Bill To:


PROGRESSIVE INSURANCE, TX
1045 Wisterwood Dr.
Houston, TX 77043

Services Rendered To:


J. Trinidad Segovia
2019 VW Jetta
VIN # 3VWC57BUXKM09823
Policy # 947407113

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-SH-201-C21-20887 08/14/2021 09/03/2021 On Receipt Angus Vol. Fire Department

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

    $150.00
    1.25
    $187.50
  2. 103 Rescue Response (Per Hour)

    $300.00
    1.25
    $375.00
  3. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1.25
    $187.50
  4. 306 Hose Per 50′ (Amt Used)

    $25.00
    1
    $25.00
  5. 206 Latex Gloves (Pairs Used)

    $2.00
    3
    $6.00
  6. 232 N95 Mask (Per Unit/Per Use)

    $10.00
    3
    $30.00
  7. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  8. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 5686 South Interstate Highway 45 West - Angus, Texas

    Ordinance Info: City of Angus Billing Authorization # 7

Subtotal $1,061.00
Total Due $1,061.00


Updated
September 3, 2021 @ 4:29 pm

Invoice updated by Geoffrey.

Status Update
September 3, 2021 @ 4:29 pm

Status changed: Draft to Pending.

Updated
September 3, 2021 @ 4:30 pm

Invoice updated by Geoffrey.

Updated
September 3, 2021 @ 4:31 pm

Invoice updated by Geoffrey.

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