Bill To:


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

Services Rendered To:


Jagoo Chhitaram
2016 W Main St
Port Lavaca, TX 77979
POLICY# 955187694

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-BB-326-23-208-E 10/28/2023 11/14/2023 On Receipt Rosharon VFD

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

    Patient

    Jagoo Chhitaram
    2016 W Main St
    Port Lavaca, TX 77979
    POLICY# 955187694

    $1,500.00
    1
    $1,500.00

  2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Fm 1462- Rosharon, TX

    Ordinance Info: Rosharon Cost Recovery Resolution

Subtotal $1,500.00
Total Due $1,500.00


Updated
November 14, 2023 @ 10:05 am

Invoice updated by Geoffrey.

Viewed
May 30, 2024 @ 10:15 am

Invoice viewed by 195.113.175.60 for the first time.