Bill To:


Dairyland Insurance
1800 North Point Drive
Stevens Point, WI 54481-1253

Services Rendered To:


CLAIM # 97A974049
Policy# 11401447963
Owner: Amanda Allen
Driver: Stephen Shivers

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-AC-409-22-070 04/28/2022 05/05/2022 On Receipt City of Huntington Vol. Fire Dept.

Product
Price
Qty
Amount
  1. 103 Rescue Response (Per Hour)

    $300.00
    1.75
    $525.00
  2. 404 Scene Lighting (Per Hour)

    $75.00
    1.75
    $131.25
  3. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.75
    $175.00

  4. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: FM 2109 & Flat Stanley Creek, Huntington, TX

Subtotal $831.25
Total Due $831.25


Updated
May 4, 2022 @ 1:57 pm

Invoice updated by Karen Smith.

Status Update
May 4, 2022 @ 1:57 pm

Status changed: Draft to Pending.

Updated
May 4, 2022 @ 2:01 pm

Invoice updated by Karen Smith.

Updated
May 19, 2022 @ 5:39 pm

Invoice updated by Geoffrey.

Viewed
May 19, 2022 @ 5:39 pm

Invoice viewed by GEOFFREY SMITH (Geoffrey) for the first time.

Updated
July 12, 2022 @ 6:18 pm

Invoice updated by Geoffrey.

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October 24, 2022 @ 7:50 am

Invoice viewed by 64.124.8.45 for the first time.

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Invoice viewed by 69.171.249.116 for the first time.