Bill To:


Trexis Insurance
PO Box 682322
Franklin, TN 37068

Services Rendered To:


Elmer or Hunter Samuel
PO Box 32
Buckner, AR 71827
POLICY# 1103021768464


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

    $500.00
    1.25
    $625.00
  2. 103 Rescue Response (Per Hour)

    $400.00
    1.25
    $500.00
  3. 404 Scene Lighting (Per Hour)

    $75.00
    1.25
    $93.75
  4. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.25
    $125.00
  5. 219 Blanket (# Used)

    $25.00
    1
    $25.00
  6. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00

  7. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Hwy 82 & Hwy 344- Waldo, AR

Subtotal $1,618.75
Total Due $1,618.75


Updated
January 9, 2024 @ 3:31 pm

Invoice updated by Geoffrey.

Status Update
January 9, 2024 @ 3:31 pm

Status changed: Draft to Pending.