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

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-HS-403-2021-437-EE 10/02/2021 10/08/2021 On Receipt McQueeney V.F.D.

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


Updated
October 7, 2021 @ 2:37 pm

Invoice updated by Geoffrey.

Updated
October 7, 2021 @ 2:37 pm

Invoice updated by Geoffrey.

Viewed
October 22, 2022 @ 7:38 pm

Invoice viewed by 64.124.8.36 for the first time.