Bill To:


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

Services Rendered To:


Cory Briggs
36478 Moccasin Trail Rd Lot#2
Shawnee, OK 74804
Vin# 3GNDA13D17S564768

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
OK-41-016-23-74 05/12/2023 05/17/2023 On Receipt Jacktown Fire Protection District

Product
Price
Qty
Amount
  1. 103 Rescue Response (Per Hour)

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

    $150.00
    1
    $150.00
  3. 206 Latex Gloves (Pairs Used)

    $2.00
    6
    $12.00
  4. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00
  5. 330 Backboard (# Used)

    $25.00
    1
    $25.00
  6. 201 Oil Absorbent Material (# Used)

    $35.00
    1
    $35.00
  7. 419 Environmental Spill

    $250.00
    1
    $250.00

  8. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 970000 S Hwy 177- Wellston, OK

Subtotal $1,022.00
Total Due $1,022.00


Updated
May 17, 2023 @ 4:19 pm

Invoice updated by Geoffrey.

Status Update
May 17, 2023 @ 4:19 pm

Status changed: Draft to Pending.