Bill To:


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

Services Rendered To:


George Laurenzana
10522 US Hwy 62
Elgin, OK 73538
POLICY# 3590861A2836B


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. 418 Environmental Hazard Cleanup/Removal

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

    $2.00
    7
    $14.00
  6. 301 Hand Tool (# Used)

    $15.00
    2
    $30.00
  7. 404 Scene Lighting (Per Hour)

    $75.00
    1.5
    $112.50
  8. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.5
    $150.00
  9. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  10. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: US Hwy 62 & Dolese Rd- Lawton, OK

Subtotal $2,531.50
Total Due $2,531.50


Updated
December 28, 2023 @ 12:38 pm

Invoice updated by Geoffrey.

Status Update
December 28, 2023 @ 12:38 pm

Status changed: Draft to Pending.

Viewed
March 29, 2024 @ 11:42 pm

Invoice viewed by 66.249.72.4 for the first time.