Bill To:


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

Services Rendered To:


Braiden Inglehart
104707 S. 3300 Rd
Harrah, OK 73045
POLICY# 4992805-A13-36


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

    $350.00
    1
    $350.00
  2. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1
    $150.00
  3. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00
  4. 206 Latex Gloves (Pairs Used)

    $2.00
    5
    $10.00
  5. 201 Oil Absorbent Material (# Used)

    $35.00
    1
    $35.00
  6. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  7. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  8. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Hwy 177 & Hwy 62- Meeker, OK

Subtotal $1,145.00
Total Due $1,145.00


Updated
February 27, 2023 @ 1:18 pm

Invoice updated by Geoffrey.

Status Update
February 27, 2023 @ 1:18 pm

Status changed: Draft to Pending.

Viewed
March 29, 2024 @ 11:12 pm

Invoice viewed by 66.249.72.4 for the first time.