Bill To:


GEICO CASUALTY INSURANCE
ONE GEICO PLAZA
WASHINGTON, DC 20076-0003

Services Rendered To:


Wendy Plata
252 W 5th St
Atoka, OK 74525
POLICY# 4353025739

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
OK-41-016-2022-178 11/01/2022 11/09/2022 On Receipt Jacktown Fire Protection District

Product
Price
Qty
Amount
  1. 103 Rescue Response (Per Hour)

    $300.00
    1.25
    $375.00
  2. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    1.25
    $187.50
  3. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1.25
    $187.50
  4. 218 Cervical Collar (# Used)

    $25.00
    1
    $25.00
  5. 206 Latex Gloves (Pairs Used)

    $2.00
    3
    $6.00
  6. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00
  7. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.25
    $125.00

  8. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Hwy 177 & Whispering

Subtotal $1,156.00
Total Due $1,156.00


Updated
November 9, 2022 @ 11:31 am

Invoice updated by Geoffrey.

Status Update
November 9, 2022 @ 11:31 am

Status changed: Draft to Pending.

Updated
November 9, 2022 @ 11:37 am

Invoice updated by Geoffrey.