Bill To:


Acceptance Insurance
P.O. Box 150769
Nashville, TN 37215

Services Rendered To:


Dallas Green
4395 Hwy 43
Tuscumbia, AL 35674
POLICY# FCAL000012160

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
AL-02-006-23-25 01/25/2023 01/27/2023 On Receipt Littleville VFD

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

    $350.00
    1
    $350.00
  2. 104 Tanker Response (Per Hour)

    $300.00
    1
    $300.00
  3. 402 Fire/Police Services (Per Hour)    

    $100.00
    1
    $100.00
  4. 301 Hand Tool (# Used)

    $15.00
    2
    $30.00
  5. 303 SCBA Breathing Apparatus (# Used)

    $50.00
    2
    $100.00
  6. 304 SCBA Cylinder (# Used)

    $25.00
    3
    $75.00
  7. 404 Scene Lighting (Per Hour)

    $75.00
    1
    $75.00

  8. Additional Incident Info

    Incident Type: Vehicle Fire Response

    Incident Location: 4395 Hwy 43- Tuscumbia, AL

    Ordinance Info: Littleville Volunteer Fire Dept. Resolution

Subtotal $1,030.00
Total Due $1,030.00


Updated
January 27, 2023 @ 11:10 am

Invoice updated by Geoffrey.

Status Update
January 27, 2023 @ 11:10 am

Status changed: Draft to Pending.