Bill To:


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

Services Rendered To:


Lisa Vidonish
961 Sabine Dr
Prosper, TX 75078
POLICY# 566 3617-E22-43

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-CN-310-23-916-A 12/06/2023 12/07/2023 On Receipt Lavon V.F.D.

Product
Price
Qty
Amount
  1. 101 Aerial/Ladder Response (Per Hour)

    $550.00
    1
    $550.00
  2. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00
  3. 402 Fire/Police Services (Per Hour)    

    $100.00
    1
    $100.00
  4. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  5. 324 Traffic Cone (# Used)

    $5.00
    5
    $25.00

  6. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: SH 78 & Lake Rd- Lavon, TX

    Ordinance Info: City of Lavon Resolution NO. 2020-03-01

Subtotal $1,025.00
Total Due $1,025.00


Updated
December 7, 2023 @ 7:42 pm

Invoice updated by Geoffrey.

Status Update
December 7, 2023 @ 7:42 pm

Status changed: Draft to Pending.