Bill To:


Zurich North America
1299 Zurich Way
schaumburg, IL 60196-1056

Services Rendered To:


Pa Piang
1412 Stewart Street
Fort Worth, TX 76104
POLICY # 909811733
CLAIM # C022579936000201


Product
Price
Qty
Amount
  1. 104 Tanker Response (Per Hour)

    $300.00
    1
    $300.00
  2. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    1
    $150.00
  3. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00
  4. 206 Latex Gloves (Pairs Used)

    $2.00
    6
    $12.00
  5. 301 Hand Tool (# Used)

    $15.00
    2
    $30.00
  6. 201 Oil Absorbent Material (# Used)

    $35.00
    1
    $35.00

  7. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Liberty School Road - Tarrant County, Texas

    Ordinance Info: Briar Reno Cost Recovery Resolution

Subtotal $777.00
Total Due $777.00


Updated
July 10, 2022 @ 7:29 pm

Invoice updated by Geoffrey.

Status Update
July 10, 2022 @ 7:29 pm

Status changed: Draft to Pending.

Updated
July 21, 2022 @ 2:27 pm

Invoice updated by Geoffrey.