Bill To:


ROOT INSURANCE COMPANY
80 EAST RICH STREET - SUITE 500
COLUMBUS, OH 43215-5249

Services Rendered To:


Tyrone Fails
2601 Glenn Avenue
Del City, OK 73115
Policy # 4LG3V8

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-CN-310-2020-392 12/09/2020 12/18/2020 On Receipt Lavon V.F.D.

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

    $350.00
    1.25
    $437.50
  2. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  3. 310 Hydraulic Tool (# Used)

    $200.00
    1
    $200.00
  4. 206 Latex Gloves (Pairs Used)

    $2.00
    10
    $20.00
  5. 301 Hand Tool (# Used)

    $15.00
    2
    $30.00
  6. 201 Oil Absorbent Material (# Used)

    $35.00
    3
    $105.00
  7. 404 Scene Lighting (Per Hour)

    $75.00
    1.25
    $93.75
  8. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.25
    $125.00

  9. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Highway 78 and Lake Road - Lavon, Texas

    Ordinance Info: City of Lavon Texas - Resolution No. 2020-03-01 Cost Recovery

Subtotal $1,261.25
Total Due $1,261.25
Updated
December 17, 2020 @ 12:52 pm

Invoice updated by Geoffrey.

Status Update
December 17, 2020 @ 12:52 pm

Status changed: Draft to Pending.

Updated
December 17, 2020 @ 12:57 pm

Invoice updated by Geoffrey.

Viewed
June 24, 2021 @ 4:46 pm

Invoice viewed by Karen Smith (KarenS) for the first time.

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October 24, 2022 @ 1:11 pm

Invoice viewed by 64.124.8.26 for the first time.