Bill To:


GEICO INSURANCE
ONE GEICO BLVD
FREDERICKSBURG, VA 22412-9000

Services Rendered To:


Judy Rose
2061 Lisa Circle
Van, TX 75103
POLICY# 44 999 19 670

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-WZ-208-22-129 10/30/2022 01/02/2023 On Receipt Van Zandt Midway VFD

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

    $350.00
    1.75
    $612.50
  2. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1.75
    $262.50
  3. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1.75
    $262.50
  4. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  5. 402 Fire/Police Services (Per Hour)    

    $100.00
    1.75
    $175.00
  6. 310 Hydraulic Tool (# Used)

    $200.00
    1
    $200.00
  7. 206 Latex Gloves (Pairs Used)

    $2.00
    4
    $8.00
  8. 301 Hand Tool (# Used)

    $15.00
    1
    $15.00
  9. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.75
    $175.00

  10. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Hwy 64 @ CR 4923- Ben Wheeler, TX

Subtotal $1,960.50
Total Due $1,960.50


Updated
January 2, 2023 @ 11:04 am

Invoice updated by Geoffrey.

Status Update
January 2, 2023 @ 11:04 am

Status changed: Draft to Pending.