Bill To:


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

Services Rendered To:


Tiffany Lydon
1958 Gilham Rd
Eugene, OR 97401
POLICY# 4152459-C19-37

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
AL-05-022-22-2845254-B 12/02/2022 12/15/2022 On Receipt Alder Springs FD

Product
Price
Qty
Amount
  1. 105 Utility Vehicle Response (Per Hour)

    $250.00
    1
    $250.00
  2. 105 Utility Vehicle Response (Per Hour)

    $250.00
    1
    $250.00
  3. 206 Latex Gloves (Pairs Used)

    $2.00
    2
    $4.00
  4. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00

  5. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Hustleville Rd & Todd Ridge Rd- Albertville, AL

Subtotal $604.00
Total Due $604.00


Updated
December 15, 2022 @ 5:55 pm

Invoice updated by Geoffrey.

Updated
February 15, 2023 @ 1:40 pm

Invoice updated by Geoffrey.