Bill To:


Old American County Mutual
P.O. Box 793747
Dallas, TX 75379

Services Rendered To:


Aundrea McCollister
POLICY# ADR01010553

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-BB-326-24-32-A 02/22/2024 03/26/2024 On Receipt Rosharon VFD

Product
Price
Qty
Amount
  1. 106 Battalion/Chief Vehicle Response (Per Hour)

    $200.00
    1
    $200.00
  2. 102 Engine Response (Per Hour)

    $500.00
    1
    $500.00
  3. 105 Utility Vehicle Response (Per Hour)

    $250.00
    1
    $250.00
  4. 103 Rescue Response (Per Hour)

    $400.00
    1
    $400.00
  5. 309 Power Tool (# Used)

    $50.00
    1
    $50.00
  6. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00
  7. 201 Oil Absorbent Material (# Used)

    $35.00
    8
    $280.00
  8. 301 Hand Tool (# Used)

    $15.00
    4
    $60.00
  9. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00
  10. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00

  11. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: FM 521- Rosharon, TX

    Ordinance Info: Rosharon Cost Recovery Resolution

Subtotal $2,340.00
Total Due $2,340.00


Updated
March 26, 2024 @ 1:04 pm

Invoice updated by Geoffrey.

Status Update
March 26, 2024 @ 1:04 pm

Status changed: Draft to Pending.