Bill To:

Assurance America Insurance
P.O. Box 725009
Atlanta, GA 31139-0009

Services Rendered To:

Alejandro Juan Gonzalez
101 Johnson St
Albertville, AL 35951
POLICY# RAL2007959


Product
Price
Qty
Amount

  1. 105 Utility Vehicle Response (Per Hour)

    $250.00
    1
    $250.00

  2. 105 Utility Vehicle Response (Per Hour)

    $250.00
    1
    $250.00

  3. 206 Latex Gloves (Pairs Used)

    $2.00
    2
    $4.00

  4. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00

    5. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Hustleville Rd & Todd Ridge Rd- Albertville, AL

Subtotal $604.00
Total Due $604.00


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
December 15, 2022 @ 5:52 pm

Invoice updated by Geoffrey.

Status Update
December 15, 2022 @ 5:52 pm

Status changed: Draft to Pending.