Bill To:

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

Services Rendered To:

Harold Hemphill
4700 Block Knob Hill Road
Azle, Texas 76020
Policy # 941932125


Product
Price
Qty
Amount

  1. 102 Engine Response (Per Hour)

    $350.00
    1.5
    $525.00

  2. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    1.5
    $225.00

  3. 103 Rescue Response (Per Hour)

    $300.00
    1.5
    $450.00

  4. 218 Cervical Collar (# Used)

    $25.00
    1
    $25.00

  5. 301 Hand Tool (# Used)

    $15.00
    1
    $15.00

  6. 330 Backboard (# Used)

    $25.00
    1
    $25.00

  7. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

    8. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 4677 Knob Hill Road - Azle, Texas

Subtotal $1,515.00
Total Due $1,515.00


Checks Payable To:

Sure Fire Recovery Service, LLC
9711 S Mason Road 125-120
Richmond, TX 77407
Federal Tax ID – 83-4417185


  Please Include Incident Number On All Correspondence.
Updated
November 12, 2021 @ 3:33 pm

Invoice updated by Geoffrey.

Status Update
November 12, 2021 @ 3:33 pm

Status changed: Draft to Pending.