Bill To:


Liberty County Mutual
175 Berkeley Street
Boston, MA 02116

Services Rendered To:


Gary Foster
9605 Slate Creek Trail
Austin, TX 78717
POLICY# Y9573381

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-XV-414-23-1099 07/14/2023 07/17/2023 On Receipt Sam Bass Fire Department

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

    $500.00
    1
    $500.00
  2. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00
  3. 301 Hand Tool (# Used)

    $15.00
    1
    $15.00
  4. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00

  5. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Hwy 45 & RM 620- Round Rock, TX

    Ordinance Info: Sam Bass Fire Dept. Resolution

Subtotal $865.00
Total Due $865.00


Updated
July 17, 2023 @ 12:52 pm

Invoice updated by Geoffrey.

Status Update
July 17, 2023 @ 12:52 pm

Status changed: Draft to Pending.

Viewed
March 20, 2024 @ 6:54 pm

Invoice viewed by 66.249.72.6 for the first time.