Bill To:


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

Services Rendered To:


Joseph Meyers
2815 S Debbie Lane
Midwest City, OK 73110
POLICY# 965864461

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
OK-41-016-23-46 03/30/2023 04/03/2023 On Receipt Jacktown Fire Protection District

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

    $300.00
    1.25
    $375.00
  2. 206 Latex Gloves (Pairs Used)

    $2.00
    2
    $4.00
  3. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.25
    $125.00
  4. 408 Air Medical Landing Zone (Used)

    $250.00
    1
    $250.00

  5. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 339817 E 980 Rd- Chandler, OK

Subtotal $754.00
Total Due $754.00


Updated
April 3, 2023 @ 2:17 pm

Invoice updated by Geoffrey.

Status Update
April 3, 2023 @ 2:17 pm

Status changed: Draft to Pending.