Bill To:


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

Services Rendered To:


Jessica Hernandez
2011 Chevy Impala
POLICY# 909609816

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
AL-05-022-22-2856864-C 11/29/2022 12/15/2022 On Receipt Alder Springs FD

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

    $250.00
    1.75
    $437.50
  2. 105 Utility Vehicle Response (Per Hour)

    $250.00
    1.75
    $437.50
  3. 206 Latex Gloves (Pairs Used)

    $2.00
    2
    $4.00
  4. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.75
    $175.00

  5. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 5000 Block Rose Rd- Albertville, AL

Subtotal $1,054.00
Total Due $1,054.00


Updated
December 15, 2022 @ 5:37 pm

Invoice updated by Geoffrey.