Bill To:


Acceptance Insurance
P.O. Box 150769
Nashville, TN 37215

Services Rendered To:


Virginia Taylor
185 AL Hwy 191
Jemison, AL 35085
POLICY# HUGO310921

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
AL-01-403-24-483 05/24/2024 06/04/2024 On Receipt Jemison Fire Department

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

    $500.00
    1
    $500.00
  2. 206 Latex Gloves (Pairs Used)

    $2.00
    6
    $12.00
  3. 215 Trauma Kit (# Used)

    $25.00
    1
    $25.00
  4. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  5. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 5669 CR 42- Jemison, AL

Subtotal $787.00
Total Due $787.00


Updated
June 4, 2024 @ 12:52 pm

Invoice updated by Geoffrey.

Status Update
June 4, 2024 @ 12:52 pm

Status changed: Draft to Pending.