Bill To:


Samuel Fields Jr.
6868 CR 2345
Marietta, TX 75566

Services Rendered To:


Samuel Fields Jr.
6868 CR 2345
Marietta, Texas 75566
Policy # 11404973233


*** THIS HAS BEEN SUBMITTED TO YOUR INSURANCE COMPANY AND DENIED. THIS IS NOW YOUR RESPONSIBILITY. ***

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

    $350.00
    1.5
    $525.00
  2. 103 Rescue Response (Per Hour)

    $300.00
    1.5
    $450.00
  3. 314 Cribbing – Lvl 1 (Passenger Vehicle) (Used)

    $100.00
    2
    $200.00
  4. 301 Hand Tool (# Used)

    $15.00
    1
    $15.00
  5. 201 Oil Absorbent Material (# Used)

    $35.00
    1
    $35.00
  6. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.5
    $150.00
  7. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  8. 409 Manpower (Per Hour)

    $50.00
    4.5
    $225.00

  9. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: SH 77 Near CR 2340 - Cass County, Texas

    Reprint

Subtotal $1,850.00
Total Due $1,850.00

Second Notice

10/04/2021


Updated
September 5, 2021 @ 5:13 pm

Invoice updated by Geoffrey.

Status Update
September 5, 2021 @ 5:13 pm

Status changed: Draft to Pending.

Updated
September 5, 2021 @ 5:13 pm

Invoice updated by Geoffrey.

Updated
October 4, 2021 @ 2:35 pm

Invoice updated by Karen Smith.

Updated
October 4, 2021 @ 2:36 pm

Invoice updated by Karen Smith.

Updated
October 21, 2021 @ 6:16 pm

Invoice updated by Geoffrey.

Updated
December 29, 2021 @ 3:29 pm

Invoice updated by Geoffrey.

Updated
December 29, 2021 @ 3:31 pm

Invoice updated by Geoffrey.