Bill To:


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

Services Rendered To:


James Anthony Rice
906 Neal Road
Huntington, TX 75949
POLICY # 428 8049-F14-431 002

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-AC-409-22-104 06/16/2022 06/20/2022 On Receipt City of Huntington VFD

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

    $300.00
    2.5
    $750.00
  2. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    2.5
    $250.00

  3. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: FM 844 & Highway 69 Southbound - Huntington, TX

Subtotal $1,000.00
Total Due $1,000.00


Updated
June 20, 2022 @ 12:30 pm

Invoice updated by Geoffrey.

Status Update
June 20, 2022 @ 12:30 pm

Status changed: Draft to Pending.

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