Bill To:


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

Services Rendered To:


Chang An
9111 Brimstone Ln
Austin, TX 78717
POLICY# 506 5591 G13 53 001


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

    $500.00
    1
    $500.00
  2. 106 Battalion/Chief Vehicle Response (Per Hour)

    $200.00
    1
    $200.00
  3. 301 Hand Tool (# Used)

    $15.00
    3
    $45.00
  4. 201 Oil Absorbent Material (# Used)

    $35.00
    1
    $35.00
  5. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  6. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00

  7. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Pocono Dr/ Oconner Dr- Round Rock, TX

    Ordinance Info: Sam Bass Fire Dept. Resolution

Subtotal $1,130.00
Total Due $1,130.00


Updated
November 3, 2023 @ 11:09 am

Invoice updated by Geoffrey.

Status Update
November 3, 2023 @ 11:09 am

Status changed: Draft to Pending.