Bill To:


American Zurich Insurance
Orlando PO Box 968084
Schaumburg, IL 60196-8084

Services Rendered To:


Southern Fluid Solutions
1061 Cotton Ford Rd
Center, TX 75935
POLICY# 3537928


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

    $400.00
    3.75
    $1,500.00
  2. 102 Engine Response (Per Hour)

    $500.00
    3.75
    $1,875.00
  3. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00
  4. 206 Latex Gloves (Pairs Used)

    $2.00
    4
    $8.00
  5. 404 Scene Lighting (Per Hour)

    $75.00
    3.75
    $281.25
  6. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    3.75
    $375.00
  7. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00
  8. 330 Backboard (# Used)

    $25.00
    1
    $25.00

  9. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Hwy 59 & Timberland Dr- Woodlawn, TX

Subtotal $4,564.25
Total Due $4,564.25


Updated
January 11, 2024 @ 12:57 pm

Invoice updated by Geoffrey.

Status Update
January 11, 2024 @ 12:57 pm

Status changed: Draft to Pending.