Bill To:


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

Services Rendered To:


Kurt Vandoran
Policy # 194 6501-614-4314
State Farm

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-CN-310-2020-96 03/24/2020 03/27/2020 On Receipt Lavon Volunteer Fire Department

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

    $350.00
    1
    $350.00
  2. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    1
    $150.00
  3. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  4. 206 Latex Gloves (Pairs Used)

    $2.00
    10
    $20.00
  5. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00

  6. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 400 Block Highway 78 - Lavon, Texas

    Ordinance Info: RESOLUTION NO. 2020-03-01

Subtotal $870.00
Total Due $870.00
Updated
March 26, 2020 @ 4:49 pm

Invoice updated by Karen Smith.

Status Update
March 26, 2020 @ 4:49 pm

Status changed: Draft to Pending.

Viewed
October 25, 2022 @ 7:13 am

Invoice viewed by 64.124.8.25 for the first time.