Bill To:


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

Services Rendered To:


Elvin Ronald Chacon Garcia
8723 Beau Monde Dr
Houston, TX 77099
POLICY# 925651135


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

    $300.00
    1.75
    $525.00
  2. 218 Cervical Collar (# Used)

    $25.00
    1
    $25.00
  3. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  4. 201 Oil Absorbent Material (# Used)

    $35.00
    9
    $315.00
  5. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  6. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: FM 933 & 2604- Whitney, TX

Subtotal $1,365.00
Total Due $1,365.00


Updated
October 11, 2022 @ 2:21 pm

Invoice updated by Geoffrey.

Status Update
October 11, 2022 @ 2:21 pm

Status changed: Draft to Pending.