Bill To:


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

Services Rendered To:


Hopkins
1905 N. Riverside Drive
Fort worth, TX 76111
Policy # 638645905


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

    $300.00
    1.5
    $450.00
  2. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    1.5
    $225.00
  3. 301 Hand Tool (# Used)

    $15.00
    1
    $15.00
  4. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00
  5. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.5
    $150.00
  6. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00

  7. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 600 West White Dove - Azle, Texas

Subtotal $1,340.00
Total Due $1,340.00


Updated
November 12, 2021 @ 2:08 pm

Invoice updated by Geoffrey.

Status Update
November 12, 2021 @ 2:08 pm

Status changed: Draft to Pending.