Bill To:


ELEPHANT INSURANCE
PO BOX 5005
GLEN ALLEN, VA 23058-5005

Services Rendered To:


Jessica Gonzales
11250 Taylor Draper Ln
Austin, TX 78759
POLICY# 24400054342

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-XV-414-23-1250 08/15/2023 08/15/2023 On Receipt Sam Bass Fire Department

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

    $200.00
    1.5
    $300.00
  2. 102 Engine Response (Per Hour)

    $500.00
    1.5
    $750.00
  3. 106 Battalion/Chief Vehicle Response (Per Hour)

    $200.00
    1.5
    $300.00
  4. 301 Hand Tool (# Used)

    $15.00
    2
    $30.00
  5. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.5
    $150.00
  6. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00

  7. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Pearson Ranch- Round Rock, TX

    Ordinance Info: Sam Bass Fire Dept. Resolution

Subtotal $1,780.00
Total Due $1,780.00


Updated
August 15, 2023 @ 2:09 pm

Invoice updated by Geoffrey.

Status Update
August 15, 2023 @ 2:09 pm

Status changed: Draft to Pending.