Bill To:


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

Services Rendered To:


Andrew Kerley
1850 Chapman Rd
GoodWater, AL 35072
POLICY# 5713429-B07-01

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
AL-01-712-23-65 05/12/2023 05/15/2023 On Receipt Millerville VFD

Product
Price
Qty
Amount
  1. 103 Rescue Response (Per Hour)

    $300.00
    2.25
    $675.00
  2. 103 Rescue Response (Per Hour)

    $300.00
    2.25
    $675.00
  3. 206 Latex Gloves (Pairs Used)

    $2.00
    12
    $24.00
  4. 317 Rescue Struts (# Used)

    $50.00
    2
    $100.00
  5. 215 Trauma Kit (# Used)

    $25.00
    1
    $25.00
  6. 326 Safety Fest (# Used)

    $2.50
    7
    $17.50

  7. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 72757 Hwy 9- Ashland, AL

Subtotal $1,516.50
Total Due $1,516.50


Updated
May 15, 2023 @ 11:25 am

Invoice updated by Geoffrey.

Status Update
May 15, 2023 @ 11:25 am

Status changed: Draft to Pending.