Bill To:


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

Services Rendered To:


Christon Morneo
315 Skyline Dr
Ashland, AL 36251
POLICY# 5529664A01-01


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

    $400.00
    2.25
    $900.00
  2. 103 Rescue Response (Per Hour)

    $400.00
    2.25
    $900.00
  3. 206 Latex Gloves (Pairs Used)

    $2.00
    10
    $20.00
  4. 215 Trauma Kit (# Used)

    $25.00
    1
    $25.00
  5. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00
  6. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00

  7. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 75920 Hwy 9- Ashland, AL

Subtotal $2,345.00
Total Due $2,345.00


Updated
December 12, 2023 @ 10:55 am

Invoice updated by Geoffrey.

Status Update
December 12, 2023 @ 10:55 am

Status changed: Draft to Pending.