Bill To:


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

Services Rendered To:


William Paseka
222 Isabella Lane
Springtown, TX 76082
Claim # 4311M960H


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

    $300.00
    1.25
    $375.00
  2. 401 Debris Cleanup/Removal (# Used)

    $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
    1.25
    $125.00
  5. 302 Hand Light (# Used)

    $5.00
    1
    $5.00

  6. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 2500 Northwest Parkway - Azle, Texas

Subtotal $759.00
Total Due $759.00


Updated
September 16, 2021 @ 3:36 pm

Invoice updated by Geoffrey.

Status Update
September 16, 2021 @ 3:36 pm

Status changed: Draft to Pending.

Updated
September 16, 2021 @ 3:37 pm

Invoice updated by Geoffrey.

Updated
October 19, 2021 @ 3:07 pm

Invoice updated by Geoffrey.

Updated
November 19, 2021 @ 5:37 pm

Invoice updated by Geoffrey.

Updated
November 19, 2021 @ 5:37 pm

Invoice updated by Geoffrey.