Bill To:


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

Services Rendered To:


Kirsten Piper
9155 Ridge Breeze
San Antonio, TX 78250
POLICY# HUGO-135432

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-AD-505-23-318-B 07/08/2023 07/10/2023 On Receipt Rock Port VFD

Product
Price
Qty
Amount
  1. 106 Battalion/Chief Vehicle Response (Per Hour)

    $200.00
    1
    $200.00
  2. 102 Engine Response (Per Hour)

    $500.00
    1
    $500.00
  3. 105 Utility Vehicle Response (Per Hour)

    $250.00
    1
    $250.00
  4. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00
  5. 201 Oil Absorbent Material (# Used)

    $35.00
    1
    $35.00
  6. 301 Hand Tool (# Used)

    $15.00
    1
    $15.00
  7. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  8. 419 Environmental Spill

    $250.00
    1
    $250.00

  9. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 4100 Business 35 S- Rockport, TX

Subtotal $1,600.00
Total Due $1,600.00


Updated
July 10, 2023 @ 12:18 pm

Invoice updated by Geoffrey.