Bill To:


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

Services Rendered To:


Vanessa Benavidez
15012 Siberian Elm Ln
Austin, TX 78724
POLICY# 438-2710-C09-53C

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-XV-414-23-770 05/16/2023 05/17/2023 On Receipt Sam Bass Fire Department

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

    $350.00
    1
    $350.00
  2. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00

  3. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 7523 Oconner Dr- Round Rock, TX

Subtotal $450.00
Total Due $450.00


Updated
May 17, 2023 @ 12:42 pm

Invoice updated by Geoffrey.

Status Update
May 17, 2023 @ 12:42 pm

Status changed: Draft to Pending.