Bill To:


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

Services Rendered To:


Janelle Anderson
642 Green Country Drive
Tahlequah, OK 74464
Policy # 03890839

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
OK-49-008-2020-11 02/12/2020 08/26/2021 On Receipt Salem-Ryal V.F.D.

Product
Price
Qty
Amount
  1. 103 Rescue Response (Per Hour)

    $300.00
    1
    $300.00
  2. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1
    $150.00
  3. 206 Latex Gloves (Pairs Used)

    $2.00
    8
    $16.00
  4. 301 Hand Tool (# Used)

    $15.00
    2
    $30.00

  5. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Indian Nation Turnpike and Canadian River - McIntosh County, OK

    Ordinance Info: SALEM-RYAL FIRE DEPT. RESOLUTION NO. 72821

Subtotal $496.00
Total Due $496.00


Updated
August 26, 2021 @ 7:58 pm

Invoice updated by Geoffrey.

Status Update
August 26, 2021 @ 7:58 pm

Status changed: Draft to Pending.

Viewed
October 24, 2022 @ 7:55 am

Invoice viewed by 64.124.8.45 for the first time.