Bill To:


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

Services Rendered To:


Yolanda Flores
376 Cimarron Dr
Floresville, TX 78114
POLICY# 638282097

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-AD-505-24-211 04/17/2024 04/25/2024 On Receipt Rock Port VFD

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

    $200.00
    1
    $200.00
  2. 102 Engine Response (Per Hour)

    $500.00
    1
    $500.00
  3. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  4. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  5. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Buss St 35- Rockport, TX

    Ordinance Info: Rockport Billing Resolution

Subtotal $1,050.00
Total Due $1,050.00


Updated
April 25, 2024 @ 1:41 pm

Invoice updated by Geoffrey.

Status Update
April 25, 2024 @ 1:41 pm

Status changed: Draft to Pending.