Bill To:


Dagoberta Andino-Montoya
9959 Adleta Blvd
Dallas, TX 75243

Services Rendered To:


Dagoberta Andino-Montoya
9959 Adleta Blvd
Dallas, TX 75243
POLICY# ASA000642-01


*** THIS HAS BEEN SUBMITTED TO YOUR INSURANCE COMPANY AND DENIED. THIS IS NOW YOUR RESPONSIBILITY. ***

Product
Price
Qty
Amount
  1. 105 Utility Vehicle Response (Per Hour)

    $250.00
    1.25
    $312.50
  2. 103 Rescue Response (Per Hour)

    $400.00
    1.25
    $500.00
  3. 404 Scene Lighting (Per Hour)

    $75.00
    1.25
    $93.75
  4. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.25
    $125.00

  5. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 218 N/B IH 45- Richland, TX

    Ordinance Info: City of Angus Billing Authorization # 7

Subtotal $1,031.25
Total Due $1,031.25


Updated
August 31, 2023 @ 11:30 am

Invoice updated by Geoffrey.

Status Update
August 31, 2023 @ 11:30 am

Status changed: Draft to Pending.

Updated
September 11, 2023 @ 3:06 pm

Invoice updated by Geoffrey.