Bill To:


Infinity Auto Insurance
2201 4th Avenue North
N. Birmingham, AL 35203

Services Rendered To:


Maria Muniz
6225 FM 2415
Alvarado, Texas 76009
Policy # 142560409854001

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-SH-214-2021-17089 07/06/2021 07/23/2021 On Receipt Richland V. F. D.

Product
Price
Qty
Amount
  1. 103 Rescue Response (Per Hour)

    $300.00
    1
    $300.00
  2. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  3. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: I-45 Northbound 220 @ 1394 Bridge - Richland, Texas

    Ordinance Info: Richland Billing Ordinance NO. 170 Cost Recovery

Subtotal $550.00
Total Due $550.00


Updated
July 23, 2021 @ 5:03 pm

Invoice updated by Geoffrey.

Status Update
July 23, 2021 @ 5:03 pm

Status changed: Draft to Pending.

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Invoice viewed by 64.124.8.45 for the first time.

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