Bill To:


ALLSTATE INSURANCE
3075 SANDERS ROAD - SUITE H1A
NORTHBROOK, IL 60062-7127

Services Rendered To:


Jenna Cantu
12730 Mykawa Rd
Pearland, TX 77581
POLICY# 436176130

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-SH-201-C23-21056 08/14/2023 10/04/2023 On Receipt Angus Vol. Fire Department

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

    $250.00
    1
    $250.00
  2. 310 Hydraulic Tool (# Used)

    $200.00
    2
    $400.00
  3. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  4. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00

  5. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 222 IH 45- Angus, TX

    Ordinance Info: City of Angus Billing Authorization # 7

Subtotal $1,000.00
Total Due $1,000.00


Updated
October 4, 2023 @ 11:42 am

Invoice updated by Geoffrey.

Status Update
October 4, 2023 @ 11:42 am

Status changed: Draft to Pending.

Updated
October 16, 2023 @ 6:04 pm

Invoice updated by Geoffrey.

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