Bill To:


Erie Insurance
100 Erie Insurance Place
Erie, PA 16530

Services Rendered To:


Travis Grider
5844 Beaver Dam Rd
Leitchfield, KY 42754
POLICY# Q07-0411732 (PL)

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
KY-50-852-23-103-E 09/25/2023 10/12/2023 On Receipt Priceville VFD

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

    Patient

    Tara Smith 

    $1,500.00
    1
    $1,500.00

  2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 6899 Priceville Rd- Munfordville, KY

Subtotal $1,500.00
Total Due $1,500.00


Updated
October 12, 2023 @ 11:16 am

Invoice updated by Geoffrey.