Bill To:


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

Services Rendered To:


Cory Lankford
5731 Country Rd 919
Nevada, TX 75137
POLICY# 250 2571-E01-43V

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-CN-310-23-2592-B 01/05/2023 01/05/2023 On Receipt Lavon VFD

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. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  4. 201 Oil Absorbent Material (# Used)

    $35.00
    1
    $35.00

  5. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: St Hwy 205- Lavon, TX

    Ordinance Info: City of Lavon Resolution NO. 2020-03-01

Subtotal $735.00
Total Due $735.00


Updated
January 5, 2023 @ 7:49 pm

Invoice updated by Geoffrey.

Viewed
January 16, 2023 @ 4:54 pm

Invoice viewed by Karen Meder - Smith (KarenS) for the first time.

Viewed
February 1, 2023 @ 11:29 pm

Invoice viewed by Karen Meder - Smith (KarenS) for the first time.