Bill To:


GEICO INSURANCE
ONE GEICO BLVD
FREDERICKSBURG, VA 22412-9000

Services Rendered To:


Ross Parker
14194 FM 315 N
Chandler, TX 75763
POLICY# 6105227687

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-WZ-208-22-130 10/28/2022 10/31/2022 On Receipt Van Zandt Midway VFD

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

    $350.00
    2.25
    $787.50
  2. 105 Utility Vehicle Response (Per Hour)

    $150.00
    2.25
    $337.50
  3. 105 Utility Vehicle Response (Per Hour)

    $150.00
    2.25
    $337.50
  4. 401 Debris Cleanup/Removal (# Used)

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

    $100.00
    2.25
    $225.00
  6. 310 Hydraulic Tool (# Used)

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

    $2.00
    2
    $4.00
  8. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    2.25
    $225.00

  9. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Fm 279 @ Van Zandt / Smith Co. Line- Tyler, TX

Subtotal $2,366.50
Total Due $2,366.50


Updated
October 31, 2022 @ 1:00 pm

Invoice updated by Geoffrey.

Status Update
October 31, 2022 @ 1:00 pm

Status changed: Draft to Pending.