Bill To:


ALLSTATE INSURANCE
3075 SANDERS ROAD - SUITE H1A
NORTHBROOK, IL 60062-7127

Services Rendered To:


Juan Gonzalez
11215 Cedarwood
Humble, TX 77338
POLICY# 000000838706066


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

    $300.00
    1.5
    $450.00
  2. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.5
    $150.00
  3. 206 Latex Gloves (Pairs Used)

    $2.00
    5
    $10.00
  4. 215 Trauma Kit (# Used)

    $25.00
    1
    $25.00

  5. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 222 SB IH 45- Angus, TX

    Ordinance Info: City of Angus Billing Authorization # 7

Subtotal $635.00
Total Due $635.00


Updated
December 15, 2022 @ 6:18 pm

Invoice updated by Geoffrey.

Status Update
December 15, 2022 @ 6:18 pm

Status changed: Draft to Pending.

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