Bill To:


ALFA INSURANCE
207 Hwy 78 W
Jasper, AL 35501

Services Rendered To:


Kristopher Stallings
Albertville, AL
POLICY# 19000289436
License Plate # 5892BH3

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
AL-05-022-22-2878031 12/14/2022 12/15/2022 On Receipt Alder Springs FD

Product
Price
Qty
Amount
  1. 105 Utility Vehicle Response (Per Hour)

    $250.00
    1.5
    $375.00
  2. 105 Utility Vehicle Response (Per Hour)

    $250.00
    1.5
    $375.00
  3. 206 Latex Gloves (Pairs Used)

    $2.00
    4
    $8.00
  4. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.5
    $150.00

  5. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 3677 Rose Rd- Albertville, AL

Subtotal $908.00
Total Due $908.00


Updated
December 15, 2022 @ 6:02 pm

Invoice updated by Geoffrey.

Status Update
December 15, 2022 @ 6:02 pm

Status changed: Draft to Pending.