Bill To:


ALFA INSURANCE
207 Hwy 78 W
Jasper, AL 35501

Services Rendered To:


Tiffany Lydon
1958 Gilham Rd
Eugene, OR 97401
POLICY# 4152459-C19-37


Product
Price
Qty
Amount
  1. 105 Utility Vehicle Response (Per Hour)

    $250.00
    1
    $250.00
  2. 105 Utility Vehicle Response (Per Hour)

    $250.00
    1
    $250.00
  3. 206 Latex Gloves (Pairs Used)

    $2.00
    2
    $4.00
  4. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00

  5. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Hustleville Rd & Todd Ridge Rd- Albertville, AL

Subtotal $604.00
Total Due $604.00


Updated
December 15, 2022 @ 5:55 pm

Invoice updated by Geoffrey.