Invoice

From:

515 E. Carefree Hwy.
Phoenix, AZ 85085-8839

insurance@pibinc.com

Invoice Number INV-0271
Invoice Date October 13, 2020
Total Due $1,205.91
To:
Structures Online

26026 S 174th Street
Queen Creek, AZ 85142

Hrs/Qty Service Rate/PriceAdjustSub Total
1 GENERAL LIABILITY INSURANCE - EARNED PREMIUM + TAXES & FEES

EARNED PREMIUM 08/19/20 - 09/28/20 $834.00
CARRIER RM FEE $295.00
ARIZONA STATE TAXES & STAMPING FEES $36.13 TOTAL - $1165.13

$1,165.133.5%$1,205.91
Sub Total $1,205.91
Tax $0.00
Total Due $1,205.91