Bill To:


Acacia Claims
P.O. Box 5489
Frisco, TX 75034

Services Rendered To:


Noelia Serrano
7512 Big Valley Dr
Weslaco, TX 78599
POLICY# AIL23007355
Claim# AIL001852

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-SP-612-24-806 05/13/2024 05/14/2024 On Receipt Nueces County ESD# 3

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

    $500.00
    1
    $500.00
  2. 105 Utility Vehicle Response (Per Hour)

    $250.00
    1
    $250.00
  3. 103 Rescue Response (Per Hour)

    $400.00
    1
    $400.00
  4. 206 Latex Gloves (Pairs Used)

    $2.00
    3
    $6.00
  5. 201 Oil Absorbent Material (# Used)

    $35.00
    1
    $35.00
  6. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  7. 324 Traffic Cone (# Used)

    $5.00
    12
    $60.00
  8. 302 Hand Light (# Used)

    $5.00
    7
    $35.00
  9. 326 Safety Fest (# Used)

    $2.50
    7
    $17.50

  10. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 746 N Hwy 77- Bishop, TX

Subtotal $1,403.50
Total Due $1,403.50


Updated
May 14, 2024 @ 12:41 pm

Invoice updated by Geoffrey.

Status Update
May 14, 2024 @ 12:41 pm

Status changed: Draft to Pending.

Updated
May 23, 2024 @ 4:30 pm

Invoice updated by Geoffrey.