Bill To:


USAA CASUALTY INSURANCE
9800 FREDERICKSBURG ROAD
SAN ANTONIO, TX 78240-4100

Services Rendered To:


Heidi Lynn Jerry
8331 Maple Acres Drive
Houston, Texas 77095
Policy # 019985848 7102

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-SH-201-C21-18351 07/19/2021 07/28/2021 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: 223 Northbound on Interstate 45 - Angus, Texas

    Ordinance Info: City of Angus Billing Authorization # 7

Subtotal $400.00
Total Due $400.00


Updated
July 27, 2021 @ 12:54 pm

Invoice updated by Geoffrey.

Status Update
July 27, 2021 @ 12:54 pm

Status changed: Draft to Pending.

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July 27, 2021 @ 12:54 pm

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