Bill To:


PROGRESSIVE INSURANCE – MEDICAL
6300 WILSON MILLS ROAD
MAYFIELD VILLAGE, OH 44143-2109

Services Rendered To:


Lacey Pumel
1010 Foxwood Lane
Wylie, Texas 75098
Policy # 930865338

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-CN-310-2020-408-E 12/27/2020 12/31/2020 On Receipt Lavon V.F.D.

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

    Patient:

    Cesar Escobar

    $1,500.00
    1
    $1,500.00

  2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Lake Road and Moore Road - Lavon, Texas

    Ordinance Info: City of Lavon Resolution NO 2020-03-01

Subtotal $1,500.00
Total Due $1,500.00
Updated
December 31, 2020 @ 4:07 pm

Invoice updated by Geoffrey.

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