Bill To:

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

Services Rendered To:

Kevin Stokes
9682 Highway 8 North
Douglassville, Texas 75560
POLICY # 929007624
CLAIM# 22-7529266


Product
Price
Qty
Amount

  1. 218 Cervical Collar (# Used)

    $25.00
    1
    $25.00

  2. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  3. 103 Rescue Response (Per Hour)

    $300.00
    1
    $300.00

    4. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: FM 995 - East of Highway 8 - Cass County, Texas

Subtotal $575.00
Total Due $575.00


Checks Payable To:

Sure Fire Recovery Service, LLC
9711 S Mason Road 125-120
Richmond, TX 77407
Federal Tax ID – 83-4417185


  Please Include Incident Number On All Correspondence.
Updated
January 5, 2023 @ 12:07 pm

Invoice updated by Geoffrey.