Bill To:


Redpoint County Mutual Insurance Co.
13215 Bee Cave Parkway
Bldg. 2, Suite 150
Austin, TX 78738

Services Rendered To:


Dewayne Jackson
POLICY# 6RBRNF

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-CN-310-24-76-E 03/24/2024 05/16/2024 On Receipt Lavon V.F.D.

Product
Price
Qty
Amount
  1. 406 Medical Extrication – Lvl 2

    Patient

    Carmen Silva
    POLICY# 15TX9966674

    $1,500.00
    1
    $1,500.00

  2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 11562 ST Hwy 205- Lavon, TX

    Ordinance Info: City of Lavon Resolution NO. 2020-03-01

Subtotal $1,500.00
Total Due $1,500.00


Updated
May 16, 2024 @ 1:19 pm

Invoice updated by Geoffrey.