Bill To:


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

Services Rendered To:


James Stephen
407 Williamsburg
Clute, TX
POLICY# 116 2665-G02-53M 002


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

    $400.00
    2
    $800.00
  2. 104 Tanker Response (Per Hour)

    $400.00
    2
    $800.00
  3. 105 Utility Vehicle Response (Per Hour)

    $250.00
    2
    $500.00
  4. 206 Latex Gloves (Pairs Used)

    $2.00
    6
    $12.00
  5. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    2
    $200.00
  6. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00
  7. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00

  8. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: FM 1462 on Hwy- Rosharon, TX

    Ordinance Info: Rosharon Cost Recovery Resolution

Subtotal $2,812.00
Total Due $2,812.00


Updated
October 23, 2023 @ 10:57 am

Invoice updated by Geoffrey.

Status Update
October 23, 2023 @ 10:57 am

Status changed: Draft to Pending.