Bill To:

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

Services Rendered To:

Randy Lauderdale
503 Pool
Shawnee, OK 74801
POLICY# 3336530B126A


Product
Price
Qty
Amount

  1. 103 Rescue Response (Per Hour)

    $300.00
    1.25
    $375.00

  2. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00

  3. 402 Fire/Police Services (Per Hour)    

    $100.00
    1.25
    $125.00

  4. 206 Latex Gloves (Pairs Used)

    $2.00
    2
    $4.00

  5. 301 Hand Tool (# Used)

    $15.00
    2
    $30.00

  6. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.25
    $125.00

  7. 215 Trauma Kit (# Used)

    $25.00
    1
    $25.00

    8. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Hwy 177 & 1010 Rd- Meeker, OK

Subtotal $934.00
Total Due $934.00
Total Payments Received $934.00
Balance $0.00


Checks Payable To:

Sure Fire Recovery Service, LLC
9711 S Mason Road 125-120
Richmond, TX 77407
Federal Tax ID – 83-4417185


  Please Include Incident Number On All Correspondence.

Updated
November 9, 2022 @ 11:48 am

Invoice updated by Geoffrey.

Status Update
November 9, 2022 @ 11:48 am

Status changed: Draft to Pending.

Status Update
February 24, 2023 @ 4:28 pm

Status changed: Pending to Paid.

Payment
February 24, 2023 @ 9:28 pm

Admin Payment
Payment Total: $934.00