Bill To:


STATE FARM MUTUAL INSURANCE
ONE STATE FARM PLAZA
BLOOMINGTON, IL 61710-0001

Services Rendered To:


Traevon Lingard
3015 Aspen Ln
Manvel, TX 77578
POLICY# 447 9501-K06-53A 002

Incident Table
Incident # Loss Date Invoice Date Terms Fire Dept
TX-BB-326-22-250-B 11/28/2022 06/09/2023 On Receipt Rosharon VFD

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

    $350.00
    1.5
    $525.00
  2. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1.5
    $225.00
  3. 103 Rescue Response (Per Hour)

    $300.00
    1.5
    $450.00
  4. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1.5
    $225.00
  5. 102 Engine Response (Per Hour)

    $350.00
    1.5
    $525.00
  6. 404 Scene Lighting (Per Hour)

    $75.00
    5
    $375.00
  7. 319 Generator (Per Generator/Per Hour)

    $75.00
    5
    $375.00
  8. 310 Hydraulic Tool (# Used)

    $200.00
    2
    $400.00
  9. 309 Power Tool (# Used)

    $50.00
    2
    $100.00
  10. 201 Oil Absorbent Material (# Used)

    $35.00
    15
    $525.00
  11. 313 TIC Thermal Imaging Camera (# Used)

    $100.00
    1
    $100.00
  12. 301 Hand Tool (# Used)

    $15.00
    5
    $75.00
  13. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.5
    $150.00
  14. 418 Environmental Hazard Cleanup/Removal

    $250.00
    1
    $250.00
  15. 419 Environmental Spill

    $250.00
    1
    $250.00
  16. 207 Wetting Agent (Amt Used)

    $25.00
    3
    $75.00

  17. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 1333 Fm 1462- Rosharon, TX

Subtotal $4,625.00
Total Due $4,625.00


Updated
June 9, 2023 @ 12:08 pm

Invoice updated by Geoffrey.