Bill To:


AMICA MUTUAL INSURANCE
2 WALNUT GROVE DRIVE - SUITE 230
HORSHAM, PA 19044-7704

Services Rendered To:


Richard McAllum
1915 Tarver Road
Burleson, Texas 76028
Policy # 90114225PU

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-KP-403-2020-8220 08/18/2020 08/19/2020 On Receipt White Bluff V.F.D.

Product
Price
Qty
Amount
  1. 105 Utility Vehicle Response (Per Hour)

    Brush #231

    $150.00
    1
    $150.00
  2. 104 Tanker Response (Per Hour)

    Tanker #131

    $300.00
    1
    $300.00
  3. 105 Utility Vehicle Response (Per Hour)

    Brush #331

    $150.00
    1
    $150.00
  4. 402 Fire/Police Services (Per Hour)   

    Two Hours 

    $100.00
    2
    $200.00
  5. 201 Oil Absorbent Material (# Used)

    $35.00
    1
    $35.00
  6. 403 Traffic Control / Road Closure (Per Hour)

    Traffic control in place for two hours while vehicle was extracted from the scene

    $100.00
    2
    $200.00
  7. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  8. 301 Hand Tool (# Used)

    $15.00
    5
    $75.00

  9. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Intersection of 933 and 3049 - Blum, Texas

Subtotal $1,360.00
Total Due $1,360.00
Updated
August 18, 2020 @ 10:49 pm

Invoice updated by Karen Smith.

Status Update
August 18, 2020 @ 10:49 pm

Status changed: Draft to Pending.

Updated
August 18, 2020 @ 10:51 pm

Invoice updated by Karen Smith.

Viewed
October 22, 2022 @ 8:01 pm

Invoice viewed by 64.124.8.32 for the first time.