Bill To:


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

Services Rendered To:


Russell Forward
18009 Lake Ray Hubbard Dr
Forney, TX 75126
POLICY# 970762265

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-SH-201-C23-16494-B 06/28/2023 08/31/2023 On Receipt Angus Vol. Fire Department

Product
Price
Qty
Amount
  1. 104 Tanker Response (Per Hour)

    $400.00
    1
    $400.00
  2. 103 Rescue Response (Per Hour)

    $400.00
    1
    $400.00
  3. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  4. 206 Latex Gloves (Pairs Used)

    $2.00
    1
    $2.00
  5. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00

  6. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 222 IH 45- Angus, TX

    Ordinance Info: City of Angus Billing Authorization # 7

Subtotal $1,152.00
Total Due $1,152.00


Updated
August 31, 2023 @ 11:07 am

Invoice updated by Geoffrey.