Bill To:

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

Services Rendered To:

Daniel Davidson
12115 Highway East
Eldridge, MO 65463
Policy # 11626723


Product
Price
Qty
Amount

  1. 105 Utility Vehicle Response (Per Hour)

    $500.00
    1.5
    $750.00

  2. 106 Battalion/Chief Vehicle Response (Per Hour)

    $500.00
    1.5
    $750.00

  3. 218 Cervical Collar (# Used)

    $25.00
    1
    $25.00

  4. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00

  5. 206 Latex Gloves (Pairs Used)

    $2.00
    4
    $8.00

  6. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.5
    $150.00

  7. 215 Trauma Kit (# Used)

    $25.00
    1
    $25.00

  8. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

    9. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 17037 Highway East - Eldridge, MO

Subtotal $2,208.00
Total Due $2,208.00


Checks Payable To:

Sure Fire Recovery Service, LLC
9711 S Mason Road 125-120
Richmond, TX 77407
Federal Tax ID – 83-4417185


  Please Include Incident Number On All Correspondence.
Updated
July 17, 2021 @ 3:57 pm

Invoice updated by Geoffrey.

Status Update
July 17, 2021 @ 3:57 pm

Status changed: Draft to Pending.

Updated
July 17, 2021 @ 3:59 pm

Invoice updated by Geoffrey.