Bill To:


Jackie Carroll Williams
227 N. Texas Street
Pittsburg, TX 75686

Services Rendered To:


Jackie Carrol Williams
2311 35th Street
Lubbock, Texas 79412
Policy # AWP164614


*** THIS HAS BEEN SUBMITTED TO YOUR INSURANCE COMPANY AND DENIED. THIS IS NOW YOUR RESPONSIBILITY. ***

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. 206 Latex Gloves (Pairs Used)

    $2.00
    9
    $18.00
  4. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  5. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  6. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: US-87 - O'Donnell, Texas

Subtotal $1,018.00
Total Due $1,018.00


Updated
June 23, 2021 @ 4:05 pm

Invoice updated by Geoffrey.

Status Update
June 23, 2021 @ 4:05 pm

Status changed: Draft to Pending.

Viewed
June 23, 2021 @ 4:06 pm

Invoice viewed by 69.147.192.197 for the first time.

Updated
August 10, 2021 @ 5:12 pm

Invoice updated by Geoffrey.

Viewed
August 10, 2021 @ 5:12 pm

Invoice viewed by 63.88.73.4 for the first time.

Viewed
August 21, 2021 @ 7:09 pm

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

Updated
November 16, 2021 @ 11:53 am

Invoice updated by Geoffrey.

Viewed
November 16, 2021 @ 11:54 am

Invoice viewed by 204.186.55.232 for the first time.

Updated
June 12, 2022 @ 4:18 pm

Invoice updated by Karen Smith.

Viewed
March 15, 2024 @ 1:28 pm

Invoice viewed by 66.249.72.4 for the first time.

Viewed
March 20, 2024 @ 5:43 pm

Invoice viewed by 66.249.72.6 for the first time.