Bill To:

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

Services Rendered To:

Enrique Ramirez
1006 Ferndale Lane
Richmond, Texas 77406
Policy # 91321783


Product
Price
Qty
Amount

  1. 405 Medical Extrication – Lvl 1

    Patient:

    Isabella Grace Griffis
    317 Norwood Court
    Schertz, Texas 78108
    Policy # 014553130U-71067

    $500.00
    1
    $500.00

    2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: FM 78 & FM 1620 - McQueeney, Texas

    Ordinance Info: McQueeney Cost Recovery Resolution 4521

Subtotal $500.00
Total Due $500.00


Checks Payable To:

Sure Fire Recovery Service, LLC
9711 S Mason Road 125-120
Richmond, TX 77407
Federal Tax ID – 83-4417185


  Please Include Incident Number On All Correspondence.
Updated
October 7, 2021 @ 2:37 pm

Invoice updated by Geoffrey.

Updated
October 7, 2021 @ 2:37 pm

Invoice updated by Geoffrey.