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<br /> <br />Farmers Insurance Exchange <br /> <br />iF A R ME R S National Document Center <br />PO Box 268994 <br />Oklahoma City, OK 73126-8994 <br />Fax- 877-217-1389 <br />claimsdocuments@farmersinsurance.com <br /> <br />Summary for Backup of Sewer or Drain <br /> <br />Line Item Total <br />Mati Sales Tax Reimb <br /> <br />@ <br /> <br />6.500% x <br /> <br />1,840.62 <br /> <br />Subtotal <br />Cleaning Sales Tax <br /> <br />6.500% x <br /> <br />312.50 <br /> <br />@ <br /> <br />Replacement Cost Value <br />Less Deductible <br /> <br />Net Claim <br /> <br />Benjamin Henry <br /> <br />2007-04-16-2036 <br /> <br />5,037.02 <br />119.64 <br /> <br />5,156.66 <br />20.31 <br /> <br />5,176.97 <br />(500.00) <br /> <br />4,676.97 <br /> <br />04/16/2007 Page: 5 <br />