Bill To:


Old American County Mutual
P.O. Box 793747
Dallas, TX 75379

Services Rendered To:


Betty Genoveva Puente
600 South Milam Street
Sequin, Texas 78155
Policy # CCAA01002815


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

    $350.00
    1
    $350.00
  2. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1
    $150.00
  3. 103 Rescue Response (Per Hour)

    $300.00
    1
    $300.00
  4. 331 Air Bags (# Used)

    $150.00
    2
    $300.00
  5. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  6. 402 Fire/Police Services (Per Hour)    

    $100.00
    1
    $100.00
  7. 206 Latex Gloves (Pairs Used)

    $2.00
    6
    $12.00
  8. 201 Oil Absorbent Material (# Used)

    $35.00
    5
    $175.00
  9. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  10. 215 Trauma Kit (# Used)

    $25.00
    1
    $25.00
  11. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  12. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 3500 Block of FM 78 - McQueeney, Texas

    Ordinance Info: McQueeney Cost Recovery Resolution 4521

Subtotal $2,012.00
Total Due $2,012.00


Updated
December 8, 2021 @ 6:28 pm

Invoice updated by Geoffrey.

Status Update
December 8, 2021 @ 6:28 pm

Status changed: Draft to Pending.