Bill To:


US Lloyds
8190 Precinct Line Road
Colleyville, TX 76034

Services Rendered To:


James Bailey
125 Houston Street
Zavalla, Texas 75980
Policy # USOA116553
CLAIM # Q0008


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

    $150.00
    1.25
    $187.50
  2. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1.25
    $187.50
  3. 206 Latex Gloves (Pairs Used)

    $2.00
    6
    $12.00
  4. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.25
    $125.00
  5. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  6. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: FM 2109 and Bryan Street - Zavalla, Texas

Subtotal $762.00
Total Due $762.00


Updated
February 18, 2021 @ 4:27 pm

Invoice updated by Geoffrey.

Status Update
February 18, 2021 @ 4:27 pm

Status changed: Draft to Pending.

Updated
February 18, 2021 @ 4:33 pm

Invoice updated by Geoffrey.