Bill To:

Everast Danali Insurance
100 Everest Way
Warren, NJ 07059

Services Rendered To:

CapTech Financial LLC
10679 Hwy 56 East
Sherman, TX 75090
POLICY# EN6CA00266-221


Product
Price
Qty
Amount

  1. 102 Engine Response (Per Hour)

    $350.00
    1.75
    $612.50

  2. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1.75
    $262.50

  3. 105 Utility Vehicle Response (Per Hour)

    $150.00
    1.75
    $262.50

  4. 218 Cervical Collar (# Used)

    $25.00
    2
    $50.00

  5. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00

  6. 310 Hydraulic Tool (# Used)

    $200.00
    2
    $400.00

  7. 206 Latex Gloves (Pairs Used)

    $2.00
    5
    $10.00

  8. 301 Hand Tool (# Used)

    $15.00
    4
    $60.00

  9. 201 Oil Absorbent Material (# Used)

    $35.00
    1
    $35.00

  10. 202 Oil Absorbent Sheet (# Used)

    $2.50
    2
    $5.00

  11. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    1.75
    $175.00

  12. 215 Trauma Kit (# Used)

    $25.00
    1
    $25.00

  13. 306 Hose Per 50′ (Amt Used)

    $25.00
    1
    $25.00

  14. 330 Backboard (# Used)

    $25.00
    1
    $25.00

  15. 324 Traffic Cone (# Used)

    $5.00
    6
    $30.00

  16. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

    17. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Int of LCR 707 & State Hwy 7 East- Kosse, TX

Subtotal $2,477.50
Total Due $2,477.50
Total Payments Received $2,477.50
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
October 31, 2022 @ 12:14 pm

Invoice updated by Geoffrey.

Status Update
October 31, 2022 @ 12:14 pm

Status changed: Draft to Pending.

Status Update
December 29, 2022 @ 10:34 am

Status changed: Pending to Paid.

Payment
December 29, 2022 @ 3:34 pm

Admin Payment
Payment Total: $2,477.50