Bill To:


Progressive Insurance – Medical
P.O. Box 2930
Clinton, IA 52733-2930

Services Rendered To:


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


Product
Price
Qty
Amount
  1. 406 Medical Extrication – Lvl 2

    Patient:

    Joann Saenz
    409 Country Acres Drive
    Sequin, Texas 78155
    POLICY # 142560575999001

    $1,500.00
    1
    $1,500.00

  2. 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

Subtotal $1,500.00
Total Due $1,500.00


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