Bill To:


PROGRESSIVE NORTHERN INSURANCE
6300 WILSON MILLS ROAD - W33
MAYFIELD VILLAGE, PA 44143-2182

Services Rendered To:


Christopher Daniel
1302 Coon Creek Road
Eufaula, OK 74432
Policy # 936542275

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
OK-49-008-2021-48 11/09/2021 11/10/2021 On Receipt Salem Ryal Fire Department

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

    $300.00
    2.25
    $675.00
  2. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  3. 301 Hand Tool (# Used)

    $15.00
    5
    $75.00

  4. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Indian Nation Turnpike @ MM 98 - McIntosh County, OK

    Ordinance Info: SALEM-RYAL FIRE DEPT. RESOLUTION NO. 72821

Subtotal $1,000.00
Total Due $1,000.00


Updated
November 9, 2021 @ 2:56 pm

Invoice updated by Geoffrey.

Status Update
November 9, 2021 @ 2:56 pm

Status changed: Draft to Pending.

Updated
November 9, 2021 @ 3:00 pm

Invoice updated by Geoffrey.