Bill To:


Connect Insurance
3500 Packerland Drive
De Pere, WI 54115

Services Rendered To:


Paula Nunez
3755 Sweet Home Road
Sequin, Texas 78155
CLAIM # CCB 01222250


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

    $350.00
    1
    $350.00
  2. 103 Rescue Response (Per Hour)

    $300.00
    1
    $300.00
  3. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00
  4. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00

  5. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: FM 78 and FM 1044 - Marion, exas

    Ordinance Info: McQueeney Cost Recovery Resolution 4521

Subtotal $1,000.00
Total Due $1,000.00


Updated
February 12, 2021 @ 10:43 pm

Invoice updated by Geoffrey.

Status Update
February 12, 2021 @ 10:43 pm

Status changed: Draft to Pending.

Updated
July 21, 2021 @ 8:07 pm

Invoice updated by Geoffrey.

Updated
July 22, 2021 @ 2:31 pm

Invoice updated by Geoffrey.