Bill To:


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

Services Rendered To:


Mildred Radford
245 Lower River St
Burkesville, KY 42717
POLICY# 3033863-C12-17A

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
KY-00-921-24-16453 10/18/2023 06/06/2024 On Receipt Breeding Area VFD

Product
Price
Qty
Amount
  1. 103 Rescue Response (Per Hour)

    $400.00
    1.25
    $500.00
  2. 102 Engine Response (Per Hour)

    $500.00
    1.25
    $625.00
  3. 206 Latex Gloves (Pairs Used)

    $2.00
    6
    $12.00
  4. 309 Power Tool (# Used)

    $50.00
    2
    $100.00
  5. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.25
    $125.00
  6. 215 Trauma Kit (# Used)

    $25.00
    1
    $25.00

  7. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 13951 Burkesville Rd- Breeding Area, KY

Subtotal $1,387.00
Total Due $1,387.00


Updated
June 6, 2024 @ 1:04 pm

Invoice updated by Geoffrey.

Status Update
June 6, 2024 @ 1:04 pm

Status changed: Draft to Pending.

Viewed
June 13, 2024 @ 3:07 pm

Invoice viewed by Karen Meder - Smith (KarenS) for the first time.