Bill To:


Old American County Mutual
P.O. Box 793747
Dallas, TX 75379-3747

Services Rendered To:


Policy# TEJ01797962-02
Owner: James Tatum
Driver: Xavier Bennett


Product
Price
Qty
Amount
  1. 103 Rescue Response (Per Hour)

    $300.00
    1
    $300.00
  2. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  3. 505 Standby at Accident Scene

    $150.00
    1
    $150.00

  4. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: US Hwy 695, 1/2 mile South of City Limits

Subtotal $550.00
Total Due $550.00


Updated
May 4, 2022 @ 2:09 pm

Invoice updated by Karen Smith.

Status Update
May 4, 2022 @ 2:09 pm

Status changed: Draft to Pending.