Bill To:


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

Services Rendered To:


Billy Osburn
4413 FM 1326
Dekalb, Texas 75559
Policy # 06090192-4


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

    Patient:

    Caroline Blackard 
    1253 CR 1455
    Mt. Pleasant, TX 75455
    Policy # 21914614

    $1,500.00
    1
    $1,500.00

  2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Harrold Truck Stop - Vernon, Texas

    Ordinance Info: City of Electra Resolution NO. 2018-05

Subtotal $1,500.00
Total Due $1,500.00


Updated
April 22, 2022 @ 5:54 pm

Invoice updated by Geoffrey.