Bill To:


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

Services Rendered To:


David Chandler
Policy # 301 6338-E15-43B

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-CN-310-2020-177-B 06/10/2020 06/17/2020 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
    8
    $16.00
  5. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00

  6. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 512 Lake Road - Lavon, Texas

    Ordinance Info: CITY OF LAVON TEXAS - RESOLUTION NO. 2020-03-01

Subtotal $866.00
Total Due $866.00
Updated
June 17, 2020 @ 3:42 pm

Invoice updated by Karen Smith.

Updated
June 17, 2020 @ 3:43 pm

Invoice updated by Karen Smith.

Updated
June 17, 2020 @ 3:44 pm

Invoice updated by Karen Smith.

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