Bill To:


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

Services Rendered To:


Forrest Ward
Lawton, OK 73507
POLICY# 959155558

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
OK-16-016-23-312 03/31/2023 04/03/2023 On Receipt Wichita Mountain Estates V.F.D.

Product
Price
Qty
Amount
  1. 102 Engine Response (Per Hour)

    $500.00
    1.25
    $625.00
  2. 102 Engine Response (Per Hour)

    $500.00
    1.25
    $625.00
  3. 106 Battalion/Chief Vehicle Response (Per Hour)

    $500.00
    1.25
    $625.00
  4. 218 Cervical Collar (# Used)

    $25.00
    1
    $25.00
  5. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  6. 205 Foam (Per Gallon)

    $65.00
    1
    $65.00
  7. 206 Latex Gloves (Pairs Used)

    $2.00
    8
    $16.00
  8. 301 Hand Tool (# Used)

    $15.00
    2
    $30.00
  9. 201 Oil Absorbent Material (# Used)

    $35.00
    1
    $35.00
  10. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.25
    $125.00
  11. 207 Wetting Agent (Amt Used)

    $25.00
    1
    $25.00
  12. 306 Hose Per 50′ (Amt Used)

    $25.00
    1
    $25.00
  13. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  14. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: I44 MM 44.5- Lawton, OK

Subtotal $2,721.00
Total Due $2,721.00


Updated
April 3, 2023 @ 1:41 pm

Invoice updated by Geoffrey.

Status Update
April 3, 2023 @ 1:41 pm

Status changed: Draft to Pending.