Bill To:


Assurant Global Specialty Operations
PO Box 979220
Miami, FL 33197

Services Rendered To:


Owner
2005 County Rd 625
Thorsby, AL 35171
Claim# 0020170595

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
AL-01-403-21-1089 11/01/2021 10/24/2023 On Receipt Jemison Fire Department

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

    $500.00
    2.75
    $1,375.00
  2. 303 SCBA Breathing Apparatus (# Used)

    $50.00
    4
    $200.00
  3. 304 SCBA Cylinder (# Used)

    $25.00
    4
    $100.00
  4. 306 Hose Per 50′ (Amt Used)

    $25.00
    8
    $200.00

  5. Additional Incident Info

    Incident Type: Structure Fire Response

    Incident Location: 2005 County Rd 625 Thorsby, AL 35171

Subtotal $1,875.00
Total Due $1,875.00


Updated
October 24, 2023 @ 11:54 am

Invoice updated by Geoffrey.

Status Update
October 24, 2023 @ 11:54 am

Status changed: Draft to Pending.

Updated
October 24, 2023 @ 11:56 am

Invoice updated by Geoffrey.