Bill To:


ALLSTATE INSURANCE
3075 SANDERS ROAD - SUITE H1A
NORTHBROOK, IL 60062-7127

Services Rendered To:


William Saylor
503 Susan Dr
Leander, TX 78641
POLICY# 416271368

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-XV-414-23-2050 12/12/2023 12/14/2023 On Receipt Sam Bass Fire Department

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

    $500.00
    1
    $500.00
  2. 106 Battalion/Chief Vehicle Response (Per Hour)

    $200.00
    1
    $200.00
  3. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00
  4. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00

  5. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 45 & 620- Austin, TX

    Ordinance Info: Sam Bass Fire Dept. Resolution

Subtotal $1,050.00
Total Due $1,050.00


Updated
December 14, 2023 @ 10:36 am

Invoice updated by Geoffrey.

Status Update
December 14, 2023 @ 10:36 am

Status changed: Draft to Pending.