Bill To:


Direct Auto Insurance Claims Department
PO Box 1623
Winston Salem, NC 27102

Services Rendered To:


Laura Giercia
1731 SW 116th Way
Miramae, FL 33025

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
MO-05-307-23-162 12/16/2023 12/28/2023 On Receipt Eldridge V.F.D.

Product
Price
Qty
Amount
  1. 103 Rescue Response (Per Hour)

    $400.00
    1
    $400.00
  2. 106 Battalion/Chief Vehicle Response (Per Hour)

    $200.00
    1
    $200.00
  3. 102 Engine Response (Per Hour)

    $500.00
    1
    $500.00
  4. 102 Engine Response (Per Hour)

    $500.00
    1
    $500.00

  5. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: North 5- Eldridge, MO

Subtotal $1,600.00
Total Due $1,600.00


Updated
December 28, 2023 @ 1:41 pm

Invoice updated by Geoffrey.

Status Update
December 28, 2023 @ 1:41 pm

Status changed: Draft to Pending.