Bill To:


Progressive Insurance
6300 Wilson Mills Rd.
Mayfield, OH 44143

Services Rendered To:


Edward Montesdeoca
Policy# 02669670-3

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-BY205-2019-0430-B 04/30/2019 09/16/2019 On Receipt Douglassville Volunteer Fire Department

Product
Price
Qty
Amount
  1. 102 Engine Response (Per Hour)

    $350.00
    1.25
    $437.50
  2. 103 Rescue Response (Per Hour)

    $300.00
    1.25
    $375.00
  3. 218 Cervical Collar (# Used)

    $25.00
    1
    $25.00
  4. 216 Oxygen (# Used)

    $25.00
    1
    $25.00
  5. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    3
    $300.00

  6. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: TX S. Hwy 77 West St.

Subtotal $1,162.50
Total Due $1,162.50
Updated
September 12, 2019 @ 6:32 pm

Invoice updated by Karen Smith.

Status Update
September 12, 2019 @ 6:33 pm

Status changed: Draft to Pending.

Updated
September 12, 2019 @ 6:34 pm

Invoice updated by Karen Smith.

Updated
September 12, 2019 @ 8:40 pm

Invoice updated by Karen Smith.

Updated
September 12, 2019 @ 8:49 pm

Invoice updated by Karen Smith.

Status Update
October 20, 2019 @ 12:22 pm

Status changed: Pending to Outstanding Balance.

Status Update
October 20, 2019 @ 12:24 pm

Status changed: Outstanding Balance to Pending.

Viewed
July 4, 2024 @ 12:37 am

Invoice viewed by 8.219.196.178 for the first time.