Bill To:


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

Services Rendered To:


Vehicle Owner
POLICY# 1034455605

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
AL-02-006-22-351 12/12/2022 12/13/2022 On Receipt Littleville VFD

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

    $350.00
    1.5
    $525.00
  2. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1.5
    $225.00
  3. 331 Air Bags (# Used)

    $150.00
    6
    $900.00
  4. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  5. 402 Fire/Police Services (Per Hour)    

    $100.00
    1.5
    $150.00
  6. 205 Foam (Per Gallon)

    $65.00
    25
    $1,625.00
  7. 310 Hydraulic Tool (# Used)

    $200.00
    1
    $200.00
  8. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.5
    $150.00
  9. 306 Hose Per 50′ (Amt Used)

    $25.00
    1
    $25.00

  10. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Hwy 43 & Spring Valley Rd- Russellville, AL

Subtotal $4,050.00
Total Due $4,050.00


Updated
December 13, 2022 @ 12:16 pm

Invoice updated by Geoffrey.

Status Update
December 13, 2022 @ 12:16 pm

Status changed: Draft to Pending.

Viewed
December 28, 2022 @ 7:41 pm

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

Viewed
February 1, 2023 @ 11:33 pm

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