Bill To:


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

Services Rendered To:


Destany Coone
6432 N Lone Star Pkwy
Crawford, TX 76638
POLICY# 5218091H1743A001


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

    $300.00
    1.25
    $375.00
  2. 102 Engine Response (Per Hour)

    $350.00
    1.25
    $437.50
  3. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    1.25
    $187.50
  4. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.25
    $125.00

  5. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: SH 6 SB Main Lanes- Waco, TX

Subtotal $1,125.00
Total Due $1,125.00