Bill To:


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

Services Rendered To:


Andres Huerta
3408 Marshall
Vernon, Texas 76384
Policy # 945512717

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-XR-403-2021-54 04/26/2021 04/30/2021 On Receipt Electra Fire Department

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

    $150.00
    1.5
    $225.00
  2. 103 Rescue Response (Per Hour)

    $300.00
    1.5
    $450.00
  3. 102 Engine Response (Per Hour)

    $350.00
    1.5
    $525.00
  4. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  5. 301 Hand Tool (# Used)

    $15.00
    4
    $60.00
  6. 306 Hose Per 50′ (Amt Used)

    $25.00
    1
    $25.00
  7. 206 Latex Gloves (Pairs Used)

    $2.00
    2
    $4.00

  8. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 287 Northbound on County Line Road - Electra, Texas

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

Subtotal $1,539.00
Total Due $1,539.00


Updated
April 30, 2021 @ 12:11 pm

Invoice updated by Geoffrey.

Status Update
April 30, 2021 @ 12:11 pm

Status changed: Draft to Pending.

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