Bill To:


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

Services Rendered To:


Christopher Gagne
3726 Tacy Street
Fort Sill, OK 73507
Policy # 3624652447


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

    $350.00
    1.25
    $437.50
  2. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  3. 206 Latex Gloves (Pairs Used)

    $2.00
    4
    $8.00
  4. 201 Oil Absorbent Material (# Used)

    $35.00
    2
    $70.00
  5. 404 Scene Lighting (Per Hour)

    $75.00
    1.25
    $93.75
  6. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  7. 404 Scene Lighting (Per Hour)

    $75.00
    1.25
    $93.75
  8. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  9. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Interstate 44 @ MM 47 - Lawton, OK

Subtotal $1,303.00
Total Due $1,303.00


Updated
September 3, 2021 @ 5:49 pm

Invoice updated by Geoffrey.

Status Update
September 3, 2021 @ 5:49 pm

Status changed: Draft to Pending.

Updated
September 3, 2021 @ 5:49 pm

Invoice updated by Geoffrey.