Bill To:


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

Services Rendered To:


Jon Payne
12450 South State Highway 205
Lavon, Texas 75166
Policy # 005184385C7-7108-2


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

    $350.00
    1.5
    $525.00
  2. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    1.5
    $225.00
  3. 218 Cervical Collar (# Used)

    $25.00
    1
    $25.00
  4. 309 Power Tool (# Used)

    $50.00
    1
    $50.00
  5. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  6. 206 Latex Gloves (Pairs Used)

    $2.00
    12
    $24.00
  7. 301 Hand Tool (# Used)

    $15.00
    2
    $30.00
  8. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.5
    $150.00

  9. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 12446 South State Highway 205 Lavon, Texas 75166

    Ordinance Info: City of Lavon, Texas - Resolution NO. 2020-03-01

Subtotal $1,279.00
Total Due $1,279.00


Updated
February 3, 2021 @ 3:31 pm

Invoice updated by Geoffrey.

Status Update
February 3, 2021 @ 3:31 pm

Status changed: Draft to Pending.

Viewed
June 24, 2021 @ 5:34 pm

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

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October 22, 2022 @ 8:27 pm

Invoice viewed by 64.124.8.32 for the first time.