Bill To:


ALLSTATE INSURANCE
3075 SANDERS ROAD - SUITE H1A
NORTHBROOK, IL 60062-7127

Services Rendered To:


Nicole Beltram
8718 Tumblewood Dr
Baytown, TX 77523
POLICY# 938676354

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-AK-305-23-2141 07/09/2023 07/18/2023 On Receipt San Felipe Frydek V.F.D.

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

    $200.00
    1.25
    $250.00
  2. 105 Utility Vehicle Response (Per Hour)

    $250.00
    1.25
    $312.50
  3. 102 Engine Response (Per Hour)

    $500.00
    1.25
    $625.00
  4. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00
  5. 206 Latex Gloves (Pairs Used)

    $2.00
    2
    $4.00
  6. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.25
    $125.00

  7. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 428 Briar Creek Ln- Sealy, TX

Subtotal $1,566.50
Total Due $1,566.50


Updated
July 18, 2023 @ 12:22 pm

Invoice updated by Geoffrey.

Status Update
July 18, 2023 @ 12:22 pm

Status changed: Draft to Pending.

Updated
July 26, 2023 @ 1:07 pm

Invoice updated by Geoffrey.