Bill To:


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

Services Rendered To:


Timothy Yaden
3329 Ditney Trail
Oneida, TN 37841

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TN-76-821-24-1-B 01/08/2024 01/09/2024 On Receipt Paint Rock VFD

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

    $500.00
    1
    $500.00
  2. 301 Hand Tool (# Used)

    $15.00
    4
    $60.00
  3. 326 Safety Fest (# Used)

    $2.50
    4
    $10.00
  4. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00

  5. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Paint Rock Rd- Helenwood, TN

Subtotal $670.00
Total Due $670.00


Updated
January 9, 2024 @ 2:05 pm

Invoice updated by Geoffrey.