Bill To:

STATE FARM INSURANCE
PO BOX 52250
PHOENIX, AZ 85072-2250

Services Rendered To:

Huzefay Ghor
4205 Highgrove Drive
Arlington, TX 76001
Policy # 338 0410-L01-53B 002


Product
Price
Qty
Amount

  1. 103 Rescue Response (Per Hour)

    $300.00
    1
    $300.00

  2. 803 Basic EMS Assistance (Response Fee)

    $250.00
    1
    $250.00

    3. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Interstate 45 Southbound @ 214 - Richland, Texas

    Ordinance Info: Richland Billing Ordinance NO. 170 Cost Recovery

Subtotal $550.00
Total Due $550.00


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
January 6, 2022 @ 6:01 pm

Invoice updated by Geoffrey.

Status Update
January 6, 2022 @ 6:01 pm

Status changed: Draft to Pending.