Bill To:


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

Services Rendered To:


Amy Ridgeway
18602 Clay Road
Houston, Texas 77084
Policy # 638262089

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-SH-201-C21-05872 03/12/2021 04/01/2021 On Receipt Angus Vol. Fire Department

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

    $300.00
    1
    $300.00
  2. 206 Latex Gloves (Pairs Used)

    $2.00
    2
    $4.00
  3. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  4. 232 N95 Mask (Per Unit/Per Use)

    $10.00
    2
    $20.00

  5. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 217 Northbound and Interstate 45 - Richland, Texas

    Ordinance Info: City of Angus Billing Authorization Item # 7

Subtotal $424.00
Total Due $424.00


Updated
March 31, 2021 @ 4:36 pm

Invoice updated by Geoffrey.

Status Update
March 31, 2021 @ 4:36 pm

Status changed: Draft to Pending.