Bill To:


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

Services Rendered To:


Vehicle Owner
State Farm
Policy # 4532411A2001


Product
Price
Qty
Amount
  1. 106 Battalion/Chief Vehicle Response (Per Hour)

    $500.00
    1.5
    $750.00
  2. 105 Utility Vehicle Response (Per Hour)

    $500.00
    1.5
    $750.00
  3. 301 Hand Tool (# Used)

    $15.00
    1
    $15.00
  4. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00
  5. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00

  6. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 107652 Highway 150 - Checotah, OK

Subtotal $2,015.00
Total Due $2,015.00


Updated
July 3, 2021 @ 2:51 pm

Invoice updated by Geoffrey.

Status Update
July 3, 2021 @ 2:51 pm

Status changed: Draft to Pending.

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November 29, 2021 @ 11:30 am

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

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October 25, 2022 @ 2:52 pm

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