Bill To:


Farmers Insurance
PO Box 268993
Oklahoma City, OK 73126

Services Rendered To:


Jannete Holly Bailey
141 Blueridge Church Rd
Hamilton, TX 76531


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

    $400.00
    1
    $400.00
  2. 331 Air Bags (# Used)

    $150.00
    1
    $150.00
  3. 314 Cribbing – Lvl 1 (Passenger Vehicle) (Used)

    $100.00
    1
    $100.00
  4. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00
  5. 201 Oil Absorbent Material (# Used)

    $35.00
    1
    $35.00
  6. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  7. 306 Hose Per 50′ (Amt Used)

    $25.00
    1
    $25.00

  8. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: FM 1241- Hamilton, TX 76531

Subtotal $1,060.00
Total Due $1,060.00


Updated
March 26, 2024 @ 2:53 pm

Invoice updated by Geoffrey.

Status Update
March 26, 2024 @ 2:53 pm

Status changed: Draft to Pending.