Bill To:


Progressive County Mutual Insurance
6300 Wilson Mills Rd.
Mayfield, OH 44143

Services Rendered To:


Steven & Elizabeth Gunderson
40 CR 1266
Whitesboro, TX 76273
POLICY# 951379925

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-CW-201-23-477761 01/28/2023 02/07/2023 On Receipt Callisburg VFD

Product
Price
Qty
Amount
  1. 105 Utility Vehicle Response (Per Hour)

    $150.00
    2.25
    $337.50
  2. 102 Engine Response (Per Hour)

    $350.00
    2.25
    $787.50
  3. 201 Oil Absorbent Material (# Used)

    $35.00
    1
    $35.00
  4. 404 Scene Lighting (Per Hour)

    $75.00
    2.25
    $168.75
  5. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    2.25
    $225.00

  6. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: CR 115 & CR 122- Whitesboro, TX

Subtotal $1,553.75
Total Due $1,553.75


Updated
February 7, 2023 @ 2:40 pm

Invoice updated by Geoffrey.

Status Update
February 7, 2023 @ 2:40 pm

Status changed: Draft to Pending.