Bill To:


Zurich North America
1299 Zurich Way
schaumburg, IL 60196-1056

Services Rendered To:


Sysco Leasing, LLC
4000 West 62nd Street
Indianapolis, IN 46268
POLICY # BAP2347204


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

    Patient:

    Ricky Sparks
    206 Melanie Drive
    Longview, Texas 75603
    (DRIVER)

    $1,500.00
    1
    $1,500.00

  2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 6265 US-59 North - Marshall, Texas

Subtotal $1,500.00
Total Due $1,500.00


Updated
February 14, 2022 @ 12:44 pm

Invoice updated by Geoffrey.

Updated
February 14, 2022 @ 12:44 pm

Invoice updated by Geoffrey.