Bill To:


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

Services Rendered To:


Garrett Christopher Howton
231 Lake Ridge Drive
Sequin, Texas 78155
Policy # 1000206420


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

    $300.00
    1
    $300.00
  2. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    1
    $150.00
  3. 206 Latex Gloves (Pairs Used)

    $2.00
    10
    $20.00
  4. 201 Oil Absorbent Material (# Used)

    $35.00
    5
    $175.00
  5. 404 Scene Lighting (Per Hour)

    $75.00
    1
    $75.00
  6. 215 Trauma Kit (# Used)

    $25.00
    1
    $25.00
  7. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00
  8. 407 Patient Care / Evaluation (Per Patient)

    $50.00
    5
    $250.00
  9. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00

  10. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 3400 Block of FM 78 @ Bridge Road - Sequin, Texas

    Ordinance Info: McQueeney Cost Recovery Resolution NO. 4521

Subtotal $1,495.00
Total Due $1,495.00


Updated
May 3, 2021 @ 9:03 pm

Invoice updated by Geoffrey.