Bill To:


American Family Connect Property and Casualty
3500 Packerland Drive
Depere, WI 54115

Services Rendered To:


Brian Nguyen
14211 Eucalyptus
Austin, TX 78723
POLICY# 13X12085125


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

    $500.00
    1
    $500.00
  2. 301 Hand Tool (# Used)

    $15.00
    3
    $45.00
  3. 201 Oil Absorbent Material (# Used)

    $35.00
    1
    $35.00
  4. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  5. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00

  6. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 620 & 45- Round Rock, TX

    Ordinance Info: Sam Bass Fire Dept. Resolution

Subtotal $930.00
Total Due $930.00


Updated
July 10, 2023 @ 12:57 pm

Invoice updated by Geoffrey.

Status Update
July 10, 2023 @ 12:57 pm

Status changed: Draft to Pending.

Viewed
March 29, 2024 @ 11:54 pm

Invoice viewed by 66.249.72.6 for the first time.