Bill To:


HUDSON INSURANCE
100 WILLIAM STREET -5TH FLOOR
NEW YORK, NY 10038-5044

Services Rendered To:


Asphalt Transport Inc.
17311 Market Street
Channelview, TX 77530
Policy # HMU200095-05


Product
Price
Qty
Amount
  1. 406 Medical Extrication – Lvl 2

    Patient:

    Rafael Segovia
    1706 Oak Manor Drive
    Huffman, TX 77336

    $1,500.00
    1
    $1,500.00

  2. Additional Incident Info

    Incident Type: MVA w/Entrapment Response

    Incident Location: MM 224.5 Northbound on IH 45 - Angus, Texas

    Ordinance Info: City of Angus Billing Authorization # 7

Subtotal $1,500.00
Total Due $1,500.00


Updated
March 30, 2022 @ 5:40 pm

Invoice updated by Geoffrey.