Bill To:


Progressive County Mutual Insurance
6300 Wilson Mills Rd.
Mayfield, OH 44143

Services Rendered To:


Eloise Tidwell
1215 Whaley
Gainesville, TX 76240
POLICY# 948771783

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-CW-201-23-476198 01/06/2023 01/06/2023 On Receipt Callisburg VFD

Product
Price
Qty
Amount
  1. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1
    $150.00
  2. 102 Engine Response (Per Hour)

    $350.00
    1
    $350.00
  3. 404 Scene Lighting (Per Hour)

    $75.00
    1
    $75.00
  4. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  5. 323 Portable Radio (# Used)

    $10.00
    4
    $40.00
  6. 324 Traffic Cone (# Used)

    $5.00
    5
    $25.00

  7. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: FM 2896 @ CR136- Gainesville, TX

Subtotal $740.00
Total Due $740.00


Updated
January 6, 2023 @ 4:40 pm

Invoice updated by Geoffrey.

Status Update
January 6, 2023 @ 4:40 pm

Status changed: Draft to Pending.