Bill To:


Arch Insurance Group Claims Department
P.O. Box 542033
Omaha, NE 68154

Services Rendered To:


Daniel Rose
1105 Baker Rd
Albertville, AL 35951
POLICY# ZACAT7002902


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

    $350.00
    1.5
    $525.00
  2. 404 Scene Lighting (Per Hour)

    $75.00
    1.5
    $112.50
  3. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.5
    $150.00

  4. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Hustleville Rd & Rice Mill Chaviers- Albertville, AL

Subtotal $787.50
Total Due $787.50


Updated
December 13, 2022 @ 12:00 pm

Invoice updated by Geoffrey.

Status Update
December 13, 2022 @ 12:00 pm

Status changed: Draft to Pending.

Updated
January 16, 2023 @ 9:15 pm

Invoice updated by Karen Smith.