Bill To:


ALLSTATE FIRE AND CASUALTY
2775 SANDERS ROAD
NORTHBROOK, IL 60062-6110

Services Rendered To:


Emili Ann Hays
License Plate # RXG1561
POLICY# 863806258

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-CW-201-22-464039-B 07/30/2022 01/23/2023 On Receipt Callisburg VFD

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

    $150.00
    2
    $300.00
  2. 102 Engine Response (Per Hour)

    $350.00
    2
    $700.00
  3. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  4. 209 Extinguisher (# Used)

    $50.00
    2
    $100.00
  5. 402 Fire/Police Services (Per Hour)    

    $100.00
    2
    $200.00
  6. 206 Latex Gloves (Pairs Used)

    $2.00
    2
    $4.00
  7. 201 Oil Absorbent Material (# Used)

    $35.00
    2
    $70.00
  8. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    2
    $200.00
  9. 306 Hose Per 50′ (Amt Used)

    $25.00
    2
    $50.00

  10. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: CR 163 & US Hwy 82- Gainesville, TX

Subtotal $1,874.00
Total Due $1,874.00


Updated
January 23, 2023 @ 11:43 am

Invoice updated by Geoffrey.

Status Update
January 23, 2023 @ 11:43 am

Status changed: Draft to Pending.

Viewed
May 30, 2024 @ 3:40 pm

Invoice viewed by 195.113.175.60 for the first time.