Bill To:


Ace American Insurance
436 Walnut Street
Philadelphia, PA 19106-3703

Services Rendered To:


Republic Services
1103 Martin Ave
Round Rock, TX 78681
POLICY# ISAH10735786

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-XV-414-24-951 05/31/2024 06/04/2024 On Receipt Sam Bass Fire Department

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

    $500.00
    1.75
    $875.00
  2. 105 Utility Vehicle Response (Per Hour)

    $250.00
    1.75
    $437.50
  3. 301 Hand Tool (# Used)

    $15.00
    3
    $45.00
  4. 202 Oil Absorbent Sheet (# Used)

    $2.50
    10
    $25.00
  5. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  6. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00
  7. 201 Oil Absorbent Material (# Used)

    $35.00
    1
    $35.00

  8. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 14878 SH 45 West- Austin, TX

    Ordinance Info: Sam Bass Fire Dept. Resolution

Subtotal $1,767.50
Total Due $1,767.50


Updated
June 4, 2024 @ 1:03 pm

Invoice updated by Geoffrey.

Status Update
June 4, 2024 @ 1:03 pm

Status changed: Draft to Pending.