Bill To:


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

Services Rendered To:


Logan Baker
825 CR 454
Clanton, AL 35046
POLICY# 0132245544

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
AL-01-403-23-1161 10/22/2023 10/26/2023 On Receipt Jemison Fire Department

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

    $500.00
    1
    $500.00
  2. 103 Rescue Response (Per Hour)

    $400.00
    1
    $400.00
  3. 206 Latex Gloves (Pairs Used)

    $2.00
    6
    $12.00
  4. 215 Trauma Kit (# Used)

    $25.00
    1
    $25.00
  5. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00
  6. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00
  7. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00

  8. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 224 I-65 NB- Jemison, AL

Subtotal $1,537.00
Total Due $1,537.00


Updated
October 26, 2023 @ 1:09 pm

Invoice updated by Geoffrey.

Status Update
October 26, 2023 @ 1:09 pm

Status changed: Draft to Pending.