Bill To:


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

Services Rendered To:


Phillip & Vanessa Ormsby
928 S Magnolia St
Rockport, TX 78382
POLICY# 440 8982 B20 53A

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-AD-505-24-27 01/16/2024 01/16/2024 On Receipt Rock Port VFD

Product
Price
Qty
Amount
  1. 102 Engine Response (Per Hour)

    $500.00
    1
    $500.00
  2. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  3. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00

  4. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 1400 N BNS 55- Rockport, TX

Subtotal $850.00
Total Due $850.00


Updated
January 16, 2024 @ 1:07 pm

Invoice updated by Geoffrey.

Status Update
January 16, 2024 @ 1:07 pm

Status changed: Draft to Pending.