Bill To:


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

Services Rendered To:


Marilyn Cleghorn
3374 Hwy 108 W
Fureman, AR 71836
POLICY# 0410182604

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-BY-205-23-4262 04/26/2023 05/03/2023 On Receipt Douglassville V.F.D.

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

    $350.00
    1.5
    $525.00
  2. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1.5
    $225.00
  3. 301 Hand Tool (# Used)

    $15.00
    3
    $45.00
  4. 201 Oil Absorbent Material (# Used)

    $35.00
    1
    $35.00
  5. 419 Environmental Spill

    $250.00
    1
    $250.00
  6. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00

  7. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: SH8 & Sulphur River Bridge- Cass County, TX

    Ordinance Info: Douglassville Volunteer Fire Dept. Resolution

Subtotal $1,330.00
Total Due $1,330.00


Updated
May 3, 2023 @ 2:21 pm

Invoice updated by Geoffrey.

Status Update
May 3, 2023 @ 2:21 pm

Status changed: Draft to Pending.

Viewed
July 23, 2024 @ 10:53 pm

Invoice viewed by 69.171.249.9 for the first time.