Bill To:


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

Services Rendered To:


Dalton Weaver
4877 FM 1270
Zavalla, TX 75980
PH # 936-240-1976
POLICY # 84GQY7413


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

    $350.00
    3.75
    $1,312.50
  2. 105 Utility Vehicle Response (Per Hour)

    $150.00
    3.75
    $562.50
  3. 104 Tanker Response (Per Hour)

    $300.00
    3.75
    $1,125.00
  4. 301 Hand Tool (# Used)

    $15.00
    1
    $15.00
  5. 303 SCBA Breathing Apparatus (# Used)

    $50.00
    2
    $100.00
  6. 304 SCBA Cylinder (# Used)

    $25.00
    2
    $50.00
  7. 404 Scene Lighting (Per Hour)

    $75.00
    3.75
    $281.25
  8. 306 Hose Per 50′ (Amt Used)

    $25.00
    6
    $150.00

  9. Additional Incident Info

    Incident Type: Structure Fire Response

    Incident Location: 4877 FM 1270 Zavalla, TX 75980

Subtotal $3,596.25
Total Due $3,596.25


Updated
August 24, 2022 @ 2:33 pm

Invoice updated by Geoffrey.

Status Update
August 24, 2022 @ 2:33 pm

Status changed: Draft to Pending.