Order No. 28524
Special Risk Insurance
Came to be heard this the 9th day of February 2004 with a motion made by Commissioner Letz,
Seconded by Commissioner Williams, the Court unanimously approved by a vote of 4-0-0, to
pay JI Special Risk Insurance Agency $2,784.00 out of line item 15-611-480 for the Storage
Tank Pollution Liability Insurance Renewal.
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~ FOR AUDITOR'S OFFICE USE ONLY
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LATE BILL FOR 02/09/04
WILL NEED A HANDCHECK
2904
VENDOR #
INVOICE #
PAID TO: JI SPECIAL RISKS INS. AGENCY
AMOUNT: 52,784.00
EXPENSE CODE: 15-611-d80
DESCRIPTION: Storage Tank Pollution Liab Ins Renew.
(Policy # USC3584450-04) 2123/04-05
INV. NUMBER 16278
INV. DATE: 02/03/04
RCVD DATE: 02/05/04
DUE DATE: 02/09/04
Attention: Martina Morales
P.O. Box 26655
Austin. Texas 78755-0655
JI Speciai Risks Ins. Agency (2 ~ G ~)
INVOICE
P. O. Box 26655
Austin, TX 78755-0655
(800)541-5477
Invoice Date: 2/3/2004
Invoice No.: 016278
Customer No.: KERB CO
Due Date: Due Upon Receipt
Tommy Tomlinson
Kerr County
700 Main #103
Kerrville, TX 780285327
Page: 1
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Storage Tank Pollution Liab.
Policv No. USC3584450-04
Effective Dates: 02/23/04-OS
FE B 0 52004
2,784.00
0.00
0.00
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Please make checks payable to JI Special Risks Ins. Agency.

2,784.00