Bill To:


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

Services Rendered To:


Robert Davis
4421 Phillips
Wichita Falls, TX 76308
POLICY# 1003378C0143F


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

    $1,000.00
    2.75
    $2,750.00
  2. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    2.75
    $275.00
  3. 324 Traffic Cone (# Used)

    $5.00
    20
    $100.00
  4. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00
  5. 105 Utility Vehicle Response (Per Hour)

    $500.00
    2.75
    $1,375.00

  6. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: I-40 WB MM 255- Checotah, OK

Subtotal $4,750.00
Total Due $4,750.00


Updated
January 23, 2023 @ 10:09 am

Invoice updated by Geoffrey.

Status Update
January 23, 2023 @ 10:09 am

Status changed: Draft to Pending.