Bill To:


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

Services Rendered To:


Mr Corrol
825 Annadale Rd
Huntsville, TN 37841
Claim# 17-59H9-57M
Attn: Chris Mance

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TN-76-821-23-1823 11/16/2023 11/30/2023 On Receipt Paint Rock VFD

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

    $500.00
    1
    $500.00
  2. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  3. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  4. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 3000 Block Paint Rock Rd- Oneida, TN

Subtotal $850.00
Total Due $850.00


Updated
November 30, 2023 @ 11:16 am

Invoice updated by Geoffrey.

Status Update
November 30, 2023 @ 11:16 am

Status changed: Draft to Pending.

Updated
February 12, 2024 @ 7:03 pm

Invoice updated by Geoffrey.