Bill To:


Lazarito Sibala Vicman
11414 Freestone Ave
Pearland, TX 77584

Services Rendered To:


Lazarito Sibala Vicman
11414 Freestone Ave
Pearland, TX 77584

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-BB-326-23-58-E 04/23/2023 06/23/2023 On Receipt Rosharon VFD

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

    Patient

    Lazarito Sibala Vicman
    11414 Freestone Ave
    Pearland, TX 77584

    $1,500.00
    1
    $1,500.00

  2. Additional Incident Info

    Incident Type: Vehicle Fire Response

    Incident Location: Hwy 288 SB & CR 51- Rosharon, TX

    Ordinance Info: Rosharon Cost Recovery Resolution

Subtotal $1,500.00
Total Due $1,500.00


Updated
June 23, 2023 @ 10:56 am

Invoice updated by Geoffrey.