Bill To:


Victor Ramirez
3131 SW 89th Street, Apt 7101
Oklahoma City, OK 73159

Services Rendered To:


Victor Liorente Manuel Ramirez
3131 SW 89th St. Apt.# 7101
Oklahoma City, OK 73159
Progressive Insurance
Policy # 03376466


*** Please Submit this to your AUTO Insurance Company for processing and payment, OR YOU MAY CONTACT OUR OFFICE AND PROVIDE US WITH YOUR INSURANCE INFORMATION FOR PROCESSING. ***

Product
Price
Qty
Amount
  1. 105 Utility Vehicle Response (Per Hour)

    $500.00
    1
    $500.00
  2. 104 Tanker Response (Per Hour)

    $500.00
    1
    $500.00
  3. 105 Utility Vehicle Response (Per Hour)

    $500.00
    1
    $500.00
  4. 215 Trauma Kit (# Used)

    $25.00
    1
    $25.00
  5. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  6. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: I-40 @ MM 249 - Henryetta, OK

Subtotal $1,775.00
Total Due $1,775.00


Updated
July 12, 2021 @ 4:38 pm

Invoice updated by Geoffrey.

Status Update
July 12, 2021 @ 4:38 pm

Status changed: Draft to Pending.

Updated
July 12, 2021 @ 4:38 pm

Invoice updated by Geoffrey.

Viewed
August 7, 2021 @ 4:22 pm

Invoice viewed by Karen Smith (KarenS) for the first time.

Updated
June 10, 2022 @ 5:03 pm

Invoice updated by Geoffrey.

Updated
June 10, 2022 @ 5:04 pm

Invoice updated by Geoffrey.

Viewed
October 24, 2022 @ 7:05 am

Invoice viewed by 64.124.8.45 for the first time.