Bill To:


STATE FARM MUTUAL INSURANCE
ONE STATE FARM PLAZA
BLOOMINGTON, IL 61710-0001

Services Rendered To:


Vickie Cunningham
897 Plantation Drive
Lufkin, Texas 75901
Policy # 377 4695-A17-43E 003


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

    $300.00
    1.25
    $375.00
  2. 102 Engine Response (Per Hour)

    $350.00
    1.25
    $437.50
  3. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1.25
    $187.50
  4. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  5. 204 Flate (# Used)

    $8.00
    4
    $32.00
  6. 206 Latex Gloves (Pairs Used)

    $2.00
    5
    $10.00
  7. 301 Hand Tool (# Used)

    $15.00
    5
    $75.00
  8. 201 Oil Absorbent Material (# Used)

    $35.00
    1
    $35.00
  9. 211 Salvage Cover (Amt Used)   

    $35.00
    1
    $35.00
  10. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.25
    $125.00
  11. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00
  12. 408 Air Medical Landing Zone (Used)

    $250.00
    1
    $250.00

  13. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Highway 69 South @ Lazy Brook RV Park - Huntington, Texas

Subtotal $2,062.00
Total Due $2,062.00


Updated
February 4, 2022 @ 12:01 pm

Invoice updated by Geoffrey.

Status Update
February 4, 2022 @ 12:01 pm

Status changed: Draft to Pending.

Updated
February 4, 2022 @ 12:01 pm

Invoice updated by Geoffrey.

Updated
February 4, 2022 @ 12:03 pm

Invoice updated by Geoffrey.