Bill To:


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

Services Rendered To:


Mary Lloyd
100 C.R. 2125
Douglassville, TX 75560
POLICY # TPA154771875

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-BY-205-22-0517 05/17/2022 06/02/2022 On Receipt Douglassville V.F.D.

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

    $150.00
    1.5
    $225.00
  2. 218 Cervical Collar (# Used)

    $25.00
    1
    $25.00
  3. 302 Hand Light (# Used)

    $5.00
    1
    $5.00
  4. 301 Hand Tool (# Used)

    $15.00
    1
    $15.00
  5. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.5
    $150.00

  6. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: State Highway 77 West @ CR 2229 - Douglassville, Texas

Subtotal $420.00
Total Due $420.00


Updated
June 2, 2022 @ 3:08 pm

Invoice updated by Geoffrey.

Status Update
June 2, 2022 @ 3:08 pm

Status changed: Draft to Pending.

Viewed
October 24, 2022 @ 6:05 am

Invoice viewed by 64.124.8.42 for the first time.