance
4245 N. Central Expressway, Suite 500
Dallas, TX 75205

Services Rendered To:


Hailey Lamond
17508 CR 4174 E
Lindale, TX 75771
POLICY# 6079323562221

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-WZ-205-23-155-A 12/13/2023 12/19/2023 On Receipt Edom VFD

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

    $500.00
    1
    $500.00
  2. 105 Utility Vehicle Response (Per Hour)

    $250.00
    1
    $250.00
  3. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  4. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00
  5. 218 Cervical Collar (# Used)

    $25.00
    1
    $25.00

  6. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: St Hwy 64 & FM 314- Ben Wheeler, TX

Subtotal $1,125.00
Total Due $1,125.00


Updated
December 19, 2023 @ 11:31 am

Invoice updated by Geoffrey.

Status Update
December 19, 2023 @ 11:31 am

Status changed: Draft to Pending.

Updated
December 19, 2023 @ 11:31 am

Invoice updated by Geoffrey.