Bill To:


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

Services Rendered To:


Amber Fernandez
1705 Fidelity Street
Houston, Texas 77029
Policy # 952819898

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-SH-201-C21-29631 11/25/2021 12/28/2021 On Receipt Angus Vol. Fire Department

Product
Price
Qty
Amount
  1. 103 Rescue Response (Per Hour)

    $300.00
    1
    $300.00
  2. 206 Latex Gloves (Pairs Used)

    $2.00
    4
    $8.00
  3. 301 Hand Tool (# Used)

    $15.00
    1
    $15.00
  4. 404 Scene Lighting (Per Hour)

    $75.00
    1
    $75.00

  5. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Highway 226 Southbound / Interstate 45 - Angus, Texas

    Ordinance Info: City of Angus Billing Authorization # 7

Subtotal $398.00
Total Due $398.00


Updated
December 28, 2021 @ 8:42 pm

Invoice updated by Geoffrey.

Status Update
December 28, 2021 @ 8:42 pm

Status changed: Draft to Pending.

Viewed
July 27, 2022 @ 6:43 pm

Invoice viewed by Karen Smith (KarenS) for the first time.

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