Bill To:


LIBERTY MUTUAL GROUP
PO BOX 515097
LOS ANGELES, CA 90051-5097

Services Rendered To:


Savannah O'Reagan
1095 Sterling Lane
Azle, Texas 76020
Policy # Y8322948


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

    $300.00
    1
    $300.00
  2. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1
    $150.00
  3. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  4. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 12130 FM 730 North - Azle, Texas

Subtotal $700.00
Total Due $700.00


Updated
November 12, 2021 @ 4:53 pm

Invoice updated by Geoffrey.

Status Update
November 12, 2021 @ 4:53 pm

Status changed: Draft to Pending.