Bill To:

GREAT WEST CASUALTY
1100 WEST 29th STREET
SOUTH SOUIX CITY, NE 68776-3130

Services Rendered To:

Policy# MCP53799B
Owner: RB Transport
2065 Whiskey Hollow
West, TX 76691


Product
Price
Qty
Amount

  1. 102 Engine Response (Per Hour)

    Hours Reduced – Less $350.00

    $350.00
    6
    $2,100.00

  2. 103 Rescue Response (Per Hour)

    Hours Reduced – Less $300.00

    $300.00
    6
    $1,800.00

  3. 102 Engine Response (Per Hour)

    Hours Reduced – Less $350.00

    $350.00
    6
    $2,100.00

  4. 105 Utility Vehicle Response (Per Hour)

    Hours Reduced – Less $150.00

    $150.00
    6
    $900.00

  5. 105 Utility Vehicle Response (Per Hour)

    Hours Reduced – Less $150.00

    $150.00
    6
    $900.00

  6. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00

  7. 208 Fire Line Tap (Per Foot, Amt Used)

    $0.25
    20
    $5.00

  8. 206 Latex Gloves (Pairs Used)

    $2.00
    2
    $4.00

  9. 404 Scene Lighting (Per Hour)

    Hours Reduced – Less $75.00

    $75.00
    6
    $450.00

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

    Hours Reduced – Less $200.00

    $100.00
    5
    $500.00

    11. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: FM 317 and Avenue D, Valley Mills, TX

Subtotal $9,009.00
Total Due $9,009.00

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, 2020 @ 6:15 pm

Invoice updated by Karen Smith.

Status Update
November 9, 2020 @ 6:15 pm

Status changed: Draft to Pending.

Updated
November 9, 2020 @ 6:17 pm

Invoice updated by Karen Smith.

Updated
December 28, 2020 @ 5:48 pm

Invoice updated by Geoffrey.