Bill To:

GEICO INSURANCE
ONE GEICO BLVD
FREDERICKSBURG, VA 22412-9000

Services Rendered To:

Charles Miller
6094 Hidden Circle
Azle, Texas 76020
Policy # 4568-69-53-00


Product
Price
Qty
Amount

  1. 104 Tanker Response (Per Hour)

    $300.00
    1.25
    $375.00

  2. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1.25
    $187.50

  3. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    1.25
    $187.50

  4. 218 Cervical Collar (# Used)

    $25.00
    4
    $100.00

  5. 314 Cribbing – Lvl 1 (Passenger Vehicle) (Used)

    $100.00
    2
    $200.00

  6. 208 Fire Line Tap (Per Foot, Amt Used)

    $0.25
    1
    $0.25

  7. 328 GlassMaster (# Used)

    $25.00
    1
    $25.00

  8. 310 Hydraulic Tool (# Used)

    $200.00
    2
    $400.00

  9. 206 Latex Gloves (Pairs Used)

    $2.00
    10
    $20.00

  10. 301 Hand Tool (# Used)

    $15.00
    3
    $45.00

  11. 202 Oil Absorbent Sheet (# Used)

    $2.50
    1
    $2.50

  12. 203 Oil Boom (# Used)

    $20.00
    1
    $20.00

  13. 201 Oil Absorbent Material (# Used)

    $35.00
    1
    $35.00

  14. 211 Salvage Cover (Amt Used)           

    $35.00
    1
    $35.00

  15. 330 Backboard (# Used)

    $25.00
    2
    $50.00

  16. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  17. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.25
    $125.00

  18. 407 Patient Care / Evaluation (Per Patient)

    $50.00
    4
    $200.00

  19. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00

    20. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 14400 FM 730 - Azle, Texas

    Ordinance Info: Briar-Reno Cost Recovery Bylaws Amendment

Subtotal $2,507.75
Total Due $2,507.75

Checks Payable To:

Sure Fire Recovery Service, LLC
9711 S Mason Road 125-120
Richmond, TX 77407
Federal Tax ID – 83-4417185


  Please Include Incident Number On All Correspondence.
Updated
December 1, 2020 @ 2:39 pm

Invoice updated by Geoffrey.

Status Update
December 1, 2020 @ 2:39 pm

Status changed: Draft to Pending.