Bill To:


STATE FARM FIRE CLAIMS
PO BOX 106169
ATLANTA, GA 30348-6169

Services Rendered To:


Insured: Peggy M. Moser
Driver: Rusty Wayne Vercher
Policy # 2844742L0353E002
Claim # 53-15S9-66G
D.O.L. 01/23/2021


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

    $350.00
    1
    $350.00
  2. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1
    $150.00
  3. 101 Aerial/Ladder Response (Per Hour)

    $400.00
    1
    $400.00
  4. 314 Cribbing – Lvl 1 (Passenger Vehicle) (Used)

    $100.00
    1
    $100.00
  5. 310 Hydraulic Tool (# Used)

    $200.00
    1
    $200.00
  6. 206 Latex Gloves (Pairs Used)

    $2.00
    5
    $10.00
  7. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  8. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00
  9. 701 Body Removal (Per Body)    

    $250.00
    1
    $250.00

  10. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Texas 35 East of Hawley Cemetery Road - El Maton, Texas

Subtotal $1,810.00
Total Due $1,810.00


Updated
May 12, 2022 @ 2:41 pm

Invoice updated by Geoffrey.

Status Update
May 12, 2022 @ 2:41 pm

Status changed: Draft to Pending.

Updated
May 12, 2022 @ 2:43 pm

Invoice updated by Geoffrey.

Updated
September 15, 2022 @ 4:44 pm

Invoice updated by Geoffrey.

Updated
September 15, 2022 @ 4:45 pm

Invoice updated by Geoffrey.

Updated
September 15, 2022 @ 4:45 pm

Invoice updated by Geoffrey.

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