Bill To:


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

Services Rendered To:


Tonya Gonzales
1401 Scenic Dr
Longview, TX 75604
POLICY# 331 0079-D27-43J

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-HP-309-23-195 07/02/2023 07/03/2023 On Receipt White Oak VFD

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

    $350.00
    4.25
    $1,487.50
  2. 105 Utility Vehicle Response (Per Hour)

    $150.00
    4.25
    $637.50
  3. 103 Rescue Response (Per Hour)

    $300.00
    4.25
    $1,275.00
  4. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    4.25
    $637.50
  5. 306 Gas/Co Detector (# Used)

    $50.00
    2
    $100.00
  6. 310 Hydraulic Tool (# Used)

    $200.00
    1
    $200.00
  7. 206 Latex Gloves (Pairs Used)

    $2.00
    6
    $12.00
  8. 301 Hand Tool (# Used)

    $15.00
    2
    $30.00
  9. 404 Scene Lighting (Per Hour)

    $75.00
    4.25
    $318.75
  10. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    4.25
    $425.00
  11. 306 Hose Per 50′ (Amt Used)

    $25.00
    4
    $100.00
  12. 408 Air Medical Landing Zone (Used)

    $250.00
    1
    $250.00
  13. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00
  14. 419 Environmental Spill

    $250.00
    1
    $250.00

  15. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: TX-42 & W Texaco Rd- Longview, TX

    Ordinance Info: City of White Oak Ordinance 2021-02

Subtotal $5,973.25
Total Due $5,973.25


Updated
July 3, 2023 @ 5:54 pm

Invoice updated by Geoffrey.

Status Update
July 3, 2023 @ 5:54 pm

Status changed: Draft to Pending.