Bill To:


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

Services Rendered To:


Estella Ortiz
1010 S Heatherwild Blvd
Pflugerville, TX 78660
POLICY# TXOP0051271


Product
Price
Qty
Amount
  1. 406 Medical Extrication – Lvl 2

    Patient

    Estella Ortiz
    1010 S Heatherwild Blvd
    Pflugerville, TX 78660
    POLICY# TXOP0051271

    $1,500.00
    1
    $1,500.00

  2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: RM 620 & Cornerwood Dr- Austin, TX 78717

    Ordinance Info: Sam Bass Cost Recovery Resolution

Subtotal $1,500.00
Total Due $1,500.00


Updated
April 23, 2024 @ 1:22 pm

Invoice updated by Geoffrey.