Bill To:


Old American County Mutual
P.O. Box 793747
Dallas, TX 75379

Services Rendered To:


Jose Humberto Castillo
6041 Dimsley Ct
Ft Worth, TX 76137
POLICY# HGA54242

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-SH-201-C23-9092 04/09/2023 05/18/2023 On Receipt Angus Vol. Fire Department

Product
Price
Qty
Amount
  1. 103 Rescue Response (Per Hour)

    $300.00
    1
    $300.00
  2. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00

  3. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 220 NB IH 45- Richland, TX

    Ordinance Info: City of Angus Billing Authorization # 7

Subtotal $400.00
Total Due $400.00


Updated
May 18, 2023 @ 9:57 am

Invoice updated by Geoffrey.

Status Update
May 18, 2023 @ 9:57 am

Status changed: Draft to Pending.