Bill To:


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

Services Rendered To:


Gary Edwards
375 County Rd 132
Jemison, AL 35085
POLICY# 0135727460


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

    $500.00
    1.75
    $875.00
  2. 103 Rescue Response (Per Hour)

    $400.00
    1.75
    $700.00
  3. 105 Utility Vehicle Response (Per Hour)

    $250.00
    1.75
    $437.50
  4. 218 Cervical Collar (# Used)

    $25.00
    1
    $25.00
  5. 314 Cribbing – Lvl 1 (Passenger Vehicle) (Used)

    $100.00
    1
    $100.00
  6. 319 Generator (Per Generator/Per Hour)

    $50.00
    1.75
    $87.50
  7. 310 Hydraulic Tool (# Used)

    $200.00
    3
    $600.00
  8. 206 Latex Gloves (Pairs Used)

    $2.00
    12
    $24.00
  9. 301 Hand Tool (# Used)

    $15.00
    2
    $30.00
  10. 216 Oxygen (# Used)

    $25.00
    1
    $25.00
  11. 215 Trauma Kit (# Used)

    $25.00
    2
    $50.00
  12. 408 Air Medical Landing Zone (Used)

    $250.00
    1
    $250.00
  13. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  14. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00

  15. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 12550 CR 42- Jemison, AL

Subtotal $3,554.00
Total Due $3,554.00


Updated
October 17, 2023 @ 2:55 pm

Invoice updated by Geoffrey.

Status Update
October 17, 2023 @ 2:55 pm

Status changed: Draft to Pending.