Bill To:


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

Services Rendered To:


Andy Tate
2850 Rose Trail
Melbourne, AR 72556

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
AR-33-002-24-242 02/18/2024 02/20/2024 On Receipt Melbourne FD

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

    $500.00
    2
    $1,000.00
  2. 104 Tanker Response (Per Hour)

    $400.00
    2
    $800.00
  3. 102 Engine Response (Per Hour)

    $500.00
    2
    $1,000.00
  4. 301 Hand Tool (# Used)

    $15.00
    2
    $30.00
  5. 303 SCBA Breathing Apparatus (# Used)

    $50.00
    2
    $100.00
  6. 304 SCBA Cylinder (# Used)

    $25.00
    2
    $50.00
  7. 404 Scene Lighting (Per Hour)

    $75.00
    2
    $150.00
  8. 207 Wetting Agent (Amt Used)

    $25.00
    20
    $500.00
  9. 306 Hose Per 50′ (Amt Used)

    $25.00
    6
    $150.00

  10. Additional Incident Info

    Incident Type: Structure Fire Response

    Incident Location: 2850 Rose Trail Melbourne, AR 72556

Subtotal $3,780.00
Total Due $3,780.00


Updated
February 20, 2024 @ 10:19 am

Invoice updated by Geoffrey.

Status Update
February 20, 2024 @ 10:19 am

Status changed: Draft to Pending.