Bill To:


GEICO INSURANCE COMPANY
PO BOX 9515
FREDERICKSBURG, VA 22403-9515

Services Rendered To:


Shau Nettles
7420 Elman Lane
Azle, Texas 76020
Policy # 4553722796

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-WB206-2019-858 11/12/2019 11/14/2019 On Receipt Briar - Reno Fire Department

Product
Price
Qty
Amount
  1. 104 Tanker Response (Per Hour)

    $300.00
    1
    $300.00
  2. 218 Cervical Collar (# Used)

    $25.00
    2
    $50.00
  3. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  4. 206 Latex Gloves (Pairs Used)

    $2.00
    4
    $8.00
  5. 301 Hand Tool (# Used)

    $15.00
    2
    $30.00
  6. 201 Oil Absorbent Material (# Used)

    $35.00
    1
    $35.00
  7. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  8. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  9. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 12000 FM RD 730 North, Azle Texas

Subtotal $1,023.00
Total Due $1,023.00
Updated
November 13, 2019 @ 2:59 pm

Invoice updated by Karen Smith.

Status Update
November 13, 2019 @ 3:00 pm

Status changed: Draft to Pending.

Updated
November 13, 2019 @ 3:06 pm

Invoice updated by Karen Smith.

Updated
November 13, 2019 @ 3:11 pm

Invoice updated by Karen Smith.

Updated
December 3, 2019 @ 5:59 pm

Invoice updated by Karen Smith.

Updated
January 3, 2020 @ 7:04 pm

Invoice updated by Karen Smith.

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