Bill To:


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

Services Rendered To:


Ruthie Young
753 VZ County Rd 4910
Ben Wheeler, TX 75754
POLICY# 0991398-C19-431

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-WZ-301-24-9920 04/12/2024 04/16/2024 On Receipt Ben Wheeler FD

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

    $500.00
    1
    $500.00
  2. 103 Rescue Response (Per Hour)

    $400.00
    1
    $400.00
  3. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00
  4. 402 Fire/Police Services (Per Hour)    

    $100.00
    1
    $100.00
  5. 206 Latex Gloves (Pairs Used)

    $2.00
    4
    $8.00
  6. 301 Hand Tool (# Used)

    $15.00
    1
    $15.00
  7. 201 Oil Absorbent Material (# Used)

    $35.00
    1
    $35.00
  8. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00

  9. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: St Hwy 64 & FM 858- Ben Wheeler, TX

Subtotal $1,408.00
Total Due $1,408.00


Updated
April 16, 2024 @ 9:34 am

Invoice updated by Geoffrey.

Status Update
April 16, 2024 @ 9:34 am

Status changed: Draft to Pending.