Bill To:


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

Services Rendered To:


Cory Vallien
11313 Misty Mornings Street
Pearland, Texas 77584
Policy # 217 6457-E10-531 003

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-SH-201-C21-16254 06/27/2021 07/01/2021 On Receipt Angus Vol. Fire Department

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

    $300.00
    1
    $300.00
  2. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1
    $150.00
  3. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00

  4. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 220 Southbound Interstate Highway 45 - Angus, Texas

    Ordinance Info: City of Angus Billing Authorization # 7

Subtotal $550.00
Total Due $550.00


Updated
June 30, 2021 @ 10:39 pm

Invoice updated by Geoffrey.

Status Update
June 30, 2021 @ 10:39 pm

Status changed: Draft to Pending.