Bill To:


ALLSTATE FIRE AND CASUALTY
2775 SANDERS ROAD
NORTHBROOK, IL 60062-6110

Services Rendered To:


Michael Vinson
109 Oak Branch Trail
Waxahachie, TX 75167
Policy # 000000886176888

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-KP-401-21-78-1 09/05/2021 12/18/2021 On Receipt Peoria V.F.D.

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

    $150.00
    1
    $150.00
  2. 102 Engine Response (Per Hour)

    $350.00
    1
    $350.00
  3. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1
    $150.00
  4. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  5. 402 Fire/Police Services (Per Hour)    

    $100.00
    1
    $100.00
  6. 206 Latex Gloves (Pairs Used)

    $2.00
    20
    $40.00
  7. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  8. 324 Traffic Cone (# Used)

    $5.00
    3
    $15.00
  9. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  10. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: State Highway 22 & HCR 1313 - Hillsboro, Texas

    Ordinance Info: Recovery of Service Costs for Peoria VFD

Subtotal $1,405.00
Total Due $1,405.00


Updated
December 17, 2021 @ 2:57 pm

Invoice updated by Geoffrey.

Status Update
December 17, 2021 @ 2:58 pm

Status changed: Draft to Pending.

Updated
December 17, 2021 @ 2:58 pm

Invoice updated by Geoffrey.

Viewed
October 24, 2022 @ 8:00 am

Invoice viewed by 64.124.8.45 for the first time.