Bill To:


Progressive County Mutual Insurance
6300 Wilson Mills Rd.
Mayfield, OH 44143

Services Rendered To:


Tiffany Strasser
474B North Mesa St
Te El Paso, TX
POLICY# 969350337

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-XV-414-23-2088 12/19/2023 12/28/2023 On Receipt Sam Bass Fire Department

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

    $500.00
    1
    $500.00
  2. 106 Battalion/Chief Vehicle Response (Per Hour)

    $200.00
    1
    $200.00
  3. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00
  4. 301 Hand Tool (# Used)

    $15.00
    3
    $45.00
  5. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00

  6. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 1431 & Sam Bass Rd- Round Rock, TX

    Ordinance Info: Sam Bass Fire Dept. Resolution

Subtotal $1,095.00
Total Due $1,095.00


Updated
December 28, 2023 @ 1:02 pm

Invoice updated by Geoffrey.

Status Update
December 28, 2023 @ 1:02 pm

Status changed: Draft to Pending.