Bill To:


ALLSTATE INSURANCE
3075 SANDERS ROAD - SUITE H1A
NORTHBROOK, IL 60062-7127

Services Rendered To:


Donna Reed
PO Box 1830
Springtown, TX 76082
POLICY# 876078464

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-WB-206-22-225 02/17/2022 12/09/2023 On Receipt Briar-Reno Fire Department

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

    $500.00
    1
    $500.00
  2. 104 Tanker Response (Per Hour)

    $400.00
    1
    $400.00
  3. 106 Battalion/Chief Vehicle Response (Per Hour)

    $200.00
    1
    $200.00
  4. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00
  5. 206 Latex Gloves (Pairs Used)

    $2.00
    6
    $12.00
  6. 301 Hand Tool (# Used)

    $15.00
    2
    $30.00
  7. 201 Oil Absorbent Material (# Used)

    $35.00
    1
    $35.00
  8. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  9. 322 Turn Out Gear / PPE (Per FireFighter)

    $250.00
    2
    $500.00

  10. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Reno Rd- Azle, TX

    Ordinance Info: Briar Reno Cost Recovery Ordinance

Subtotal $2,027.00
Total Due $2,027.00


Updated
December 9, 2023 @ 1:16 pm

Invoice updated by Geoffrey.

Status Update
December 9, 2023 @ 1:16 pm

Status changed: Draft to Pending.