Bill To:


Assurance America Insurance
P.O. Box 725009
Atlanta, GA 31139-0009

Services Rendered To:


Alejandro Juan Gonzalez
101 Johnson St
Albertville, AL 35951
POLICY# RAL2007959


Product
Price
Qty
Amount
  1. 105 Utility Vehicle Response (Per Hour)

    $250.00
    1
    $250.00
  2. 105 Utility Vehicle Response (Per Hour)

    $250.00
    1
    $250.00
  3. 206 Latex Gloves (Pairs Used)

    $2.00
    2
    $4.00
  4. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00

  5. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Hustleville Rd & Todd Ridge Rd- Albertville, AL

Subtotal $604.00
Total Due $604.00


Updated
December 15, 2022 @ 5:52 pm

Invoice updated by Geoffrey.

Status Update
December 15, 2022 @ 5:52 pm

Status changed: Draft to Pending.