Bill To:


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

Services Rendered To:


Sargent Marine
100 Clement Road
Sargent, TX 77414
Driver: Jeremy Johnson
Policy # 838-984-463

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-RG-207-21-31185 11/28/2021 12/22/2021 On Receipt Sargent V.F.D.

Product
Price
Qty
Amount
  1. 105 Utility Vehicle Response (Per Hour)

    $150.00
    2.25
    $337.50
  2. 102 Engine Response (Per Hour)

    $350.00
    2.25
    $787.50
  3. 103 Rescue Response (Per Hour)

    $300.00
    2.25
    $675.00
  4. 314 Cribbing – Lvl 1 (Passenger Vehicle) (Used)

    $100.00
    1
    $100.00
  5. 319 Generator (Per Generator/Per Hour)

    $50.00
    2.25
    $112.50
  6. 310 Hydraulic Tool (# Used)

    $200.00
    3
    $600.00
  7. 206 Latex Gloves (Pairs Used)

    $2.00
    4
    $8.00
  8. 404 Scene Lighting (Per Hour)

    $75.00
    2.25
    $168.75
  9. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    2.25
    $225.00
  10. 330 Backboard (# 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: 8214 FM 457 - Sargent, Texas

Subtotal $3,289.25
Total Due $3,289.25


Updated
December 22, 2021 @ 6:02 pm

Invoice updated by Geoffrey.

Status Update
December 22, 2021 @ 6:02 pm

Status changed: Draft to Pending.

Viewed
October 25, 2022 @ 12:10 am

Invoice viewed by 64.124.8.28 for the first time.