Bill To:


Loya Insurance Company
P.O. Box 972450
El Paso, TX 79997

Services Rendered To:


Owner: Christian Miles Brewer
Driver: Maria Rodriquez
235 Buffalo
Glen Heights, Texas 75154
Policy # 66639539854


Product
Price
Qty
Amount
  1. 102 Engine Response (Per Hour)

    $350.00
    1.25
    $437.50
  2. 103 Rescue Response (Per Hour)

    $300.00
    1.25
    $375.00
  3. 310 Hydraulic Tool (# Used)

    $200.00
    1
    $200.00
  4. 309 Power Tool (# Used)

    $50.00
    1
    $50.00
  5. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  6. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00
  7. 413 Fire Department Response Fee – Lvl 4

    Fire Department Responded to Roll Over Crash

    Driver and Passenger had to be Extricated from Vehicle

    $500.00
    1
    $500.00

  8. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: I-45 223 Southbound - Angus, Texas

Subtotal $2,062.50
Total Due $2,062.50
Updated
November 19, 2020 @ 6:08 pm

Invoice updated by Geoffrey.

Status Update
November 19, 2020 @ 6:08 pm

Status changed: Draft to Pending.

Viewed
October 22, 2022 @ 8:27 am

Invoice viewed by 64.124.8.27 for the first time.