Bill To:


Ignition Insurance
PO Box 830568
Richardson, TX 75083

Services Rendered To:


Martin Huerta
Vin# 1GKEC13RXJ775424
POLICY# GNM-40065352-0000

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-CN-310-23-44965-E 03/16/2023 03/23/2023 On Receipt Lavon V.F.D.

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

    Patient

    Martin Huerta

    $1,500.00
    1
    $1,500.00

  2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: State Hwy 78/ Lakepointe Blvd- Lavon, TX

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

Subtotal $1,500.00
Total Due $1,500.00


Updated
March 23, 2023 @ 7:27 pm

Invoice updated by Geoffrey.

Viewed
March 16, 2024 @ 12:10 am

Invoice viewed by 66.249.72.5 for the first time.