Bill To:


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

Services Rendered To:


Victoria Brennan
11397 South FM 730
Texas, 76020
Policy # 927615199

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-WB206-2019-948 12/19/2019 03/17/2020 On Receipt Briar - Reno Fire Department

Product
Price
Qty
Amount
  1. 104 Tanker Response (Per Hour)

    $300.00
    1
    $300.00
  2. 106 Battalion/Chief Vehicle Response (Per Hour)

    Battalion Chief

    $150.00
    1
    $150.00
  3. 106 Battalion/Chief Vehicle Response (Per Hour)

    Squad

    $150.00
    1
    $150.00
  4. 218 Cervical Collar (# Used)

    $25.00
    1
    $25.00
  5. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  6. 206 Latex Gloves (Pairs Used)

    $2.00
    6
    $12.00
  7. 301 Hand Tool (# Used)

    $15.00
    2
    $30.00
  8. 201 Oil Absorbent Material (# Used)

    $35.00
    1
    $35.00
  9. 404 Scene Lighting (Per Hour)

    $75.00
    1
    $75.00
  10. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  11. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  12. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Northwest Parkway and Manor Drive - Reno, Texas

    Ordinance Info: Resolution

Subtotal $1,377.00
Total Due $1,377.00
Updated
March 16, 2020 @ 6:47 pm

Invoice updated by Karen Smith.

Status Update
March 16, 2020 @ 6:47 pm

Status changed: Draft to Pending.

Updated
March 16, 2020 @ 6:49 pm

Invoice updated by Karen Smith.

Updated
March 16, 2020 @ 6:50 pm

Invoice updated by Karen Smith.