Bill To:


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

Services Rendered To:


Miquel lopez
133 Star Street
Hereford, Texas 79045
Policy # 01438247


Product
Price
Qty
Amount
  1. 103 Rescue Response (Per Hour)

    $300.00
    6.25
    $1,875.00
  2. 102 Engine Response (Per Hour)

    $350.00
    6.25
    $2,187.50
  3. 102 Engine Response (Per Hour)

    $350.00
    6.25
    $2,187.50
  4. 218 Cervical Collar (# Used)

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

    $250.00
    1
    $250.00
  6. 319 Generator (Per Generator/Per Hour)

    $50.00
    6.25
    $312.50
  7. 206 Latex Gloves (Pairs Used)

    $2.00
    4
    $8.00
  8. 301 Hand Tool (# Used)

    $15.00
    2
    $30.00
  9. 403 Traffic Control / Road Closure (Per Hour)

     

    $100.00
    6.25
    $625.00
  10. 215 Trauma Kit (# Used)

    $25.00
    1
    $25.00
  11. 105 Utility Vehicle Response (Per Hour)

    Front End Loader – Used for Debris Removal – (2 Hours) Cost per Hour $250.00

    $250.00
    2
    $500.00
  12. 409 Manpower (Per Hour)

    $20.00
    5
    $100.00
  13. 205 Foam (Per Gallon)

    $65.00
    18
    $1,170.00
  14. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  15. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: FM 217 and CR 216 - Gatesville, Texas

    Ordinance Info:

Subtotal $9,545.50
Total Due $9,545.50
Updated
June 28, 2020 @ 6:34 pm

Invoice updated by Karen Smith.

Status Update
June 28, 2020 @ 6:34 pm

Status changed: Draft to Pending.

Updated
July 27, 2020 @ 12:57 pm

Invoice updated by Karen Smith.