Bill To:


GEICO INSURANCE
ONE GEICO BLVD
FREDERICKSBURG, VA 22412-9000

Services Rendered To:


Rhena Franlo
15405 Montoya Cove
Austin, TX 78729
POLICY# 6129916240

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-XV-414-23-801 05/21/2023 05/22/2023 On Receipt Sam Bass Fire Department

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

    $350.00
    1
    $350.00
  2. 301 Hand Tool (# Used)

    $15.00
    3
    $45.00
  3. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00

  4. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 15610 North RM 620- Round Rock, TX

Subtotal $495.00
Total Due $495.00


Updated
May 22, 2023 @ 11:57 am

Invoice updated by Geoffrey.

Status Update
May 22, 2023 @ 11:57 am

Status changed: Draft to Pending.