Bill To:


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

Services Rendered To:


Shelly Dominguez
29 South Point Circle
Rockport, TX 78382
Claim#5362T206W


Product
Price
Qty
Amount
  1. 106 Battalion/Chief Vehicle Response (Per Hour)

    $200.00
    2
    $400.00
  2. 102 Engine Response (Per Hour)

    $500.00
    2
    $1,000.00
  3. 102 Engine Response (Per Hour)

    $500.00
    2
    $1,000.00
  4. 102 Engine Response (Per Hour)

    $500.00
    2
    $1,000.00
  5. 102 Engine Response (Per Hour)

    $500.00
    2
    $1,000.00
  6. 101 Aerial/Ladder Response (Per Hour)

    $550.00
    2
    $1,100.00
  7. 105 Utility Vehicle Response (Per Hour)

    $250.00
    2
    $500.00
  8. 306 Hose Per 50′ (Amt Used)

    $25.00
    3
    $75.00
  9. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00

  10. Additional Incident Info

    Incident Type: Structure Fire Response

    Incident Location: 29 South Point Circle Rockport, TX 78382

Subtotal $6,325.00
Total Due $6,325.00


Updated
February 8, 2024 @ 10:45 am

Invoice updated by Geoffrey.

Status Update
February 8, 2024 @ 10:45 am

Status changed: Draft to Pending.