Bill To:


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

Services Rendered To:


Eric Swaetzbaugh
1612 Lilac Avenue
Lufkin, Texas 75601
Policy # 336-3566-E06-43L 003


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

    $350.00
    2.5
    $875.00
  2. 103 Rescue Response (Per Hour)

    $300.00
    2.5
    $750.00
  3. 105 Utility Vehicle Response (Per Hour)

    $150.00
    2.5
    $375.00
  4. 206 Latex Gloves (Pairs Used)

    $2.00
    10
    $20.00
  5. 301 Hand Tool (# Used)

    $15.00
    1
    $15.00
  6. 404 Scene Lighting (Per Hour)

    $75.00
    2.5
    $187.50
  7. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00
  8. 408 Air Medical Landing Zone (Used)

    $250.00
    1
    $250.00

  9. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Highway 63 @ TC Pouland Road - Zavalla, Texas

Subtotal $2,722.50
Total Due $2,722.50


Updated
August 26, 2021 @ 9:22 pm

Invoice updated by Geoffrey.

Status Update
August 26, 2021 @ 9:22 pm

Status changed: Draft to Pending.

Viewed
January 29, 2022 @ 2:32 pm

Invoice viewed by Karen Smith (KarenS) for the first time.