Bill To:


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

Services Rendered To:


Lance Garrett Stevens
732 Vista Parkway
New Braunfels, TX 78130
Policy # 367 7015-D17-53A 001


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

    $300.00
    1
    $300.00
  2. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1
    $150.00
  3. 331 Air Bags (# Used)

    $150.00
    1
    $150.00
  4. 218 Cervical Collar (# Used)

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

    $250.00
    1
    $250.00
  6. 402 Fire/Police Services (Per Hour)    

    $100.00
    1
    $100.00
  7. 206 Latex Gloves (Pairs Used)

    $2.00
    6
    $12.00
  8. 201 Oil Absorbent Material (# Used)

    $35.00
    5
    $175.00
  9. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  10. 215 Trauma Kit (# Used)

    $25.00
    1
    $25.00

  11. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: FM 1044 - McQueeney, Texas

    Ordinance Info: McQueeney Cost Recovery Resolution 4521

Subtotal $1,287.00
Total Due $1,287.00


Updated
December 8, 2021 @ 7:06 pm

Invoice updated by Geoffrey.

Status Update
December 8, 2021 @ 7:07 pm

Status changed: Draft to Pending.

Updated
March 17, 2022 @ 4:10 pm

Invoice updated by Geoffrey.

Viewed
October 25, 2022 @ 3:40 am

Invoice viewed by 64.124.8.55 for the first time.