Bill To:


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

Services Rendered To:


Nicole Morgan
9520 Spectrum Dr
Austin, TX 78717
POLICY# 5272621-B09-53

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-XV-414-24-731 05/01/2024 05/02/2024 On Receipt Sam Bass Fire Department

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

    $500.00
    1
    $500.00
  2. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00
  3. 301 Hand Tool (# Used)

    $15.00
    2
    $30.00
  4. 201 Oil Absorbent Material (# Used)

    $35.00
    1
    $35.00
  5. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00

  6. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 15102 RM 620- Round Rock, TX

    Ordinance Info: Sam Bass Fire Dept. Resolution

Subtotal $915.00
Total Due $915.00


Updated
May 2, 2024 @ 3:20 pm

Invoice updated by Geoffrey.

Status Update
May 2, 2024 @ 3:20 pm

Status changed: Draft to Pending.