Bill To:


GEICO CASUALTY INSURANCE
ONE GEICO PLAZA
WASHINGTON, DC 20076-0003

Services Rendered To:


Nicole Campbell
402 South Hogan Loop
Ponce De Leon, Florida 32455
Policy # 408-56-98-30109170

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
FL-51-061-2021-43 03/28/2021 04/01/2021 On Receipt Ponce De Leon Fire and Rescue

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

    $300.00
    1
    $300.00
  2. 102 Engine Response (Per Hour)

    $350.00
    1
    $350.00
  3. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  4. 326 Safety Fest (# Used)

    $2.50
    7
    $17.50
  5. 407 Patient Care / Evaluation (Per Patient)

    $50.00
    2
    $100.00

  6. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Highway 81 South at the Railroad Tracks - Ponce De Leon, Florida

Subtotal $867.50
Total Due $867.50


Updated
March 31, 2021 @ 6:55 pm

Invoice updated by Geoffrey.

Status Update
March 31, 2021 @ 6:55 pm

Status changed: Draft to Pending.

Viewed
June 24, 2021 @ 4:38 pm

Invoice viewed by Karen Smith (KarenS) for the first time.

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October 25, 2022 @ 2:42 am

Invoice viewed by 64.124.8.53 for the first time.