Bill To:


STATE FARM INSURANCE
PO BOX 52250
PHOENIX, AZ 85072-2250

Services Rendered To:


Ruby Delorge
151 New Hope Court
Boyd, Texas 76023
Policy # 145 9200-F08-431-001

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-WB-440-2020-876-B 09/29/2020 01/12/2021 On Receipt Briar-Reno Fire Department

Product
Price
Qty
Amount
  1. 104 Tanker Response (Per Hour)

    $300.00
    1.25
    $375.00
  2. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    1.25
    $187.50
  3. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.25
    $125.00
  4. 402 Fire/Police Services (Per Hour)    

    $100.00
    1.25
    $125.00
  5. 326 Safety Fest (# Used)

    $2.50
    3
    $7.50
  6. 407 Patient Care / Evaluation (Per Patient)

    $50.00
    2
    $100.00

  7. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: FM 2257 (Knob Hill Road)

    Ordinance Info: Briar-Reno Cost Recovery Amendment

Subtotal $920.00
Total Due $920.00


Updated
January 11, 2021 @ 4:31 pm

Invoice updated by Geoffrey.

Updated
February 2, 2021 @ 6:11 pm

Invoice updated by Geoffrey.

Updated
February 2, 2021 @ 6:15 pm

Invoice updated by Geoffrey.

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