Bill To:


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

Services Rendered To:


Floreeta Ann Paxton
226 Pecan Drive SW
McQueeney, Texas 78123
Policy # 1757078K1453B001

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-HS-403-2021-538-A 12/10/2021 12/17/2021 On Receipt McQueeney V.F.D.

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. 103 Rescue Response (Per Hour)

    $300.00
    1
    $300.00
  4. 331 Air Bags (# Used)

    $150.00
    2
    $300.00
  5. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  6. 402 Fire/Police Services (Per Hour)    

    $100.00
    1
    $100.00
  7. 301 Hand Tool (# Used)

    $15.00
    2
    $30.00
  8. 201 Oil Absorbent Material (# Used)

    $35.00
    5
    $175.00
  9. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  10. 310 Hydraulic Tool (# Used)

    $200.00
    1
    $200.00

  11. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 510 Pecos Circle - New Braunfels, Texas

    Ordinance Info: McQueeney Cost Recovery Resolution 4521

Subtotal $1,955.00
Total Due $1,955.00


Updated
December 16, 2021 @ 10:18 pm

Invoice updated by Geoffrey.

Status Update
December 16, 2021 @ 10:18 pm

Status changed: Draft to Pending.

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