Bill To:


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

Services Rendered To:


Lidia Granados Vallejo
6313 Sheila
Nevada, TX 75713
POLICY# 923388774


Product
Price
Qty
Amount
  1. 101 Aerial/Ladder Response (Per Hour)

    $400.00
    1
    $400.00
  2. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    1
    $150.00
  3. 218 Cervical Collar (# Used)

    $25.00
    2
    $50.00
  4. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  5. 402 Fire/Police Services (Per Hour)    

    $100.00
    1
    $100.00
  6. 206 Latex Gloves (Pairs Used)

    $2.00
    6
    $12.00
  7. 301 Hand Tool (# Used)

    $15.00
    2
    $30.00
  8. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  9. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  10. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: State Hwy 78- Lavon, TX

    Ordinance Info: City of Lavon Resolution NO. 2020-03-01

Subtotal $1,342.00
Total Due $1,342.00


Updated
December 9, 2022 @ 10:27 am

Invoice updated by Geoffrey.

Status Update
December 9, 2022 @ 10:27 am

Status changed: Draft to Pending.

Updated
December 9, 2022 @ 11:29 am

Invoice updated by Geoffrey.