Bill To:


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

Services Rendered To:


Terea Mills
9608 Dalewood Dr
Austin, TX 78725
POLICY# 281-3824-D27-53H

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-XV-414-23-1030 07/03/2023 07/10/2023 On Receipt Sam Bass Fire Department

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

    $500.00
    1
    $500.00
  2. 106 Battalion/Chief Vehicle Response (Per Hour)

    $200.00
    1
    $200.00
  3. 106 Battalion/Chief Vehicle Response (Per Hour)

    $200.00
    1
    $200.00
  4. 301 Hand Tool (# Used)

    $15.00
    3
    $45.00
  5. 201 Oil Absorbent Material (# Used)

    $35.00
    1
    $35.00
  6. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00

  7. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Pearson Ranch & 620- Round Rock, TX

    Ordinance Info: Sam Bass Fire Dept. Resolution

Subtotal $1,230.00
Total Due $1,230.00


Updated
July 10, 2023 @ 11:53 am

Invoice updated by Geoffrey.

Status Update
July 10, 2023 @ 11:53 am

Status changed: Draft to Pending.

Viewed
July 21, 2024 @ 7:02 pm

Invoice viewed by 69.171.249.13 for the first time.