Bill To:


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

Services Rendered To:


Karina Garcia
712 North Avenue I
Clifton, Texas 76634
Policy # 944782058

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-RN-424-22-1518-E 02/02/2022 03/17/2022 On Receipt Speegleville V.F.D.

Product
Price
Qty
Amount
  1. 405 Medical Extrication – Lvl 1

    Patient:

    Karina Garcia
    712 North Avenue I
    Clifton, Texas 76634
    Policy # 944782058

    $500.00
    1
    $500.00

  2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: South Highway 6 just South of Compton Road - Crawford, Texas

Subtotal $500.00
Total Due $500.00


Updated
March 17, 2022 @ 12:36 pm

Invoice updated by Geoffrey.

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