Bill To:


Chubb National Insurance Co
15 Mountain View Road
Warren, NJ 07059

Services Rendered To:


Gleco Fleet Trust
940 Ridgebrook Road
Sparks, MD 21152
PH# 800-282-8157
Driver: David Tilley


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

    Patient:

    David Tilley

    3603 S. New Haven 

    Tulsa, OK 74135

    $500.00
    1
    $500.00

  2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Highway 412 Cimarron Turnpike @ MM 54 - Terlton, Oklahoma

Subtotal $500.00
Total Due $500.00


Updated
May 15, 2022 @ 3:07 pm

Invoice updated by Geoffrey.