Bill To:


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

Services Rendered To:


Jennifer Headley
200 Princeton Ln Apt F-1
Jemison, AL 35085
POLICY# 0134169063


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

    $500.00
    1
    $500.00
  2. 103 Rescue Response (Per Hour)

    $400.00
    1
    $400.00
  3. 218 Cervical Collar (# Used)

    $25.00
    1
    $25.00
  4. 314 Cribbing – Lvl 1 (Passenger Vehicle) (Used)

    $100.00
    1
    $100.00
  5. 310 Hydraulic Tool (# Used)

    $200.00
    1
    $200.00
  6. 206 Latex Gloves (Pairs Used)

    $2.00
    4
    $8.00
  7. 301 Hand Tool (# Used)

    $15.00
    2
    $30.00
  8. 201 Oil Absorbent Material (# Used)

    $35.00
    1
    $35.00
  9. 215 Trauma Kit (# Used)

    $25.00
    1
    $25.00
  10. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00

  11. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: US Hwy 31 & Princeton Ln- Jemison, AL

Subtotal $1,573.00
Total Due $1,573.00


Updated
July 12, 2023 @ 12:38 pm

Invoice updated by Geoffrey.

Status Update
July 12, 2023 @ 12:38 pm

Status changed: Draft to Pending.