Bill To:


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

Services Rendered To:


Salvador Diaz Rivas
163 Forrest Lawn
Wharton, Texas 77488
Policy # 932452966


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

    $350.00
    1
    $350.00
  2. 104 Tanker Response (Per Hour)

    $300.00
    1
    $300.00
  3. 103 Rescue Response (Per Hour)

    $300.00
    1
    $300.00
  4. 314 Cribbing – Lvl 1 (Passenger Vehicle) (Used)

    $100.00
    2
    $200.00
  5. 402 Fire/Police Services (Per Hour)    

    $100.00
    1
    $100.00
  6. 319 Generator (Per Generator/Per Hour)

    $50.00
    1
    $50.00
  7. 310 Hydraulic Tool (# Used)

    $200.00
    2
    $400.00
  8. 206 Latex Gloves (Pairs Used)

    $2.00
    12
    $24.00
  9. 301 Hand Tool (# Used)

    $15.00
    2
    $30.00
  10. 329 Stokes Basket (# Used)

    $25.00
    2
    $50.00
  11. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  12. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: FM 1489 @ Highway 60 - Orchard, Texas

Subtotal $2,054.00
Total Due $2,054.00
Updated
October 19, 2020 @ 3:39 pm

Invoice updated by Geoffrey.

Status Update
October 19, 2020 @ 3:39 pm

Status changed: Draft to Pending.