Bill To:


Rosa Hernandez
688 16th Street
Kerman, CA 93630

Services Rendered To:


Rosa Hernandez
408 Still Street
Kilgore, Texas 75662
Policy # TSF01001524

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-CX-409-2020-48 11/02/2020 12/04/2020 On Receipt Turnersville Fire Department

*** THIS HAS BEEN SUBMITTED TO YOUR INSURANCE COMPANY AND DENIED. THIS IS NOW YOUR RESPONSIBILITY. ***

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

    $150.00
    1
    $150.00
  2. 103 Rescue Response (Per Hour)

    $300.00
    1
    $300.00
  3. 102 Engine Response (Per Hour)

    $350.00
    1
    $350.00
  4. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  5. 206 Latex Gloves (Pairs Used)

    $2.00
    4
    $8.00
  6. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  7. 409 Manpower (Per Hour)

    $50.00
    6
    $300.00

  8. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 14000 Block of FM 182

    Ordinance Info: Turnersville Policy #55 Recovery of Service Costs

Subtotal $1,458.00
Total Due $1,458.00


Updated
December 3, 2020 @ 2:14 pm

Invoice updated by Geoffrey.

Status Update
December 3, 2020 @ 2:14 pm

Status changed: Draft to Pending.

Updated
October 24, 2021 @ 2:46 pm

Invoice updated by Geoffrey.

Updated
June 11, 2022 @ 6:34 pm

Invoice updated by Karen Smith.

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