Bill To:


Sentry Insurance
1800 N. Point Drive
Stevens Point, WI 54481

Services Rendered To:


Jeremy Azcarate
210 Hickory Street
Naples, TX 75568
Driver: Josiah Azcarate
POLICY # 11407104211


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

    $350.00
    1.5
    $525.00
  2. 103 Rescue Response (Per Hour)

    $300.00
    1.5
    $450.00
  3. 330 Backboard (# Used)

    $25.00
    1
    $25.00
  4. 218 Cervical Collar (# Used)

    $25.00
    1
    $25.00
  5. 314 Cribbing – Lvl 1 (Passenger Vehicle) (Used)

    $100.00
    1
    $100.00
  6. 301 Hand Tool (# Used)

    $15.00
    2
    $30.00
  7. 216 Oxygen (# Used)

    $25.00
    1
    $25.00
  8. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.5
    $150.00
  9. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00

  10. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: State Highway 77 East & CR 2120 - ( Cass County ) Douglassville, Texas

Subtotal $1,580.00
Total Due $1,580.00


Updated
April 28, 2022 @ 3:52 pm

Invoice updated by Geoffrey.

Status Update
April 28, 2022 @ 3:52 pm

Status changed: Draft to Pending.

Updated
April 28, 2022 @ 3:53 pm

Invoice updated by Geoffrey.

Updated
May 19, 2022 @ 5:27 pm

Invoice updated by Geoffrey.

Updated
August 3, 2022 @ 5:41 pm

Invoice updated by Karen Smith.

Updated
September 9, 2022 @ 5:11 pm

Invoice updated by Geoffrey.