Bill To:


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

Services Rendered To:


Barbara Perry
209 N Main St
Urbana, MO 65767
POLICY# 668-5228-A13-25

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
MO-08-409-24-8409 02/15/2024 05/23/2024 On Receipt Dunnegan Rural FD

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

    $400.00
    1
    $400.00
  2. 102 Engine Response (Per Hour)

    $500.00
    1
    $500.00
  3. 105 Utility Vehicle Response (Per Hour)

    $250.00
    1
    $250.00
  4. 319 Generator (Per Generator/Per Hour)

    $50.00
    1
    $50.00
  5. 310 Hydraulic Tool (# Used)

    $200.00
    1
    $200.00
  6. 206 Latex Gloves (Pairs Used)

    $2.00
    8
    $16.00
  7. 211 Salvage Cover (Amt Used)           

    $35.00
    1
    $35.00
  8. 404 Scene Lighting (Per Hour)

    $75.00
    1
    $75.00
  9. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00
  10. 330 Backboard (# Used)

    $25.00
    1
    $25.00

  11. Additional Incident Info

    Incident Type: MVA w/Entrapment Response

    Incident Location: 32 Hwy & E 43 Rd- Fair Play, MO

Subtotal $1,801.00
Total Due $1,801.00


Updated
May 23, 2024 @ 11:00 am

Invoice updated by Geoffrey.

Status Update
May 23, 2024 @ 11:00 am

Status changed: Draft to Pending.