Bill To:


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

Services Rendered To:


Tara Fant
305 Crisfield Circle
Alabaster, AL 35007
POLICY# 000000985804135


Product
Price
Qty
Amount
  1. 102 Engine Response (Per Hour)

    $500.00
    2
    $1,000.00
  2. 103 Rescue Response (Per Hour)

    $400.00
    2
    $800.00
  3. 218 Cervical Collar (# Used)

    $25.00
    1
    $25.00
  4. 206 Latex Gloves (Pairs Used)

    $2.00
    4
    $8.00
  5. 215 Trauma Kit (# Used)

    $25.00
    1
    $25.00
  6. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  7. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: CR 44 & CR 51- Jemison, AL

Subtotal $2,108.00
Total Due $2,108.00


Updated
October 17, 2023 @ 3:14 pm

Invoice updated by Geoffrey.

Status Update
October 17, 2023 @ 3:14 pm

Status changed: Draft to Pending.