Bill To:


GEICO INSURANCE
ONE GEICO BLVD
FREDERICKSBURG, VA 22412-9000

Services Rendered To:


Jason Collins
5908 Gaston Avenue # 206
Dallas, Texas 75214
Policy # 6050910642

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-WZ-208-2021-210763 07/02/2021 07/23/2021 On Receipt Van Zandt Midway V.F.D.

Product
Price
Qty
Amount
  1. 105 Utility Vehicle Response (Per Hour)

    $150.00
    2.5
    $375.00
  2. 105 Utility Vehicle Response (Per Hour)

    $150.00
    2.5
    $375.00
  3. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  4. 402 Fire/Police Services (Per Hour)    

    $100.00
    2.5
    $250.00
  5. 310 Hydraulic Tool (# Used)

    $200.00
    1
    $200.00
  6. 206 Latex Gloves (Pairs Used)

    $2.00
    2
    $4.00
  7. 301 Hand Tool (# Used)

    $15.00
    1
    $15.00
  8. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    2.5
    $250.00
  9. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00
  10. 701 Body Removal (Per Body)    

    $250.00
    1
    $250.00

  11. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Highway 64 @ CR 4914 - Ben Wheeler, Texas

Subtotal $2,219.00
Total Due $2,219.00


Updated
July 23, 2021 @ 4:51 pm

Invoice updated by Geoffrey.

Status Update
July 23, 2021 @ 4:51 pm

Status changed: Draft to Pending.

Viewed
October 24, 2022 @ 12:33 pm

Invoice viewed by 64.124.8.30 for the first time.