Bill To:


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

Services Rendered To:


David Durbin
Policy # 000000844416941


Product
Price
Qty
Amount
  1. 104 Tanker Response (Per Hour)

    $300.00
    1
    $300.00
  2. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    1
    $150.00
  3. 206 Latex Gloves (Pairs Used)

    $2.00
    2
    $4.00
  4. 301 Hand Tool (# Used)

    $15.00
    2
    $30.00
  5. 302 Hand Light (# Used)

    $5.00
    2
    $10.00
  6. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  7. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 730 South Reno Road - Azle, Texas

Subtotal $744.00
Total Due $744.00


Updated
November 8, 2021 @ 12:48 pm

Invoice updated by Geoffrey.

Status Update
November 8, 2021 @ 12:48 pm

Status changed: Draft to Pending.