Bill To:


National Interstate Insurance
P.O. Box 521
Richfield, OH 44286

Services Rendered To:


AWL Transport Inc
4626 State Route 82
Mantua, OH 44255
POLICY# VPP4900043-15

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
AL-01-403-23-1257 11/21/2023 12/05/2023 On Receipt Jemison Fire Department

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

    $500.00
    1
    $500.00
  2. 103 Rescue Response (Per Hour)

    $400.00
    1
    $400.00
  3. 206 Latex Gloves (Pairs Used)

    $2.00
    8
    $16.00
  4. 215 Trauma Kit (# Used)

    $25.00
    1
    $25.00
  5. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00

  6. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 100 Patton St-Jemison, AL

Subtotal $1,191.00
Total Due $1,191.00


Updated
December 5, 2023 @ 1:49 pm

Invoice updated by Geoffrey.

Status Update
December 5, 2023 @ 1:49 pm

Status changed: Draft to Pending.