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


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 @ 4:45 pm

Invoice updated by Geoffrey.