Bill To:


PROGRESSIVE NORTHERN INSURANCE
6300 WILSON MILLS ROAD - W33
MAYFIELD VILLAGE, PA 44143-2182

Services Rendered To:


Toni Sanchez
114807 S. 4200 Road
Checotah, OK 74426
POLICY # 934936749

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
OK-49-015-22-814 08/14/2022 08/18/2022 On Receipt Tiger Mountain Fire Dept.

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

    $150.00
    1.5
    $225.00
  2. 102 Engine Response (Per Hour)

    $350.00
    1.5
    $525.00
  3. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1.5
    $225.00
  4. 215 Trauma Kit (# Used)

    $25.00
    1
    $25.00
  5. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00
  6. 330 Backboard (# Used)

    $25.00
    2
    $50.00

  7. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Interstate 40 West Bound @ MM 247 - Henryetta, OK

    Ordinance Info: Tiger Mountain - McIntosh County Resolution 72021

Subtotal $1,300.00
Total Due $1,300.00


Updated
August 17, 2022 @ 6:29 pm

Invoice updated by Geoffrey.

Status Update
August 17, 2022 @ 6:29 pm

Status changed: Draft to Pending.

Updated
August 17, 2022 @ 6:30 pm

Invoice updated by Geoffrey.

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