Bill To:


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

Services Rendered To:


Josalyn Lakegburge
POLICY# 952394910

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-WB-206-22-489 04/25/2023 12/12/2023 On Receipt Briar-Reno Fire Department

Product
Price
Qty
Amount
  1. 104 Tanker Response (Per Hour)

    $400.00
    1
    $400.00
  2. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00
  3. 206 Latex Gloves (Pairs Used)

    $2.00
    4
    $8.00
  4. 301 Hand Tool (# Used)

    $15.00
    1
    $15.00
  5. 201 Oil Absorbent Material (# Used)

    $35.00
    1
    $35.00
  6. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  7. 322 Turn Out Gear / PPE (Per FireFighter)

    $250.00
    2
    $500.00

  8. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 1420 E Reno Rd- Azle, TX

    Ordinance Info: Briar Reno Cost Recovery Ordinance

Subtotal $1,308.00
Total Due $1,308.00


Updated
December 12, 2023 @ 12:38 pm

Invoice updated by Geoffrey.

Status Update
December 12, 2023 @ 12:38 pm

Status changed: Draft to Pending.