Bill To:

GEICO INSURANCE COMPANY
PO BOX 9515
FREDERICKSBURG, VA 22403-9515

Services Rendered To:

Shau Nettles
7420 Elman Lane
Azle, Texas 76020
Policy # 4553722796


Product
Price
Qty
Amount

  1. 104 Tanker Response (Per Hour)

    $300.00
    1
    $300.00

  2. 218 Cervical Collar (# Used)

    $25.00
    2
    $50.00

  3. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00

  4. 206 Latex Gloves (Pairs Used)

    $2.00
    4
    $8.00

  5. 301 Hand Tool (# Used)

    $15.00
    2
    $30.00

  6. 201 Oil Absorbent Material (# Used)

    $35.00
    1
    $35.00

  7. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1
    $100.00

  8. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

    9. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 12000 FM RD 730 North, Azle Texas

Subtotal $1,023.00
Total Due $1,023.00

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 13, 2019 @ 2:59 pm

Invoice updated by Karen Smith.

Status Update
November 13, 2019 @ 3:00 pm

Status changed: Draft to Pending.

Updated
November 13, 2019 @ 3:06 pm

Invoice updated by Karen Smith.

Updated
November 13, 2019 @ 3:11 pm

Invoice updated by Karen Smith.

Updated
December 3, 2019 @ 5:59 pm

Invoice updated by Karen Smith.

Updated
January 3, 2020 @ 7:04 pm

Invoice updated by Karen Smith.