Bill To:


GEICO INSURANCE – MEDICAL
ONE GEICO BLVD
FREDERICKSBURG, VA 22412-9000

Services Rendered To:


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

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-SH-214-2021-44-E 05/09/2021 05/15/2021 On Receipt Richland Volunteer Fire Department

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

    Patient:

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

    $1,500.00
    1
    $1,500.00

  2. Additional Incident Info

    Incident Type: Select One

    Incident Location: Highway 14 - Richland, Texas

    Ordinance Info: Richland Billing Ordinance NO. 170 Cost Recovery

Subtotal $1,500.00
Total Due $1,500.00


Updated
May 14, 2021 @ 6:45 pm

Invoice updated by Geoffrey.

Updated
May 14, 2021 @ 6:46 pm

Invoice updated by Geoffrey.

Viewed
November 10, 2023 @ 12:22 am

Invoice viewed by 70.74.133.128 for the first time.