Bill To:


Liberty County Mutual
175 Berkeley Street
Boston, MA 02116

Services Rendered To:


Jacob Scarborough
531 Lazy Acres
Woodway, Texas 76712
Policy # Y9088067

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-RN-424-22-1511 01/26/2022 03/17/2022 On Receipt Speegleville V.F.D.

Product
Price
Qty
Amount
  1. 103 Rescue Response (Per Hour)

    $300.00
    1
    $300.00
  2. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00

  3. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Lazy Acres Drive - Waco, Texas

Subtotal $400.00
Total Due $400.00


Updated
March 17, 2022 @ 12:21 pm

Invoice updated by Geoffrey.

Status Update
March 17, 2022 @ 12:21 pm

Status changed: Draft to Pending.

Updated
March 17, 2022 @ 12:21 pm

Invoice updated by Geoffrey.