Bill To:


Integon Insurance
P.O. Box 3199
Winston Salem, NC 27102

Services Rendered To:


Juan Pedro
618 Madison St NE
Russelville, AL 35653
POLICY# 2016019723

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
AL-02-006-24-47 02/09/2024 02/12/2024 On Receipt Littleville VFD

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

    $250.00
    1
    $250.00
  2. 102 Engine Response (Per Hour)

    $500.00
    1
    $500.00
  3. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00

  4. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 1495 George Wallace Hwy- Russellville, AL

    Ordinance Info: Littleville FD Billing Resolution

Subtotal $850.00
Total Due $850.00


Updated
February 12, 2024 @ 6:29 pm

Invoice updated by Geoffrey.

Status Update
February 12, 2024 @ 6:29 pm

Status changed: Draft to Pending.

Updated
April 1, 2024 @ 4:16 pm

Invoice updated by Karen Smith.

Viewed
April 1, 2024 @ 4:16 pm

Invoice viewed by Karen Meder - Smith (KarenS) for the first time.