Bill To:


ROOT INSURANCE COMPANY
80 EAST RICH STREET - SUITE 500
COLUMBUS, OH 43215-5249

Services Rendered To:


Riley James Dwyer
1620 Peach Leaf Street
Houston, Texas 77039
Policy # DCLPGQ


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

    $300.00
    2
    $600.00
  2. 105 Utility Vehicle Response (Per Hour)

    $150.00
    2
    $300.00
  3. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  4. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 220 Southbound on Interstate 45 - Angus, Texas

    Ordinance Info: City of Angus Billing Authorization # 7

Subtotal $1,150.00
Total Due $1,150.00


Updated
October 12, 2021 @ 3:14 pm

Invoice updated by Geoffrey.

Status Update
October 12, 2021 @ 3:14 pm

Status changed: Draft to Pending.