Bill To:


PROGRESSIVE INSURANCE
6300 WILSON MILLS ROAD
MAYFIELD VILLAGE, OH 44143-2109

Services Rendered To:


Jose Palacio
7711 Oconner Dr #2107
Round Rock, TX 78681
POLICY# 965439337

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-XV-414-23-783 05/17/2023 05/19/2023 On Receipt Sam Bass Fire Department

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

    $350.00
    1.25
    $437.50
  2. 102 Engine Response (Per Hour)

    $350.00
    1.25
    $437.50
  3. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    1.25
    $187.50
  4. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00
  5. 301 Hand Tool (# Used)

    $15.00
    2
    $30.00
  6. 201 Oil Absorbent Material (# Used)

    $35.00
    1
    $35.00
  7. 419 Environmental Spill

    $250.00
    1
    $250.00
  8. 404 Scene Lighting (Per Hour)

    $75.00
    1.25
    $93.75
  9. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.25
    $125.00

  10. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 15901 Great Oaks Dr- Round Rock, TX

Subtotal $1,846.25
Total Due $1,846.25


Updated
May 19, 2023 @ 8:53 am

Invoice updated by Geoffrey.

Status Update
May 19, 2023 @ 8:53 am

Status changed: Draft to Pending.

Viewed
July 22, 2024 @ 3:00 am

Invoice viewed by 66.220.149.24 for the first time.