Bill To:


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

Services Rendered To:


Rebecca Price Thomas
303 E Edwards
Savoy, TX 75479
POLICY# 35729058

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-CW-201-23-23024 04/03/2023 04/05/2023 On Receipt Callisburg V.F.D.

Product
Price
Qty
Amount
  1. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    1
    $150.00
  2. 102 Engine Response (Per Hour)

    $350.00
    1
    $350.00
  3. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  4. 419 Environmental Spill

    $250.00
    1
    $250.00
  5. 201 Oil Absorbent Material (# Used)

    $35.00
    1
    $35.00
  6. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  7. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00
  8. 330 Backboard (# Used)

    $25.00
    1
    $25.00

  9. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: US Hwy 82 & County Rd 142- Whitesboro, TX

    Ordinance Info: City Of Callisburg Resolution

Subtotal $1,410.00
Total Due $1,410.00


Updated
April 5, 2023 @ 3:28 pm

Invoice updated by Geoffrey.

Status Update
April 5, 2023 @ 3:28 pm

Status changed: Draft to Pending.