Bill To:


MGA INSURANCE COMPANY
3333 Lee Parkway Suite 1200 PO Box 199023
Dallas, TX 75219

Services Rendered To:


Sergio Flores
1521 W 5th Ave
Corsicana, TX 75110
POLICY# 03MGEP0230585

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-SH-201-C23-30030-A 11/23/2023 01/11/2024 On Receipt Angus Vol. Fire Department

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

    $500.00
    1.5
    $750.00
  2. 103 Rescue Response (Per Hour)

    $400.00
    1.5
    $600.00
  3. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.5
    $150.00

  4. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 216 S/B IH45- Richland, TX

    Ordinance Info: City of Angus Billing Authorization # 7

Subtotal $1,500.00
Total Due $1,500.00


Updated
January 11, 2024 @ 12:01 pm

Invoice updated by Geoffrey.

Status Update
January 11, 2024 @ 12:01 pm

Status changed: Draft to Pending.