Bill To:


NATIONAL GENERAL INSURANCE
PO BOX 3199
WINSTON SALEM, NC 27102-3199

Services Rendered To:


Mariano Rico
85 CR 960
Jemison, AL 35085
POLICY# 2013159821

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
AL-01-403-23-1213-E 11/07/2023 11/16/2023 On Receipt Jemison Fire Department

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

    Patient

    Pascaul Ruizprez
    65 County Rd 960
    Jemison, AL 35085

    $1,500.00
    1
    $1,500.00

  2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 28530 US Hwy 31- Jemison, AL

Subtotal $1,500.00
Total Due $1,500.00


Updated
November 16, 2023 @ 10:54 am

Invoice updated by Geoffrey.