Bill To:


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

Services Rendered To:


William Cooksy
118 Beacon Hill
Forney, TX 75126
POLICY# 504 1571-E11-43A

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-CN-310-23-652-B 09/18/2023 09/19/2023 On Receipt Lavon V.F.D.

Product
Price
Qty
Amount
  1. 101 Aerial/Ladder Response (Per Hour)

    $550.00
    1.25
    $687.50
  2. 106 Battalion/Chief Vehicle Response (Per Hour)

    $200.00
    1.25
    $250.00
  3. 105 Utility Vehicle Response (Per Hour)

    $250.00
    1.25
    $312.50
  4. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00
  5. 301 Hand Tool (# Used)

    $15.00
    1
    $15.00
  6. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.25
    $125.00

  7. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: FM 2755 - Lavon, Texas

    Ordinance Info: City of Lavon Resolution NO. 2020-03-01

Subtotal $1,640.00
Total Due $1,640.00


Updated
September 19, 2023 @ 11:55 am

Invoice updated by Geoffrey.