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


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


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
March 17, 2022 @ 12:36 pm

Invoice updated by Geoffrey.