Bill To:


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

Services Rendered To:


Michael Griswold
830 Rustic Way
Josephine, TX 75189
Policy # 416466878

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-CN-310-2021-409-B 09/27/2021 10/15/2021 On Receipt Lavon V.F.D.

Product
Price
Qty
Amount
  1. 101 Aerial/Ladder Response (Per Hour)

    $400.00
    1
    $400.00
  2. 401 Debris Cleanup/Removal (# Used)

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

    $2.00
    6
    $12.00
  4. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00

  5. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Highway 78 & Highway 205 - Lavon, Texas

    Ordinance Info: City of Lavon - Resolution NO. 2020-03-01

Subtotal $762.00
Total Due $762.00


Updated
October 14, 2021 @ 5:32 pm

Invoice updated by Geoffrey.

Viewed
October 23, 2022 @ 12:03 am

Invoice viewed by 64.124.8.29 for the first time.