Bill To:


Old American County Mutual
P.O. Box 793747
Dallas, TX 75379

Services Rendered To:


Debbie Fitzgerald
Dodge Charger 2015
License Plate# PGL9828
POLICY# 15TX6041941


Product
Price
Qty
Amount
  1. 106 Battalion/Chief Vehicle Response (Per Hour)

    $200.00
    3
    $600.00
  2. 102 Engine Response (Per Hour)

    $500.00
    3
    $1,500.00
  3. 105 Utility Vehicle Response (Per Hour)

    $250.00
    3
    $750.00
  4. 218 Cervical Collar (# Used)

    $25.00
    2
    $50.00
  5. 314 Cribbing – Lvl 1 (Passenger Vehicle) (Used)

    $100.00
    2
    $200.00
  6. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00
  7. 402 Fire/Police Services (Per Hour)    

    $100.00
    3
    $300.00
  8. 205 Foam (Per Gallon)

    $65.00
    1
    $65.00
  9. 310 Hydraulic Tool (# Used)

    $200.00
    4
    $800.00
  10. 206 Latex Gloves (Pairs Used)

    $2.00
    10
    $20.00
  11. 301 Hand Tool (# Used)

    $15.00
    5
    $75.00
  12. 201 Oil Absorbent Material (# Used)

    $35.00
    2
    $70.00
  13. 404 Scene Lighting (Per Hour)

    $75.00
    3
    $225.00
  14. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    3
    $300.00
  15. 419 Environmental Spill

    $250.00
    1
    $250.00
  16. 306 Hose Per 50′ (Amt Used)

    $25.00
    2
    $50.00

  17. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 11996 Hwy 6- Crawford, TX 76638

Subtotal $5,505.00
Total Due $5,505.00


Updated
September 25, 2023 @ 2:13 pm

Invoice updated by Geoffrey.

Status Update
September 25, 2023 @ 2:13 pm

Status changed: Draft to Pending.