Bill To:


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

Services Rendered To:


Suzanne Holloway
620 West FM 6
Nevada, Texas 75173
Policy # 000000416292283

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-CN-310-2021-187 05/03/2021 05/18/2021 On Receipt Lavon V.F.D.

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

    $350.00
    1.25
    $437.50
  2. 218 Cervical Collar (# Used)

    $25.00
    1
    $25.00
  3. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  4. 310 Hydraulic Tool (# Used)

    $200.00
    2
    $400.00
  5. 206 Latex Gloves (Pairs Used)

    $2.00
    8
    $16.00
  6. 301 Hand Tool (# Used)

    $15.00
    2
    $30.00
  7. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.25
    $125.00
  8. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  9. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Highway 78 & Lake Road - Lavon, Texas

Subtotal $1,533.50
Total Due $1,533.50


Updated
May 17, 2021 @ 6:48 pm

Invoice updated by Geoffrey.

Status Update
May 17, 2021 @ 6:48 pm

Status changed: Draft to Pending.

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