Bill To:


Progressive County Mutual Insurance
6300 Wilson Mills Rd.
Mayfield, OH 44143

Services Rendered To:


Stephan Gardner
1112 Sherman Dr
Whitesboro, TX 76273
POLICY# 949556268


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

    $150.00
    1.25
    $187.50
  2. 103 Rescue Response (Per Hour)

    $300.00
    1.25
    $375.00
  3. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  4. 206 Latex Gloves (Pairs Used)

    $2.00
    4
    $8.00
  5. 301 Hand Tool (# Used)

    $15.00
    2
    $30.00
  6. 201 Oil Absorbent Material (# Used)

    $35.00
    1
    $35.00
  7. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00
  8. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.25
    $125.00
  9. 218 Cervical Collar (# Used)

    $25.00
    1
    $25.00
  10. 330 Backboard (# Used)

    $25.00
    1
    $25.00
  11. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  12. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: FM 901 at Maverick- Gordonville, TX

Subtotal $1,560.50
Total Due $1,560.50


Updated
April 11, 2023 @ 11:14 pm

Invoice updated by Geoffrey.

Status Update
April 11, 2023 @ 11:14 pm

Status changed: Draft to Pending.

Viewed
March 29, 2024 @ 5:37 pm

Invoice viewed by 66.249.72.4 for the first time.

Viewed
March 30, 2024 @ 5:44 am

Invoice viewed by 66.249.72.5 for the first time.