Bill To:


AAA Texas County Mutual Insurance
3333 Fairview Road
Costa Mesa, CA 92626

Services Rendered To:


Jennifer Walker
7700 Ranch Road
Athens, Texas 75751
Policy # TPA0706057

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-WZ-208-2021-210545 05/28/2021 07/01/2021 On Receipt Van Zandt Midway V.F.D.

Product
Price
Qty
Amount
  1. 105 Utility Vehicle Response (Per Hour)

    $150.00
    2
    $300.00
  2. 105 Utility Vehicle Response (Per Hour)

    $150.00
    2
    $300.00
  3. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  4. 402 Fire/Police Services (Per Hour)    

    $100.00
    2
    $200.00
  5. 310 Hydraulic Tool (# Used)

    $200.00
    1
    $200.00
  6. 206 Latex Gloves (Pairs Used)

    $2.00
    4
    $8.00
  7. 301 Hand Tool (# Used)

    $15.00
    1
    $15.00
  8. 201 Oil Absorbent Material (# Used)

    $35.00
    1
    $35.00
  9. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    2
    $200.00

  10. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 6322 Highway 64 - Ben Wheeler, Texas

Subtotal $1,508.00
Total Due $1,508.00


Updated
July 1, 2021 @ 12:12 am

Invoice updated by Geoffrey.

Status Update
July 1, 2021 @ 12:12 am

Status changed: Draft to Pending.

Updated
July 1, 2021 @ 12:13 am

Invoice updated by Geoffrey.

Updated
July 1, 2021 @ 12:13 am

Invoice updated by Geoffrey.

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October 25, 2022 @ 1:58 am

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