Bill To:


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

Services Rendered To:


Ricky Evans
268 LCR 470
Mexia, TX 76667
POLICY# TXOP0075068000

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-SH-201-C24-6327 03/21/2024 04/23/2024 On Receipt Angus VFD

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

    $400.00
    1
    $400.00
  2. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  3. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00

  4. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 22028 St Hwy 14- Richland, TX

    Ordinance Info: City of Angus Billing Authorization # 7

Subtotal $750.00
Total Due $750.00


Updated
April 23, 2024 @ 12:19 pm

Invoice updated by Geoffrey.

Status Update
April 23, 2024 @ 12:19 pm

Status changed: Draft to Pending.