Bill To:


Falcon Insurance Company
P.O. Box 3577
Oak Brook, IL 60522

Services Rendered To:


Elba Profesional Cleaners LLC
1921 Cedar Park Dr
Arlington, TX 76009
POLICY# 0200756025

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-SH-201-C23-24403 09/19/2023 11/21/2023 On Receipt Angus Vol. Fire Department

Product
Price
Qty
Amount
  1. 103 Rescue Response (Per Hour)

    $400.00
    1.25
    $500.00
  2. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.25
    $125.00
  3. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00

  4. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 220 NB IH 45- Richland, TX

    Ordinance Info: City of Angus Billing Authorization # 7

Subtotal $875.00
Total Due $875.00


Updated
November 21, 2023 @ 9:46 am

Invoice updated by Geoffrey.

Status Update
November 21, 2023 @ 9:46 am

Status changed: Draft to Pending.