Bill To:


ALLSTATE FIRE AND CASUALTY
2775 SANDERS ROAD
NORTHBROOK, IL 60062-6110

Services Rendered To:


Jeffrey Coleman
2122 W US 79
Buffalo, TX 75831
POLICY# 838993011

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-GV-301-23-3983 12/09/2023 12/12/2023 On Receipt Dew VFD

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

    $400.00
    1.75
    $700.00
  2. 102 Engine Response (Per Hour)

    $500.00
    1.75
    $875.00
  3. 105 Utility Vehicle Response (Per Hour)

    $250.00
    1.75
    $437.50
  4. 314 Cribbing – Lvl 1 (Passenger Vehicle) (Used)

    $100.00
    1
    $100.00
  5. 206 Latex Gloves (Pairs Used)

    $2.00
    2
    $4.00
  6. 309 Power Tool (# Used)

    $50.00
    1
    $50.00
  7. 404 Scene Lighting (Per Hour)

    $75.00
    1
    $75.00
  8. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  9. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00
  10. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00

  11. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 509 Hwy 75 S- Dew, TX

Subtotal $2,841.50
Total Due $2,841.50


Updated
December 12, 2023 @ 11:48 am

Invoice updated by Geoffrey.

Status Update
December 12, 2023 @ 11:48 am

Status changed: Draft to Pending.