Bill To:


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

Services Rendered To:


Carrie Bankston
289 English Court
Azle, Texas 76020
Policy # 261-9375-C27-53C


Product
Price
Qty
Amount
  1. 104 Tanker Response (Per Hour)

    $300.00
    1
    $300.00
  2. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  3. 206 Latex Gloves (Pairs Used)

    $2.00
    3
    $6.00
  4. 301 Hand Tool (# Used)

    $15.00
    2
    $30.00
  5. 309 Power Tool (# Used)

    $50.00
    1
    $50.00
  6. 201 Oil Absorbent Material (# Used)

    $35.00
    1
    $35.00
  7. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00
  8. 413 Fire Department Response Fee – Lvl 4

    Patient Entrapment

    $500.00
    1
    $500.00

  9. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 500 Boyd Road - Azle, Texas

    Ordinance Info: Briar-Reno Fire Recovery Cost Amendment

Subtotal $1,421.00
Total Due $1,421.00


Updated
April 7, 2021 @ 10:47 pm

Invoice updated by Geoffrey.

Updated
April 7, 2021 @ 11:07 pm

Invoice updated by Geoffrey.

Updated
April 7, 2021 @ 11:07 pm

Invoice updated by Geoffrey.

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