Bill To:


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

Services Rendered To:


Rhonda McKee
3301 El Camino Street
Ponca City, OK 74604
POLICY# 3624835593


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

    $300.00
    1
    $300.00
  2. 102 Engine Response (Per Hour)

    $350.00
    1
    $350.00
  3. 218 Cervical Collar (# Used)

    $25.00
    1
    $25.00
  4. 206 Latex Gloves (Pairs Used)

    $2.00
    2
    $4.00
  5. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  6. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Hwy 177 & 1010 Rd- Meeker, OK

Subtotal $929.00
Total Due $929.00


Updated
November 8, 2022 @ 2:57 pm

Invoice updated by Geoffrey.

Status Update
November 8, 2022 @ 2:57 pm

Status changed: Draft to Pending.