Bill To:


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

Services Rendered To:


Oscar Castaneda
1564 Kent Dairy Rd Lot 736
Alabaster, AL 35007
POLICY# 5723064B1701

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
AL-01-403-24-338 04/12/2024 04/23/2024 On Receipt Jemison FD

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

    $500.00
    2.75
    $1,375.00
  2. 103 Rescue Response (Per Hour)

    $400.00
    2.75
    $1,100.00
  3. 206 Latex Gloves (Pairs Used)

    $2.00
    6
    $12.00
  4. 215 Trauma Kit (# Used)

    $25.00
    1
    $25.00
  5. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00
  6. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00

  7. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 3685 AL Hwy 155- Montevallo, AL

Subtotal $3,012.00
Total Due $3,012.00


Updated
April 23, 2024 @ 1:02 pm

Invoice updated by Geoffrey.

Status Update
April 23, 2024 @ 1:02 pm

Status changed: Draft to Pending.