Bill To:


Farmers Insurance
PO Box 268993
Oklahoma City, OK 73126

Services Rendered To:


Patricia Valadka
5318 W Beverly Dr
Dallas, TX 75209
POLICY# A7994757320


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

    $400.00
    1
    $400.00
  2. 102 Engine Response (Per Hour)

    $500.00
    1
    $500.00
  3. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  4. 206 Latex Gloves (Pairs Used)

    $2.00
    3
    $6.00
  5. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  6. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: IH 45 & FM 256- Streetman, TX

    Ordinance Info: City of Angus Billing Authorization # 7

Subtotal $1,256.00
Total Due $1,256.00


Updated
November 21, 2023 @ 9:53 am

Invoice updated by Geoffrey.

Status Update
November 21, 2023 @ 9:53 am

Status changed: Draft to Pending.