Bill To:


UNITED SERVICES AUTO. ASSOC. / USAA
9800 FREDERICKSBURG ROAD
SAN ANTONIO, TX 78240-4100

Services Rendered To:


Patricia Roosevelt
1829 Sagrada
Edwards, MO 65326
POLICY# 043958521G71017

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
MO-01-508-22-11539 04/30/2022 12/12/2022 On Receipt Northwest Fire Protection District

Product
Price
Qty
Amount
  1. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    2.25
    $337.50
  2. 105 Utility Vehicle Response (Per Hour)

    $150.00
    2.25
    $337.50
  3. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  4. 203 Oil Boom (# Used)

    $20.00
    1
    $20.00
  5. 201 Oil Absorbent Material (# Used)

    $35.00
    1
    $35.00
  6. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00

  7. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: St Rd FF- Edwards, MO

Subtotal $1,080.00
Total Due $1,080.00


Updated
December 12, 2022 @ 10:54 am

Invoice updated by Geoffrey.

Status Update
December 12, 2022 @ 10:54 am

Status changed: Draft to Pending.

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