Bill To:


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

Services Rendered To:


Randy Ramirez
1162 Happy Haven Road
McQueeney, TX 78123
POLICY # 911043693
CLAIM # 213788646


Product
Price
Qty
Amount
  1. 218 Cervical Collar (# Used)

    $25.00
    1
    $25.00
  2. 206 Latex Gloves (Pairs Used)

    $2.00
    4
    $8.00
  3. 215 Trauma Kit (# Used)

    $25.00
    1
    $25.00
  4. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  5. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 6400 Block of FM 78 - McQueeney, Texas

    Ordinance Info: McQueeney Cost Recovery Resolution 4521

Subtotal $308.00
Total Due $308.00


Updated
April 27, 2022 @ 4:34 pm

Invoice updated by Geoffrey.