Bill To:


GEICO INSURANCE
ONE GEICO BLVD
FREDERICKSBURG, VA 22412-9000

Services Rendered To:


Lisa Mitchell
15014 Old Richmond Road #524
Sugarland, Texas 77498
Policy # 4342378314

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-SH-214-2021-769 01/10/2021 01/13/2021 On Receipt Richland Volunteer Fire Department

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

    $350.00
    1
    $350.00
  2. 103 Rescue Response (Per Hour)

    $300.00
    1
    $300.00
  3. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00
  4. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  5. 409 Manpower (Per Hour)

    $50.00
    2
    $100.00

  6. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 215 I-45 South Bound - Richland, texas

Subtotal $1,100.00
Total Due $1,100.00


Updated
January 12, 2021 @ 5:08 pm

Invoice updated by Geoffrey.

Status Update
January 12, 2021 @ 5:08 pm

Status changed: Draft to Pending.