Bill To:


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

Services Rendered To:


SEM Express- Stormy Transport
License Plate# 95K49Y-Truck
License Plate# 55K-52C-Trailer
POLICY# 943820922

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-SH-214-22-31935 12/09/2022 12/16/2022 On Receipt Richland Twp VFD

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

    $350.00
    1
    $350.00

  2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: I-45 @ Rest Area Exit- Richland, TX

    Ordinance Info: Richland Billing Ordinance NO. 170 Cost Recovery

Subtotal $350.00
Total Due $350.00


Updated
December 16, 2022 @ 1:29 pm

Invoice updated by Geoffrey.

Status Update
December 16, 2022 @ 1:29 pm

Status changed: Draft to Pending.