Bill To:


Sahara Williams
13811 Tahoe Vista
San Antonio, TX 78253

Services Rendered To:


Sahara Williams
13811 Tahoe Vista
San Antonio, TX 78253
POLICY# 001259539U 7108 3

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-KB-403-23-29911 12/27/2023 12/28/2023 On Receipt Woodlawn Fire Department

*** Please Submit this to your AUTO Insurance Company for processing and payment, OR YOU MAY CONTACT OUR OFFICE AND PROVIDE US WITH YOUR INSURANCE INFORMATION FOR PROCESSING. ***

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

    $500.00
    1
    $500.00
  2. 317 Rescue Struts (# Used)

    $50.00
    2
    $100.00
  3. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00

  4. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: US 59 N- Marshall, TX

Subtotal $700.00
Total Due $700.00


Updated
December 28, 2023 @ 12:47 pm

Invoice updated by Geoffrey.

Status Update
December 28, 2023 @ 12:47 pm

Status changed: Draft to Pending.

Viewed
July 21, 2024 @ 8:16 pm

Invoice viewed by 69.171.249.11 for the first time.