Bill To:


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

Services Rendered To:


David Emmert
246 County Road 4890
Boyd, Texas 76023
Policy # 2226950A0243N


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

    $300.00
    1
    $300.00
  2. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1
    $150.00
  3. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    1
    $150.00
  4. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  5. 206 Latex Gloves (Pairs Used)

    $2.00
    4
    $8.00
  6. 301 Hand Tool (# Used)

    $15.00
    2
    $30.00
  7. 201 Oil Absorbent Material (# Used)

    $35.00
    1
    $35.00
  8. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  9. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 1875 Jaybird Lane - Springtown, Texas

    Ordinance Info: City of Briar Reno - Cost Recovery Amendment

Subtotal $1,173.00
Total Due $1,173.00


Updated
March 14, 2021 @ 5:48 pm

Invoice updated by Geoffrey.

Status Update
March 14, 2021 @ 5:48 pm

Status changed: Draft to Pending.

Updated
March 14, 2021 @ 5:48 pm

Invoice updated by Geoffrey.

Viewed
October 22, 2022 @ 7:08 pm

Invoice viewed by 64.124.8.36 for the first time.