Bill To:


GEICO INSURANCE
ONE GEICO BLVD
FREDERICKSBURG, VA 22412-9000

Services Rendered To:


Janie Rothrock
922 East Palestine
Mexia, Texas 76667
Policy # 4595590243


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

    $350.00
    2
    $700.00
  2. 103 Rescue Response (Per Hour)

    $300.00
    2
    $600.00
  3. 310 Hydraulic Tool (# Used)

    $200.00
    1
    $200.00
  4. 301 Hand Tool (# Used)

    $15.00
    1
    $15.00
  5. 309 Power Tool (# Used)

    $50.00
    1
    $50.00
  6. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  7. Additional Incident Info

    Incident Type: Select One

    Incident Location: Highway 14 - Richland, Texas

    Ordinance Info: Richland Billing Ordinance NO. 170 Cost Recovery

Subtotal $1,815.00
Total Due $1,815.00


Updated
May 14, 2021 @ 6:39 pm

Invoice updated by Geoffrey.

Status Update
May 14, 2021 @ 6:39 pm

Status changed: Draft to Pending.