Bill To:


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

Services Rendered To:


Sarah Wilson
East highway 84111
Eldridge, MO 36456
Policy # 942172634

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
MO-05-307-2021-0130 05/23/2021 07/17/2021 On Receipt Eldridge V.F.D.

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

    $500.00
    1.5
    $750.00
  2. 105 Utility Vehicle Response (Per Hour)

    $500.00
    1.5
    $750.00
  3. 218 Cervical Collar (# Used)

    $25.00
    2
    $50.00
  4. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  5. 310 Hydraulic Tool (# Used)

    $200.00
    1
    $200.00
  6. 206 Latex Gloves (Pairs Used)

    $2.00
    4
    $8.00
  7. 301 Hand Tool (# Used)

    $15.00
    1
    $15.00
  8. 216 Oxygen (# Used)

    $25.00
    2
    $50.00
  9. 303 SCBA Breathing Apparatus (# Used)

    $50.00
    2
    $100.00
  10. 304 SCBA Cylinder (# Used)

    $25.00
    2
    $50.00
  11. 323 Portable Radio (# Used)

    $10.00
    2
    $20.00
  12. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  13. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 18255 Highway East- Eldridge, MO

Subtotal $2,493.00
Total Due $2,493.00


Updated
July 17, 2021 @ 4:20 pm

Invoice updated by Geoffrey.

Status Update
July 17, 2021 @ 4:20 pm

Status changed: Draft to Pending.