Bill To:


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

Services Rendered To:


Stanley Temple
1708 CR 133
Gainesville, TX 76240
POLICY# 85B 9D 6135


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

    $500.00
    1
    $500.00
  2. 104 Tanker Response (Per Hour)

    $400.00
    1
    $400.00
  3. 106 Battalion/Chief Vehicle Response (Per Hour)

    $200.00
    1
    $200.00
  4. 313 TIC Thermal Imaging Camera (# Used)

    $100.00
    1
    $100.00
  5. 318 Ladder (# Used)

    $35.00
    1
    $35.00
  6. 211 Salvage Cover (Amt Used)           

    $35.00
    1
    $35.00
  7. 303 SCBA Breathing Apparatus (# Used)

    $50.00
    4
    $200.00
  8. 304 SCBA Cylinder (# Used)

    $25.00
    4
    $100.00
  9. 306 Hose Per 50′ (Amt Used)

    $25.00
    3
    $75.00
  10. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00

  11. Additional Incident Info

    Incident Type: Select One

Subtotal $1,895.00
Total Due $1,895.00


Updated
September 20, 2023 @ 12:21 pm

Invoice updated by Geoffrey.

Status Update
September 20, 2023 @ 12:21 pm

Status changed: Draft to Pending.