Bill To:


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

Services Rendered To:


Ima Reeves
12820 Briar Road
Tarrant County, Texas 76020
Policy # 2984631J0443N001

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-WB206-2019-890-B 11/26/2019 04/07/2020 On Receipt Briar Reno Fire Company

Product
Price
Qty
Amount
  1. 104 Tanker Response (Per Hour)

    T -49

    $300.00
    1
    $300.00
  2. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    1
    $150.00
  3. 102 Engine Response (Per Hour)

    B-49 Brush

    $350.00
    1
    $350.00
  4. 106 Battalion/Chief Vehicle Response (Per Hour)

    C-49

    $150.00
    1
    $150.00
  5. 104 Tanker Response (Per Hour

    WT-49

    $300.00
    1
    $300.00
  6. 106 Battalion/Chief Vehicle Response (Per Hour)

    Support Investigator

    $150.00
    1
    $150.00
  7. 102 Engine Response (Per Hour)

    Attack A-49

    $350.00
    1
    $350.00
  8. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00
  9. 206 Latex Gloves (Pairs Used)

    $2.00
    8
    $16.00
  10. 301 Hand Tool (# Used)

    $15.00
    2
    $30.00
  11. 404 Scene Lighting (Per Hour)

    $75.00
    1
    $75.00
  12. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  13. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  14. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 7945 Peden Road - Tarrant County, Texas

    Ordinance Info: Briar Reno - Billing Amendment Recovery Costs

Subtotal $2,471.00
Total Due $2,471.00
Updated
April 7, 2020 @ 3:23 pm

Invoice updated by Karen Smith.

Status Update
April 7, 2020 @ 3:23 pm

Status changed: Draft to Pending.

Updated
April 7, 2020 @ 3:24 pm

Invoice updated by Karen Smith.

Updated
April 7, 2020 @ 3:29 pm

Invoice updated by Karen Smith.

Updated
April 7, 2020 @ 3:30 pm

Invoice updated by Karen Smith.

Viewed
October 25, 2022 @ 5:39 pm

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