Bill To:


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

Services Rendered To:


Chris Loftin
POLICY# 3540013-F29-530

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-BB-326-24-117 06/10/2024 06/11/2024 On Receipt Rosharon VFD

Product
Price
Qty
Amount
  1. 105 Utility Vehicle Response (Per Hour)

    $250.00
    1
    $250.00
  2. 106 Battalion/Chief Vehicle Response (Per Hour)

    $200.00
    1
    $200.00
  3. 102 Engine Response (Per Hour)

    $500.00
    1
    $500.00
  4. 103 Rescue Response (Per Hour)

    $400.00
    1
    $400.00
  5. 105 Utility Vehicle Response (Per Hour)

    $250.00
    1
    $250.00
  6. 324 Traffic Cone (# Used)

    $5.00
    15
    $75.00
  7. 206 Latex Gloves (Pairs Used)

    $2.00
    12
    $24.00
  8. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  9. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00

  10. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Hwy 288 S & FM 1462- Rosharon, TX

    Ordinance Info: Rosharon Cost Recovery Resolution

Subtotal $2,049.00
Total Due $2,049.00


Updated
June 11, 2024 @ 3:27 pm

Invoice updated by Geoffrey.

Status Update
June 11, 2024 @ 3:27 pm

Status changed: Draft to Pending.