Bill To:


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

Services Rendered To:


Justin Adams
218 S. Coblake Street
Apache, OK 73006
Policy # 4567170D0136


Product
Price
Qty
Amount
  1. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    1
    $150.00
  2. 102 Engine Response (Per Hour)

    $350.00
    1
    $350.00
  3. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1
    $150.00
  4. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  5. 205 Foam (Per Gallon)

    $65.00
    2
    $130.00
  6. 313 TIC Thermal Imaging Camera (# Used)

    $100.00
    1
    $100.00
  7. 303 SCBA Breathing Apparatus (# Used)

    $50.00
    3
    $150.00
  8. 304 SCBA Cylinder (# Used)

    $25.00
    3
    $75.00
  9. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  10. 207 Wetting Agent (Amt Used)

    $25.00
    3
    $75.00

  11. Additional Incident Info

    Incident Type: Vehicle Fire Response

    Incident Location: I-44 @ MM 53 - Lawton, OK

Subtotal $1,530.00
Total Due $1,530.00


Updated
July 12, 2021 @ 8:30 pm

Invoice updated by Geoffrey.

Status Update
July 12, 2021 @ 8:30 pm

Status changed: Draft to Pending.