Bill To:


METROPOLITAN CASUALTY – MEDICAL
PO BOX 350
WARWICK, RI 02887-0350

Services Rendered To:


Susie Gunn
2222 Louise Street
Sequin, Texas 78155
Policy # A7999825100

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-HS-403-2021-430-E 09/30/2021 10/08/2021 On Receipt McQueeney V.F.D.

Product
Price
Qty
Amount
  1. 405 Medical Extrication – Lvl 1

    Patient:

    Susie Gunn
    2222 Louise Street
    Sequin, Texas 78155
    Policy # A7999825100

    $500.00
    1
    $500.00

  2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: FM 78 & FM 1044 - McQueeney, Texas

    Ordinance Info: McQueeney Cost Recovery Resolution 4521

Subtotal $500.00
Total Due $500.00


Updated
October 7, 2021 @ 4:00 pm

Invoice updated by Geoffrey.

Viewed
October 24, 2022 @ 1:04 am

Invoice viewed by 64.124.8.25 for the first time.