Bill To:


Esurance
PO Box 5250
Sioux Falls, SD 57117-5258

Services Rendered To:


Jessie Alan James
Policy# 7385928

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-BY205-2018-0108 01/08/2018 08/26/2019 On Receipt Douglassville Volunteer Fire Department

Product
Price
Qty
Amount
  1. 103 Rescue Response (Per Hour)

    $300.00
    2
    $600.00
  2. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    6
    $600.00
  3. 409 Manpower (Per Hour)

    $20.00
    6
    $120.00

  4. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 1 mile east of FM 2065 off SH 77 West

Subtotal $1,320.00
Total Due $1,320.00
Updated
August 24, 2019 @ 7:11 pm

Invoice updated by Karen Smith.

Status Update
August 24, 2019 @ 7:11 pm

Status changed: Draft to Pending.

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