Bill To:

KENTUCKY FARM BUREAU MUTUAL
9201 BUNSEN PARKWAY
LOUISVILLE, KY 40220-3792

Services Rendered To:

Kelli Claypool
200 Showgait Lane
Columbia, KY 42728
Policy # 002003829


Product
Price
Qty
Amount

  1. 102 Engine Response (Per Hour)

    $350.00
    1.5
    $525.00

  2. 103 Rescue Response (Per Hour)

    $300.00
    1.5
    $450.00

  3. 218 Cervical Collar (# Used)

    $25.00
    1
    $25.00

  4. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00

  5. 209 Extinguisher (# Used)

    $50.00
    1
    $50.00

  6. 310 Hydraulic Tool (# Used)

    $200.00
    1
    $200.00

  7. 206 Latex Gloves (Pairs Used)

    $2.00
    8
    $16.00

  8. 301 Hand Tool (# Used)

    $15.00
    2
    $30.00

  9. 201 Oil Absorbent Material (# Used)

    $35.00
    4
    $140.00

  10. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.5
    $150.00

  11. 215 Trauma Kit (# Used)

    $25.00
    1
    $25.00

  12. 306 Hose Per 50′ (Amt Used)

    $25.00
    2
    $50.00

  13. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

    14. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 169 Chestnut Grove Road - Columbia, Kentucky

Subtotal $2,161.00
Total Due $2,161.00


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
October 12, 2021 @ 2:07 pm

Invoice updated by Geoffrey.

Status Update
October 12, 2021 @ 2:07 pm

Status changed: Draft to Pending.