Bill To:


Nationwide Insurance
One Nationwide Plaza
Columbus, OH 43215-2220

Services Rendered To:


Constance Durant
2769 Meadow Crest Lane
Sevierville, TN 37876
POLICY# 6341J090184


Product
Price
Qty
Amount
  1. 102 Engine Response (Per Hour)

    $500.00
    1
    $500.00
  2. 206 Latex Gloves (Pairs Used)

    $2.00
    4
    $8.00
  3. 215 Trauma Kit (# Used)

    $25.00
    1
    $25.00
  4. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  5. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 219 I-65 SB- Jemison, AL

Subtotal $783.00
Total Due $783.00


Updated
October 25, 2023 @ 1:31 pm

Invoice updated by Geoffrey.

Status Update
October 25, 2023 @ 1:31 pm

Status changed: Draft to Pending.

Viewed
March 20, 2024 @ 5:41 pm

Invoice viewed by 66.249.72.4 for the first time.