Bill To:


KEMPER INFINTY MUTUAL
4418 Broadway St
Pearland, TX 77581

Services Rendered To:


Sangum Choi
129 Navigator Dr
Austin, TX 78717
POLICY# 542860087811001

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-XV-414-24-109 01/16/2024 01/18/2024 On Receipt Sam Bass Fire Department

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

    $500.00
    1
    $500.00
  2. 105 Utility Vehicle Response (Per Hour)

    $250.00
    1
    $250.00
  3. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00
  4. 301 Hand Tool (# Used)

    $15.00
    3
    $45.00
  5. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00

  6. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Great Oaks Dr & Nautical- Austin, TX

    Ordinance Info: Sam Bass Fire Dept. Resolution

Subtotal $1,145.00
Total Due $1,145.00


Updated
January 18, 2024 @ 11:47 am

Invoice updated by Geoffrey.

Status Update
January 18, 2024 @ 11:47 am

Status changed: Draft to Pending.