Bill To:


Texas Farm Bureau
7420 Fish Pond Road
Waco, TX 76710

Services Rendered To:


Mohamadsaid Husseinali
1803 S. Lake Harris Rd
White Oak, TX 75693
POLICY# 23394991


Product
Price
Qty
Amount
  1. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    1
    $150.00
  2. 102 Engine Response (Per Hour)

    $350.00
    1
    $350.00
  3. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    1
    $150.00
  4. 331 Air Bags (# Used)

    $150.00
    2
    $300.00
  5. 218 Cervical Collar (# Used)

    $25.00
    1
    $25.00
  6. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  7. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  8. Additional Incident Info

    Incident Type: Select One

    Incident Location: S White Oak Rd & Gladiola St- White Oak, TX

    Ordinance Info: Ordinance 2021-02 Section 30-6

Subtotal $1,325.00
Total Due $1,325.00


Updated
November 15, 2022 @ 1:07 pm

Invoice updated by Geoffrey.

Status Update
November 15, 2022 @ 1:07 pm

Status changed: Draft to Pending.