Bill To:


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

Services Rendered To:


Carrie Obenhaus
106 N Avenue C
Clifton, TX 76634
POLICY# 951530343

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-KP-401-23-37 02/14/2023 02/16/2023 On Receipt Peoria VFD

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

    $150.00
    1.25
    $187.50
  2. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1.25
    $187.50
  3. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  4. 206 Latex Gloves (Pairs Used)

    $2.00
    12
    $24.00
  5. 309 Power Tool (# Used)

    $50.00
    1
    $50.00
  6. 404 Scene Lighting (Per Hour)

    $75.00
    1.25
    $93.75
  7. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.25
    $125.00
  8. 306 Hose Per 50′ (Amt Used)

    $25.00
    1
    $25.00

  9. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 3838 SH 22- Hillsboro, TX

    Ordinance Info: Recovery of Service Costs for Peoria VFD

Subtotal $942.75
Total Due $942.75


Updated
February 16, 2023 @ 11:14 am

Invoice updated by Geoffrey.

Status Update
February 16, 2023 @ 11:14 am

Status changed: Draft to Pending.