Bill To:


American Access Casualty
2211 Butterfield Road, Suite 200
Downers Grove, IL 60515

Services Rendered To:


Ariel Caseras
12536 Zion Rd
Tomball, TX 77375
POLICY# 42AU001043904


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

    $400.00
    1.25
    $500.00
  2. 310 Hydraulic Tool (# Used)

    $200.00
    2
    $400.00
  3. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00
  4. 408 Air Medical Landing Zone (Used)

    $250.00
    1
    $250.00
  5. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  6. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00

  7. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 214 NB IH45- Richland, TX

    Ordinance Info: City of Angus Billing Authorization # 7

Subtotal $1,750.00
Total Due $1,750.00


Updated
January 9, 2024 @ 3:48 pm

Invoice updated by Geoffrey.

Status Update
January 9, 2024 @ 3:48 pm

Status changed: Draft to Pending.