Bill To:


Gainsco Insurance
3333 Lee Parkway #1200
Dallas, TX 75219

Services Rendered To:


Jason Jacobs
203 Bois D Arc St
Canton, TX 75103
POLICY# 03MGEP1609137-01


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

    $500.00
    1
    $500.00
  2. 105 Utility Vehicle Response (Per Hour)

    $250.00
    1
    $250.00
  3. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  4. 301 Hand Tool (# Used)

    $15.00
    1
    $15.00
  5. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00
  6. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00

  7. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 14033 St Hwy 64- Ben Wheeler, TX 75754

Subtotal $1,365.00
Total Due $1,365.00


Updated
March 5, 2024 @ 1:24 pm

Invoice updated by Geoffrey.

Status Update
March 5, 2024 @ 1:24 pm

Status changed: Draft to Pending.