Bill To:


Embark General
P.O. Box 500040
Sandy Springs, GA 31150

Services Rendered To:


Wylie Mitchell
Kent Everson
Policy # TDE10244684-6
Claim # 2142100421


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

    $350.00
    1
    $350.00
  2. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    1
    $150.00
  3. 301 Hand Tool (# Used)

    $15.00
    1
    $15.00
  4. 201 Oil Absorbent Material (# Used)

    $35.00
    1
    $35.00
  5. 340 Heavy Duty Hazmat Gloves (Per Pair)

    $25.00
    1
    $25.00
  6. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  7. 407 Patient Care / Evaluation (Per Patient)

    $50.00
    2
    $100.00

  8. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 7750 East Highway 82 - Oak Ridge, Texas

Subtotal $925.00
Total Due $925.00


Updated
February 3, 2021 @ 1:50 pm

Invoice updated by Geoffrey.

Status Update
February 3, 2021 @ 1:50 pm

Status changed: Draft to Pending.

Updated
July 19, 2021 @ 12:38 pm

Invoice updated by Geoffrey.

Updated
December 21, 2021 @ 2:17 pm

Invoice updated by Geoffrey.

Updated
December 21, 2021 @ 2:25 pm

Invoice updated by Geoffrey.