Bill To:


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

Services Rendered To:


Cody Barber
1011 West 1/2 Taliaferro St
Madill, OK 73446
POLICY# 3624867278001


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

    $150.00
    1
    $150.00
  2. 102 Engine Response (Per Hour)

    $350.00
    1
    $350.00
  3. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1
    $150.00
  4. 404 Scene Lighting (Per Hour)

    $75.00
    1
    $75.00
  5. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00
  6. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

  7. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 9569 Fm 678- Gainesville, TX

Subtotal $1,075.00
Total Due $1,075.00

Total Payments Received $1,075.00
Balance $0.00


Updated
December 12, 2022 @ 10:45 am

Invoice updated by Geoffrey.

Status Update
December 12, 2022 @ 10:45 am

Status changed: Draft to Pending.

Status Update
January 28, 2023 @ 4:12 pm

Status changed: Pending to Paid.

Payment
January 28, 2023 @ 9:12 pm

Admin Payment
Payment Total: $1,075.00