Bill To:

STATE FARM MUTUAL INSURANCE
ONE STATE FARM PLAZA
BLOOMINGTON, IL 61710-0001

Services Rendered To:

Ashley Lyda
6512 FM 1766
Naples, TX 75568
POLICY# 540-3217-I13-43-001


Product
Price
Qty
Amount

  1. 105 Utility Vehicle Response (Per Hour)

    $350.00
    2
    $700.00

  2. 105 Utility Vehicle Response (Per Hour)

    $350.00
    2
    $700.00

  3. 401 Debris Cleanup/Removal (# Used)

    $250.00
    1
    $250.00

  4. 402 Fire/Police Services (Per Hour)    

    $100.00
    2
    $200.00

  5. 301 Hand Tool (# Used)

    $15.00
    1
    $15.00

  6. 403 Traffic Control / Road Closure (Per Hour)

    $100.00
    2
    $200.00

    7. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: FM 130- Hughes Springs, TX

Subtotal $2,065.00
Total Due $2,065.00


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 3, 2023 @ 11:58 am

Invoice updated by Geoffrey.

Status Update
January 3, 2023 @ 11:58 am

Status changed: Draft to Pending.

Updated
January 3, 2023 @ 4:05 pm

Invoice updated by Karen Smith.

Updated
January 3, 2023 @ 4:06 pm

Invoice updated by Karen Smith.