Bill To:


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

Services Rendered To:


Owner
POLICY# 4929304B2453A

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-BB-326-24-101 05/22/2024 05/28/2024 On Receipt Rosharon VFD

Product
Price
Qty
Amount
  1. 105 Utility Vehicle Response (Per Hour)

    $250.00
    4.25
    $1,062.50
  2. 102 Engine Response (Per Hour)

    $500.00
    4.25
    $2,125.00
  3. 103 Rescue Response (Per Hour)

    $400.00
    4.25
    $1,700.00
  4. 106 Battalion/Chief Vehicle Response (Per Hour)

    $200.00
    4.25
    $850.00
  5. 206 Latex Gloves (Pairs Used)

    $2.00
    14
    $28.00
  6. 201 Oil Absorbent Material (# Used)

    $35.00
    2
    $70.00
  7. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00
  8. 310 Hydraulic Tool (# Used)

    $200.00
    2
    $400.00
  9. 309 Power Tool (# Used)

    $50.00
    4
    $200.00
  10. 301 Hand Tool (# Used)

    $15.00
    3
    $45.00

  11. Additional Incident Info

    Incident Type: MVA w/Entrapment Response

    Incident Location: FM 521 & CR 567- Rosharon, TX

    Ordinance Info: Rosharon Cost Recovery Resolution

Subtotal $6,730.50
Total Due $6,730.50


Updated
May 28, 2024 @ 1:27 pm

Invoice updated by Geoffrey.

Status Update
May 28, 2024 @ 1:27 pm

Status changed: Draft to Pending.