Bill To:


STATE FARM MUTUAL INSURANCE
ONE STATE FARM PLAZA
BLOOMINGTON, IL 61710-0001

Services Rendered To:


Kathleen Tillman
1815 Prairie View Drive
Princeton, TX 75407
Policy # 3316904C0243H


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

    $350.00
    2.25
    $787.50
  2. 103 Rescue Response (Per Hour)

    $300.00
    2.25
    $675.00
  3. 218 Cervical Collar (# Used)

    $25.00
    1
    $25.00
  4. 201 Oil Absorbent Material (# Used)

    $35.00
    2
    $70.00
  5. 404 Scene Lighting (Per Hour)

    $75.00
    1
    $75.00
  6. 215 Trauma Kit (# Used)

    $25.00
    1
    $25.00
  7. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  8. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Highway 901 - Sadler, Texas

Subtotal $1,907.50
Total Due $1,907.50


Updated
March 23, 2022 @ 2:21 pm

Invoice updated by Geoffrey.

Status Update
March 23, 2022 @ 2:21 pm

Status changed: Draft to Pending.