Bill To:


Consumers County Mutual Insurance
4245 N. Central Expressway, Suite 500
Dallas, TX 75205

Services Rendered To:


Camerino Arteaga
1100 S.W. McKinney St.
Rice, Texas 75155
Policy # 6080850552221

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-SH-201-C21-17259 07/07/2021 07/13/2021 On Receipt Angus Vol. Fire Department

Product
Price
Qty
Amount
  1. 103 Rescue Response (Per Hour)

    $300.00
    1.5
    $450.00
  2. 206 Latex Gloves (Pairs Used)

    $2.00
    3
    $6.00
  3. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.5
    $150.00
  4. 302 Hand Light (# Used)

    $5.00
    2
    $10.00

  5. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 5700 Block S.E. County Road 1020 - Angus, Texas

    Ordinance Info: City of Angus Billing Authorization # 7

Subtotal $616.00
Total Due $616.00


Updated
July 13, 2021 @ 3:26 pm

Invoice updated by Geoffrey.

Status Update
July 13, 2021 @ 3:26 pm

Status changed: Draft to Pending.

Viewed
October 25, 2022 @ 3:11 pm

Invoice viewed by 64.124.8.25 for the first time.