Bill To:


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

Services Rendered To:


Arturo Palacios
27707 Sierra Willow Way
Katy, TX 77494
POLICY# 4344115-J19-53B 001

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-GV-301-24-4056-B 03/09/2024 04/30/2024 On Receipt Dew VFD

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

    $400.00
    1.75
    $700.00
  2. 102 Engine Response (Per Hour)

    $500.00
    1.75
    $875.00
  3. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.75
    $175.00

  4. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: I45 & 192 North Bound- Teague, TX

Subtotal $1,750.00
Total Due $1,750.00


Updated
April 30, 2024 @ 12:54 pm

Invoice updated by Geoffrey.

Status Update
April 30, 2024 @ 12:54 pm

Status changed: Draft to Pending.

Updated
April 30, 2024 @ 12:58 pm

Invoice updated by Geoffrey.