Bill To:


Ace American Insurance
436 Walnut Street
Philadelphia, PA 19106-3703

Services Rendered To:


Autozone Parts Inc
130 Green Springs Hwy
Birmingham, AL 35209
POLICY# ISAH2555923A

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
AL-01-403-23-16-E 01/05/2023 01/27/2023 On Receipt Jemison FD

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

    Patient

    Loyce Fulgham
    225 County Rd 969
    Montevallo, AL 35115

    $1,500.00
    1
    $1,500.00

  2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 4800 Block AL Hwy 155- Montevallo, AL

Subtotal $1,500.00
Total Due $1,500.00


Updated
January 27, 2023 @ 11:37 am

Invoice updated by Geoffrey.

Updated
January 27, 2023 @ 11:37 am

Invoice updated by Geoffrey.