TX-HS-403-22-341-2 |

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Bill To:

PROGRESSIVE INSURANCE

6300 WILSON MILLS ROAD
MAYFIELD VILLAGE, OH 44143-2109

Services Rendered To:

Jose Isabel Ayon Olivares
313 Grove Lane
New Braunfels, TX 78130
POLICY # 934147458

Product

Price

Qty

Amount

102 Engine Response (Per Hour)

$350.00

1

$350.00
103 Rescue Response (Per Hour)

$300.00

1

$300.00
102 Engine Response (Per Hour)

$350.00

1

$350.00
106 Battalion/Chief Vehicle Response (Per Hour)

$150.00

1

$150.00
105 Utility Vehicle Response (Per Hour)

$150.00

1

$150.00
218 Cervical Collar (# Used)

$25.00

2

$50.00
418 Environmental Hazard Cleanup/Removal

$250.00

1

$250.00
209 Extinguisher (# Used)

$50.00

1

$50.00
402 Fire/Police Services (Per Hour)

$100.00

1

$100.00
204 Flate (# Used)

$8.00

4

$32.00
206 Latex Gloves (Pairs Used)

$2.00

6

$12.00
301 Hand Tool (# Used)

$15.00

2

$30.00
309 Power Tool (# Used)

$50.00

1

$50.00
201 Oil Absorbent Material (# Used)

$35.00

5

$175.00
216 Oxygen (# Used)

$25.00

1

$25.00
404 Scene Lighting (Per Hour)

$75.00

1

$75.00
403 Traffic Control / Road Closure (Per Hour)

$100.00

1

$100.00
215 Trauma Kit (# Used)

$25.00

2

$50.00
310 Hydraulic Tool (# Used)

$200.00

1

$200.00
330 Backboard (# Used)

$25.00

1

$25.00

Additional Incident Info

Incident Type: MVA Response

Incident Location: Terminal Loop and FM 725 Intersection - McQueeney, Texas

Ordinance Info: RESOLUTION-McQueeney Cost Recovery Resolution 4521

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
August 17, 2022 @ 4:41 pm

Invoice updated by Geoffrey.