Bill To:


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

Services Rendered To:


Iwu Ahamefula
POLICY# 512 3058-H31-53 001

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-BB-326-23-232-B 12/07/2023 12/12/2023 On Receipt Rosharon VFD

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

    $400.00
    1.5
    $600.00
  2. 102 Engine Response (Per Hour)

    $500.00
    1.5
    $750.00
  3. 105 Utility Vehicle Response (Per Hour)

    $250.00
    1.5
    $375.00
  4. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.5
    $150.00
  5. 408 Air Medical Landing Zone (Used)

    $250.00
    2
    $500.00
  6. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00
  7. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00
  8. 201 Oil Absorbent Material (# Used)

    $35.00
    3
    $105.00
  9. 301 Hand Tool (# Used)

    $15.00
    3
    $45.00
  10. 310 Hydraulic Tool (# Used)

    $200.00
    2
    $400.00
  11. 205 Foam (Per Gallon)

    $65.00
    1
    $65.00

  12. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: FM 521- Rosharon, TX

    Ordinance Info: Rosharon Cost Recovery Resolution

Subtotal $3,490.00
Total Due $3,490.00


Updated
December 12, 2023 @ 11:31 am

Invoice updated by Geoffrey.