Bill To:


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

Services Rendered To:


Brenda Lambert
8513 FM 182
Gatesville, TX 76528
Policy # 416389861

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-CX-409-2021-76 12/21/2021 01/19/2022 On Receipt Turnersville Fire Department

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

    $300.00
    1
    $300.00
  2. 102 Engine Response (Per Hour)

    $350.00
    1
    $350.00
  3. 206 Latex Gloves (Pairs Used)

    $2.00
    4
    $8.00
  4. 409 Manpower (Per Hour)

    $50.00
    5
    $250.00
  5. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  6. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 8200 FM 182 - Gatesville, Texas

    Ordinance Info: Ordinance #55: Recovery of Services Costs for Turnersville VFD

Subtotal $1,158.00
Total Due $1,158.00


Updated
January 18, 2022 @ 2:20 pm

Invoice updated by Geoffrey.

Status Update
January 18, 2022 @ 2:20 pm

Status changed: Draft to Pending.

Updated
January 18, 2022 @ 2:20 pm

Invoice updated by Geoffrey.

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