Bill To:


ACCC INSURANCE
PO BOX 2081
ALPHARETTA, GA 30023-2081

Services Rendered To:


Policy# TDU20077399-2
Juan Carlos-Posada
Vehicle VIN: 1NXBR12L41Z425725

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-CN-310-2020-55-B 02/20/2020 01/04/2021 On Receipt Lavon VFD

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

    $350.00
    1
    $350.00
  2. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  3. 206 Latex Gloves (Pairs Used)

    $2.00
    6
    $12.00
  4. 201 Oil Absorbent Material (# Used)

    $35.00
    1
    $35.00
  5. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00

  6. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 411 Highway 78, Lavon, TX

    Ordinance Info: Resolution No. 2020--03-01

Subtotal $747.00
Total Due $747.00
Updated
January 4, 2021 @ 2:10 pm

Invoice updated by Karen Smith.

Updated
January 4, 2021 @ 2:11 pm

Invoice updated by Karen Smith.

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