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

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
AL-50-022-22-1529-A 12/11/2022 12/13/2022 On Receipt Alder Springs FD

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.

Viewed
January 16, 2023 @ 9:16 pm

Invoice viewed by Karen Meder - Smith (KarenS) for the first time.