Bill To:


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

Services Rendered To:


Conner Childers
111 E St Louis Dr
Seadrift, TX 77983
POLICY# 8QW49L

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-KB-403-23-27857 11/28/2023 01/11/2024 On Receipt Woodlawn Fire Department

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

    $500.00
    3.25
    $1,625.00
  2. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    3.25
    $325.00
  3. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00
  4. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  5. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Hwy 59 & Henderson School House Rd- Marshall, TX

Subtotal $2,450.00
Total Due $2,450.00


Updated
January 11, 2024 @ 12:34 pm

Invoice updated by Geoffrey.

Status Update
January 11, 2024 @ 12:34 pm

Status changed: Draft to Pending.

Viewed
July 22, 2024 @ 6:04 am

Invoice viewed by 57.141.5.25 for the first time.