Bill To:


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

Services Rendered To:


Wendell Wilbourn
635 West Pierson St
Hamilton, TX 76531
POLICY# 157 8921-K10-43H 002

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-HW-405-23-36-B 03/24/2023 03/27/2023 On Receipt Hico VFD

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

    $300.00
    2.25
    $675.00
  2. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    2.25
    $337.50
  3. 105 Utility Vehicle Response (Per Hour)

    $150.00
    2.25
    $337.50
  4. 102 Engine Response (Per Hour)

    $350.00
    2.25
    $787.50
  5. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  6. 206 Latex Gloves (Pairs Used)

    $2.00
    10
    $20.00
  7. 301 Hand Tool (# Used)

    $15.00
    2
    $30.00
  8. 404 Scene Lighting (Per Hour)

    $75.00
    2.25
    $168.75
  9. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    2.25
    $225.00

  10. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: US 281 N CR 208-

Subtotal $2,831.25
Total Due $2,831.25


Updated
March 27, 2023 @ 5:38 pm

Invoice updated by Geoffrey.