Bill To:

MGA INSURANCE COMPANY
3333 Lee Parkway Suite 1200 PO Box 199023
Dallas, TX 75219

Services Rendered To:

Lionell Pate
10701 S IH35
Austin, TX 78717
POLICY# ETXP022525


Product
Price
Qty
Amount

  1. 102 Engine Response (Per Hour)

    $500.00
    1
    $500.00

  2. 301 Hand Tool (# Used)

    $15.00
    3
    $45.00

  3. 201 Oil Absorbent Material (# Used)

    $35.00
    1
    $35.00

  4. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00

  5. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00

    6. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 620 & 45- Round Rock, TX

    Ordinance Info: Sam Bass Fire Dept. Resolution

Subtotal $930.00
Total Due $930.00


Checks Payable To:

Sure Fire Recovery Service, LLC
9711 S Mason Road 125-120
Richmond, TX 77407
Federal Tax ID – 83-4417185


  Please Include Incident Number On All Correspondence.
Updated
July 10, 2023 @ 1:00 pm

Invoice updated by Geoffrey.

Updated
August 9, 2023 @ 12:09 pm

Invoice updated by Geoffrey.